Endometriosis more common in teenage girls than previously thought

Teenage girls are just as likely to suffer with endometriosis as adult women, a finding which UCL and University of Birmingham researchers say is surprising and could help doctors provide better treatments for younger patients.

Endometriosis is a debilitating condition, caused by excessive growth of the womb's tissue lining, which presents with pain in the lower abdomen, typically around the time of a period.

It affects around one in 10 adult women, however it has traditionally been thought to be less common in teenage girls, with doctors often putting such discomfort in younger patients down to dysmenorrhoea (severe period pain).

In the largest study of its kind, published in the Journal of Pediatric & Adolescent Gynecology, researchers undertook a systematic review and meta-analysis of 231 international studies to understand how likely it was for adolescent girls, who presented with symptoms, to have endometriosis. A systematic review carefully identifies all the relevant published and unpublished studies, rates them for quality and bias, and a meta-analysis study summarises the findings.

In total, researchers found 19 studies with meaningful cohort data. The studies included 1,243 symptomatic adolescent girls and of those 1,011 went on to have a laparoscopy, which is the common surgical procedure used to diagnose endometriosis. The research revealed 648 of 1011 (64%) were found to have endometriosis. In addition, the severity of the disease was found to be the same as in adult women, with 10% of adolescents having the most severe form of endometriosis which can lead to blockage of the bowel or kidney.

Co-lead author, Dr. Martin Hirsch (UCL EGA Institute for Women's Health and University College London Hospitals NHS Trust), said: "Endometriosis symptoms in are common in adolescent girls, with up to 90% reporting severe period pain, leading to many hours of school being lost.

"However teenage girls are typically prescribed pain killers, with few being referred on to specialist services such as those available at UCLH and Birmingham.

"This study shows some 60% of adolescents with bad pain symptoms may actually have endometriosis, which is a serious debilitating condition requiring specialised treatments."

As part of the systematic review, the team also assessed evidence where adolescent girls were offered an MRI or ultrasound to diagnose endometriosis, rather than a laparoscopy. This review also found high rates of endometriosis, with the accuracy of diagnosis proving similar to that found in adult women.

Co-lead author Dr. Rima Dhillon-Smith (University of Birmingham) added: "The increasing accuracy and availability of both MRI and ultrasound for the detection of endometriosis allows for speedy and minimally invasive diagnosis for those girls and parents wanting an answer to often debilitating symptoms.

"This opens the door for a change in how GPs manage this disease, meaning doctors can make more informed decisions earlier and provide individualised treatments which could help to prevent the condition from progressing."

The research team believe the evidence of endometriosis disease burden shown in the study, should signal a change in the national diagnostic pathway, including earlier referral for MRI or ultrasound scans.

Co-author Dr. Alfred Cutner, (UCL EGA Institute for Women's Health) said: "Referral pathways, including guidance on referral from primary (GP) to secondary (specialist), need clarity, promotion, and coordinated implementation."

Senior author, Professor Sarah Creighton (UCL EGA Institute for Women's Health) added: "Earlier recourse to advanced diagnostic tests can provide adolescents and their families with relief, liberation and legitimisation of their symptoms, together with access to support and an opportunity to discuss tailored medical or surgical management."