Clinical and diagnostic features of different forms of genital endometriosis in female adolescents


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Endometriosis is a condition that can be misdiagnosed on average for 8-10 years. This is especially true for adolescent patients, who are waiting for healthcare 2-3 times longer than adult women. Objective: To study clinical and diagnostic features of different forms of genital endometriosis in female adolescents. Materials and methods: The case-control study included adolescents aged 13-18years. The main group included 98 girls with confirmed laparoscopic diagnosis of endometriosis; the comparison group consisted of 44 somatically healthy girls. Results: The patients with endometriosis were characterized by the burden of inherited gynecologic diseases via close relatives compared to healthy girls (32.7% versus 9.1%, p<0.001), earlier menarche (11.8±2.5 versus 12.5±1.2, р<0.001), heavy (32.1% versus 10.4%, р=0.034) and irregular menstrual bleeding at menarche (42.9% versus 15.9%, р=0.002). The patients with endometriosis had lower abdominal pain in the first 3-4 days of menstruation, which scored 8-9 points on the Visual Analog Scale (VAS) (75.3% versus 13.6%, p<.001), higher levels of luteinizing hormone (LH) (8.3±6.7 versus 4.1±1.9, р<0.001), estradiol (335.2±292.3 versus 171.5±73.9, р=0.032), prolactin (481.2±312.4 versus 237.8±126.4, р<0.001), 17-OHP (5.8±3.7 versus 3.9±1.8, р=0.022), total androstenedione (10.8±4.3 versus 8.4±2.5, р=0.014). According to pelvic MRI, the signs of genital endometriosis were detected in 37 (78.7%) patients with external genital endometriosis and in 24 (88.9%) patients with adenomyosis. Conclusion: In 96.9% of cases, in adolescents with persistent dysmenorrhea scoring 8-9 points according to VAS, the diagnosis of genital endometriosis was confirmed laparoscopically. The significant factors for the diagnosis were the burden of inherited endometriosis (x2=82.8, p<0.001), persistent dysmenorrhea at menarche (x2=49.8, p<0.001), suspected genital endometriosis according to MRI results (x2=91.4, p<0.001), high levels of LH (X2=28. 5, p<0.001) and androstenedione (x2=8.0, p<0.005).

Full Text

Restricted Access

About the authors

Elena P. Khaschenko

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: khashchenko_elena@mail.ru
PhD, Senior Researcher at the 2nd Gynecological (child and adolescent) Department

Elvina Z. Allakhverideva

M.V. Lomonosov Moscow State University

Email: elya.elya2014@mail.ru
student of Faculty of Fundamental Medicine

Elena V. Uvarova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: elena-uvarova@yandex.ru
Dr. Med. Sci., Professor, Corresponding Member of the RAS, Head of the 2nd Gynecological (child and adolescent) Department

Vladimir D. Chuprynin

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: v_chuprynin@oparina4.ru
PhD, Head of General Surgery Department

Elena A. Kylabukhova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: e_kulabukhova@oparina4.ru
PhD, Doctor at the Department of Radiation Diagnostics

Irina A. Luzhina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: ijuzhina@oparina4.ru
Doctor at the Department of Radiation Diagnostics

Polina V. Uchevatkina

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: p_uchevatkina@oparina4.ru
Doctor at the Department of Radiation Diagnostics

Fatima Sh. Mamedova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia; Russian Medical Academy of Continuous Professional Education, Ministry of Health of Russia

Email: mamedova_f@mail.ru
PhD, Doctor at the Department of Ultrasound Diagnostics in Neonatology and Pediatrics

Aleksandra V. Asaturova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_asaturova@oparina4.ru
PhD, Head of the 1th Pathology Department

Anna V. Tregubova

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_tregubova@oparina4.ru
clinician-pathologist of the 1th Pathology Department

Alina S. Magnaeva

Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: a_magnaeva@oparina4.ru
clinician-pathologist at the 1th Pathology Department

References

  1. Адамян Л.В., ред. Эндометриоз: диагностика, лечение и реабилитация. Федеральные клинические рекомендации по ведению больных. М.; 2013. 64с.
  2. Ashrafi M., Jahanian Sadatmahalleh S., Akhoond M.R., Talebi M. Evaluation of risk factors associated with endometriosis in infertile women. Int. J. Fertil. Steril. 2016; 10(1): 11-21. https://dx.doi.org/10.22074/ijfs.2016.4763.
  3. Janssen E.B., Rijkers A.C., Hoppenbrouwers K., Meuleman C., D'Hooghe T.M. Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: a systematic review. Hum. Reprod. Update. 2013; 19(5): 570-82. https://dx.doi.org/10.1093/humupd/dmt016.
  4. Bishry G. El, Tselos V., Pathi A. Correlation between laparoscopic and histological diagnosis in patients with endometriosis. J. Obstet. Gynaecol. 2008; 28(5): 511-5. https://dx.doi.org/10.1080/01443610802217918.
  5. Ballweg M.L. Big picture of endometriosis helps provide guidance on approach to teens: comparative historical data show endo starting younger, is more severe. J. Pediatr. Adolesc. Gynecol. 2003; 16(3, Suppl.): S21-6. https://dx.doi.org/10.1016/s1083-3188(03)00063-9.
  6. Simoens S., Dunselman G., Dirksen C., Hummelshoj L., Bokor A., Brandes I. et al. The burden of endometriosis: costs and quality of life of women with endometriosis and treated in referral centres. Hum. Reprod. 2012; 27(5): 1292-9. https://dx.doi.org/10.1093/humrep/des073.
  7. Laufer M.R., Sanfilippo J., Rose G. Adolescent endometriosis: diagnosis and treatment approaches. J. Pediatr. Adolesc. Gynecol. 2003; 16(3, Suppl.): S3-11. https://dx.doi.org/10.1016/s1083-3188(03)00066-4.
  8. Chamie L.P., Blasbalg R., Pereira R.M.A., Warm brand G., Serafini P.C. Findings of pelvic endometriosis at transvaginal US, MR imaging, and laparoscopy. Radiographics. 2011; 31(4): E77-100. https://dx.doi.org/10.1148/rg.314105193.
  9. Chatman D.L., Zbella E.A. Biopsy in laparoscopically diagnosed endometriosis. J. Reprod. Med. 1987; 32(11): 855-7.
  10. de Sanctis V., Matalliotakis M., Soliman A.T., Elsefdy H., Di Maio S., Fiscina B. A focus on the distinctions and current evidence of endometriosis in adolescents. Best Pract. Res. Clin. Obstet. Gynaecol. 2018; 51: 138-50. https://dx.doi.org/10.1016/j.bpobgyn.2018.01.023.
  11. Sachedina A., Todd N. Dysmenorrhea, endometriosis and chronic pelvic pain in adolescents. J. Clin. Res. Pediatr. Endocrinol. 2020; 12(Suppl. 1): 7-17. https://dx.doi.org/10.4274/jcrpe.galenos.2019.2019.S0217.
  12. Patel B.G., Lenk E.E., Lebovic D.I., Shu Y., Yu J., Taylor R.N. Pathogenesis of endometriosis: Interaction between Endocrine and inflammatory pathways. Best Pract. Res. Clin. Obstet. Gynaecol. 2018; 50: 50-60. https://dx.doi.org/10.1016/j.bpobgyn.2018.01.006.
  13. Buck Louis G.M., Hediger M.L., Pena J.B. Intrauterine exposures and risk of endometriosis. Hum. Reprod. 2007; 22(12): 3232-6. https://dx.doi.org/10.1093/humrep/dem338.
  14. Nnoaham K.E., Webster P., Kumbang J., Kennedy S.H., Zondervan K.T. Is early age at menarche a risk factor for endometriosis? A systematic review and meta-analysis of case-control studies. Fertil. Steril. 2012; 98(3): 702-12. https://dx.doi.org/10.1016/j.fertnstert.2012.05.035.
  15. Wei M., Cheng Y., Bu H., Zhao Y., Zhao W. Length of menstrual cycle and risk of endometriosis: a meta-analysis of 11 case-control studies. Medicine (Baltimore). 2016; 95(9: e2922. https://dx.doi.org/10.1097/MD.0000000000002922.
  16. Farland L.V., Missmer S.A., Bijon A., Gusto G.,. Gelot A., Clavel-Chapelon F. et al. Associations among body size across the life course, adult height and endometriosis. Hum. Reprod. 2017; 32(8): 1732-42. https://dx.doi.org/10.1093/humrep/dex207.
  17. Shah D.K., Correia K.F., Vitonis A.F., Missmer S.A. Body size and endometriosis: results from 20 years of follow-up within the Nurses’ Health Study II prospective cohort. Hum. Reprod. 2013; 28(7): 1783-92. https://dx.doi.org/10.1093/humrep/det120.
  18. Tang Y., Zhao M., Lin L., Gao Y., Chen G.Q., Chen S., Chen Q. Is body mass index associated with the incidence of endometriosis and the severity of dysmenorrhoea: a case-control study in China? BMJ Open. 2020; 10(9): e037095. https://dx.doi.org/10.1136/bmjopen-2020-037095.
  19. Liu Y., Zhang W. Association between body mass index and endometriosis risk: a meta-analysis. Oncotarget. 2017; 8(29): 46928-36. https://dx.doi.org/10.18632/oncotarget.14916.
  20. Nagle C.M., Bell T.A., Purdie D.M., Treloar S.A., Olsen C.M., Grover S., Green A.C. Relative weight at ages 10 and 16 years and risk of endometriosis: a case-control analysis. Hum.Reprod. 2009; 24(6): 1501-6. https://dx.doi.org/10.1093/humrep/dep048.
  21. Tilg H., Moschen A.R. Adipocytokines: mediators linking adipose tissue, inflammation and immunity. Nat. Rev. Immunol. 2006; 6(10): 772-83. https://dx.doi.org/10.1038/nri1937.
  22. Li X., Guo L., Zhang W., He J., Ai L., Yu C. et al. Identification of potential molecular mechanism related to infertile endometriosis. Front. Vet. Sci. 2022; 9: 845709. https://dx.doi.org/10.3389/fvets.2022.845709.
  23. Calhaz-Jorge C., Mol B. W., Nunes J., Costa A.P. Clinical predictive factors for endometriosis in a Portuguese infertile population. Hum. Reprod. 2004; 19(9): 2126-31. https://dx.doi.org/10.1093/humrep/deh374.
  24. Hemmings R., Rivard M., Olive D.L., Poliquin-Fleury J., Gagne D., Hugo P., Gosselin D. Evaluation of risk factors associated with endometriosis. Fertil. Steril. 2004; 81(6): 1513-21. https://dx.doi.org/10.1016/j.fertnstert.2003.10.038.
  25. Sangi-Haghpeykar H., Poindexter A.N. 3rd. Epidemiology of endometriosis among parous women. Obstet. Gynecol. 1995; 85(6): 983-92. https://dx.doi.org/10.1016/0029-7844(95)00074-2.
  26. Moini A., Malekzadeh F., Amirchaghmaghi E., Kashfi F., Akhoond M.R., Saei M., Mirbolok M.H. Risk factors associated with endometriosis among infertile Iranian women. Arch. Med. Sci. 2013; 9(3): 506-14. https://dx.doi.org/10.5114/aoms.2013.35420.
  27. Piketty M., Chopin N., Dousset B., Millischer-Bellaische A.E., Roseau G., Leconte M. et al. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first-line imaging examination. Hum. Reprod. 2009; 24(3): 602-7. https://dx.doi.org/10.1093/humrep/den405.
  28. Coutinho A. Jr, Bittencourt L.K., Pires C.E., Junqueira F., Lima C.M., Coutinho E. et al. MR imaging in deep pelvic endometriosis: a pictorial essay. Radiographics. 2011; 31(2): 549-67. https://dx.doi.org/10.1148/rg.312105144.
  29. Del Frate C., Girometti R., Pittino M., Del Frate G., Bazzocchi M., Zuiani C. Deep retroperitoneal pelvic endometriosis: MR imaging appearance with laparoscopic correlation. Radiographics. 2006; 26(6): 1705-18. https://dx.doi.org/10.1148/rg.266065048.
  30. Dunselman G.A.J., Vermeulen N., Becker C., Calhaz-Jorge C., DHooghe T., De Bie B. et al. ESHRE guideline: management of women with endometriosis. Hum. Reprod. 2014; 29(3): 400-12. https://dx.doi.org/10.1093/humrep/det457.
  31. Lu M.Y., Niu J.L., Bin Liu B. The risk of endometriosis by early menarche is recently increased: a meta-analysis of literature published from 2000 to 2020. Arch. Gynecol. Obstet. 2022; Apr 4. https://dx.doi.org/10.1007/s00404-022-06541-0.
  32. Stratton P., Winkel C. A., Sinaii N., Merino M.J., Zimmer C., Nieman L.K. Location, color, size, depth, and volume may predict endometriosis in lesions resected at surgery. Fertil. Steril. 2002; 78(4): 743-9. https://dx.doi.org/10.1016/s0015-0282(02)03337-x.
  33. Marchino G.L., Gennarelli G., Enria R., Bongioanni F., Lipari G., Massobrio M. Diagnosis of pelvic endometriosis with use of macroscopic versus histologic findings. Fertil. Steril. 2005; 84(1): 12-5. https://dx.doi.org/10.1016/j.fertnstert.2004.09.042.
  34. Ueki M., Saeki M., Tsurunaga T., Ueda M., Ushiroyama N., Sugimoto O. et al. Visual findings and histologic diagnosis of pelvic endometriosis under laparoscopy and laparotomy. Int. J. Fertil. Menopausal Stud. 1995; 40(5): 248-53.
  35. Liakopoulou M.-K., Tsarna E., Eleftheriades A., Kalampokas E., Liakopoulou M.K., Christopoulos P. Medical and behavioral aspects of adolescent endometriosis: a review of the literature. Children (Basel). 2022; 9(3): 384. https://dx.doi.org/10.3390/children9030384.
  36. Туманова У.Н., Щеголев А.И., Павлович С.В., Серов В.Н. Факторы риска развития эндометриоза. Акушерство и гинекология. 2020; 2: 68-75. https://dx.doi.org/10.18565/aig.2020.2.68-75.
  37. Ярмолинская М.И., Сейидова Ч.И., Пьянкова В.О. Современная тактика назначения медикаментозной терапии генитального эндометриоза. Акушерство и гинекология. 2021; 4: 55-62. https://dx.doi.org/10.18565/aig.2021.4.55-62.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies