Endometriosis in adolescents: Initial medical management

GI: gastrointestinal; GU: genitourinary; IUD: intrauterine device; NSAIDs: nonsteroidal anti-inflammatory drugs.

* Hormonal therapy includes estrogen-progestin contraceptives (oral pill, transdermal patch, or vaginal ring) or progestin-only contraceptives (oral pill, injection, implant, or levonorgestrel 52 mg intrauterine device). Selection is based on patient preferences around hormone types, contraceptive needs and efficacy, dosing schedules, amenorrhea, side effects, availability, and cost.

¶ Treatment response is assessed by the patient. Adequate response is an acceptable improvement in symptoms and/or function, such as ability to attend school or work. Patients with an inadequate response do not have enough improvement in their symptoms and/or function.

Δ For most adolescent patients who have not yet had surgical diagnosis and treatment, we advise proceeding with laparoscopy at this point. However, some patients may reasonably desire an additional trial of medical therapy. For additional discussion of continued medical management or surgical diagnosis and treatment, refer to related content in UpToDate.

◊ Patients whose pain and/or other symptoms recur after initial response to hormonal treatment are again evaluated. Other causes of symptoms are excluded, including gynecologic (eg, ovarian cyst), gastrointestinal (eg, irritable bowel syndrome), and urinary (eg, urinary tract infection) processes. Co-occurring pain syndromes are treated. For detailed discussion, refer to related UpToDate content.