Evaluation for endometriosis in adolescent females with pelvic pain

HT: hormonal therapy (includes combined estrogen-progestin contraceptives [oral pills, transdermal patch, or vaginal ring] or progestin-only treatments [including oral norethindrone acetate, etonogestrel implant, or medroxyprogesterone acetate injection]); NSAID: nonsteroidal anti-inflammatory drugs; GnRH: gonadotropin-releasing hormone.
* Transabdominal ultrasound should be performed if not already done. Transvaginal ultrasound may be performed for patients who are amenable to a vaginal approach.
¶ For most patients, the preferred approach is laparoscopic surgical diagnosis and treatment. Diagnostic laparoscopy alone is not advised. The surgeon uses the techniques that are within the scope of the surgeon's clinical practice.
Δ Some patients may reasonably elect to try additional medical treatment rather than move to laparoscopy at this stage in the evaluation.
◊ The typical glands and stromal lesions that are seen in adults with endometriosis may not be present in younger adolescent patients.
§ Selection of medical treatment options is a patient-driven decision based on factors including ease of use, side effects, cost, and availability.
¥ Complementary therapies include, but are not limited to, acupuncture, acupressure, neuromodulation, and exercise therapy.