Review Article| Volume 33, ISSUE 6, P623-630, December 2020

The Prevalence of Endometriosis in Adolescents with Pelvic Pain: A Systematic Review


      Study Objective

      Endometriosis is a recognized cause of pelvic pain in adolescents with menstrual symptoms that significantly affect education, activity, and social interactions. We aim to provide an updated systematic review of the prevalence of endometriosis in adolescents with pelvic pain presenting for gynecological investigation.

      Data Sources

      We searched Medline, Embase, and Cinahl from 2011 to July 2019.

      Methods of Study Selection

      We included cohort studies of adolescents with pelvic pain undergoing gynecological investigation. Two authors independently selected studies and extracted study characteristics and prevalence data. Methodological quality was assessed using the Critical Appraisal Skills Program for cohort studies.


      This updated systematic review evaluated a total of 19 studies including 1243 symptomatic adolescents. In all, 648 of 1011 (64%) adolescents undergoing laparoscopy were found to have endometriosis. The prevalence ranged from 25% to 100%, with a mean prevalence of 64%. Thirteen studies including 381 participants categorized disease severity using the revised American Society of Reproductive Medicine classification. Among these, 53% of participants (201/381) had stage I, 28% (105/381) had stage II, 20% (76/381) had stage III, and 13% (49/381) had stage IV disease.


      The prevalence of endometriosis among adolescents with pelvic pain symptoms is high. Endometriosis is treatable, and prompt recognition will help to ensure that adolescents are signposted earlier to appropriate specialists. The management of adolescents with suspected endometriosis should be consistent with best practice guidance. Despite recommendations to increase the awareness and knowledge of endometriosis in adolescence, minimal research has followed.

      Key Words

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        • Burney R.O.
        • Giudice L.C.
        Pathogenesis and pathophysiology of endometriosis.
        Fertil Steril. 2012; 98: 511
        • Al-Jefout M.
        • Nawaiseh N.
        Continuous norethisterone acetate versus cyclical drospirenone 3 mg/ethinyl estradiol 20 μg for the management of primary dysmenorrhea in young adult women.
        J Pediatr Adolesc Gynecol. 2016; 29: 143
        • Janssen E.B.
        • Rijkers A.C.M.
        • et al.
        Prevalence of endometriosis diagnosed by laparoscopy in adolescents with dysmenorrhea or chronic pelvic pain: a systematic review.
        Hum Reprod Update. 2013; 19: 570
        • Laufer M.R.
        • Goitein L.
        • Bush M.
        • et al.
        Prevalence of endometriosis in adolescent girls with chronic pelvic pain not responding to conventional therapy.
        J Pediatr Adolesc Gynecol. 1997;
        • Gupta J.
        • Cardoso L.F.
        • Harris C.S.
        • et al.
        How do adolescent girls and boys perceive symptoms suggestive of endometriosis among their peers? Findings from focus group discussions in New York City.
        BMJ Open. 2018;
        • Dunselman G.A.J.
        • Vermeulen N.
        • Becker C.
        • et al.
        ESHRE guideline: management of women with endometriosis.
        Hum Reprod. 2014; 29: 400
        • Hudelist G.
        • English J.
        • Thomas A.E.
        • et al.
        Diagnostic accuracy of transvaginal ultrasound for non-invasive diagnosis of bowel endometriosis: systematic review and meta-analysis.
        Ultrasound Obstet Gynecol. 2011;
        • Moore J.
        • Copley S.
        • Morris J.
        • et al.
        A systematic review of the accuracy of ultrasound in the diagnosis of endometriosis.
        Ultrasound Obstet Gynecol. 2002;
        • Hadfield R.
        • Mardon H.
        • Barlow D.
        • et al.
        Delay in the diagnosis of endometriosis: a survey of women from the USA and the UK.
        Hum Reprod. 1996; 11: 878
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • et al.
        Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement.
        BMJ. 2009; 339: b2535
        • United Nations
        United Nations General Assembly. Conv rights child, treaty Ser New York United Nations. 1989; 1577:3.
        (Available at:)
        • Critical Appraisal Skills Program (CASP)
        CASP Cohort Study Checklist. Critical Appraisal Skills Programme.
        • Ragab A.
        • Shams M.
        • Badawy A.
        Prevalence of endometriosis among adolescent school girls with severe dysmenorrhea: a cross sectional prospective study.
        Int J Health Sci (Qassim). 2015;
        • Al-Jefout M.
        • Alnawaiseh N.
        • Yaghi S.
        • et al.
        Prevalence of endometriosis and its symptoms among young Jordanian women with chronic pelvic pain refractory to conventional therapy.
        J Obstet Gynaecol Canada. 2018;
        • Knox B.
        • Ong Y.C.
        • Bakar M.A.
        • et al.
        A longitudinal study of adolescent dysmenorrhoea into adulthood.
        Eur J Pediatr. 2019;
        • Fong Y.F.
        • Hon S.K.
        • Low L.L.
        • et al.
        The clinical profile of young and adolescent women with laparoscopically diagnosed endometriosis in a Singapore tertiary hospital.
        Taiwan J Obstet Gynecol. 2017;
        • Reese K.A.
        • Reddy S.
        • Rock J.A.
        Endometriosis in an adolescent population: the Emory experience.
        J Pediatr Adolesc Gynecol. 1996;
        • Stavroulis A.I.
        • Saridogan E.
        • Creighton S.M.
        • et al.
        Laparoscopic treatment of endometriosis in teenagers.
        Eur J Obstet Gynecol Reprod Biol. 2006;
        • Ventolini G.
        • Horowitz G.M.
        • Long R.
        Endometriosis in adolescence: a long-term follow-up fecundability assessment.
        Reprod Biol Endocrinol. 2005;
        • Kalu E.
        • McAuley W.
        • Richardson R.
        Teenagers, adolescents, endometriosis and recurrence: a retrospective analysis of recurrence following primary operative laparoscopy.
        Gynecol Surg. 2008;
        • Doyle J.O.
        • Missmer S.A.
        • Laufer M.R.
        The effect of combined surgical-medical intervention on the progression of endometriosis in an adolescent and young adult population.
        J Pediatr Adolesc Gynecol. 2009;
        • Chatman D.L.
        • Ward A.B.
        Endometriosis in adolescents.
        J Reprod Med Obstet Gynecol. 1982;
        • Davis G.D.
        • Thillet E.
        • Lindemann J.
        Clinical characteristics of adolescent endometriosis.
        J Adolesc Health. 1993;
        • Roman J.D.
        Adolescent endometriosis in the Waikato region of New Zealand—a comparative cohort study with a mean follow-up time of 2.6 years.
        Aust N Z J Obstet Gynaecol. 2010;
        • Vercellini P.
        • Fedele L.
        • Arcaini L.
        • et al.
        Laparoscopy in the diagnosis of chronic pelvic pain in adolescent women.
        J Reprod Med Obstet Gynecol. 1989;
        • Goldstein D.P.
        • de Cholnoky C.
        • Emans S.J.
        Adolescent endometriosis.
        J Adolesc Health Care. 1980;
        • Emmert C.
        • Romann D.
        • Riedel H.H.
        Endometriosis diagnosed by laparoscopy in adolescent girls.
        Arch Gynecol Obstet. 1998;
        • Kontoravdis A.
        • Hassan E.
        • Hassiakos D.
        • et al.
        Laparoscopic evaluation and management of chronic pelvic pain during adolescence.
        Clin Exp Obstet Gynecol. 1999;
        • Bai S.W.
        • Cho H.J.
        • Kim J.Y.
        • et al.
        Endometriosis in an adolescent population: the Severance Hospital in Korean experience.
        Yonsei Med J. 2002;
        • Vicino M.
        • Parazzini F.
        • Cipriani S.
        • et al.
        Endometriosis in young women: the experience of GISE.
        J Pediatr Adolesc Gynecol. 2010;
        • Abbas S.
        • Ihle P.
        • Köster I.
        • et al.
        Prevalence and incidence of diagnosed endometriosis and risk of endometriosis in patients with endometriosis-related symptoms: findings from a statutory health insurance-based cohort in Germany.
        Eur J Obstet Gynecol Reprod Biol. 2012;
        • Cea Soriano L.
        • López-Garcia E.
        • Schulze-Rath R.
        Incidence, treatment and recurrence of endometriosis in a UK-based population analysis using data from the Health Improvement Network and the Hospital Episode Statistics database.
        Eur J Contracept Reprod Health Care. 2017; 22: 334
        • Morassutto C.
        • Monasta L.
        • Ricci G.
        • et al.
        Incidence and estimated prevalence of endometriosis and adenomyosis in northeast Italy: a data linkage study.
        PLoS One. 2016; 11: e0154227
        • Cirstoiu C.
        • Cirstoiu M.
        • Secara D.
        • et al.
        Bone mineral density loss associated with low estrogen state induced by gonadotrophin-releasing hormone analogues for endometriosis treatment.
        Osteoporos Int. 2013; 24: S616
      1. K Semm: Operationslehre fur endoskopische Abdominal-chirurgie. Schattauer Verlag, Stuttgart1984
        • Bush D.
        • Brick E.
        • East M.C.
        • et al.
        Endometriosis education in schools: a New Zealand model examining the impact of an education program in schools on early recognition of symptoms suggesting endometriosis.
        Aust N Z J Obstet Gynaecol. 2017;
        • Laura Kuznetsov
        • Katharina Dworzynski
        • Melanie Davies
        • Caroline Overton
        • Guideline Committee
        Diagnosis and management of endometriosis: summary of NICE guidance.
        BMJ. 2017; 358: 3935
        • Hudelist G.
        • Ballard K.
        • English J.
        • et al.
        Transvaginal sonography vs. clinical examination in the preoperative diagnosis of deep infiltrating endometriosis.
        Ultrasound Obstet Gynecol. 2011; 37: 480
        • Hudelist G.
        • Fritzer N.
        • Staettner S.
        • et al.
        Uterine sliding sign: a simple sonographic predictor for presence of deep infiltrating endometriosis of the rectum.
        Ultrasound Obstet Gynecol. 2013; 41: 692
        • Nisenblat V.
        • Bossuyt P.M.M.
        • Farquhar C.
        • et al.
        Imaging modalities for the non-invasive diagnosis of endometriosis.
        Cochrane Database Syst Rev. 2016;
        • Horne A.W.
        • Daniels J.
        • Hummelshoj L.
        • et al.
        Surgical removal of superficial peritoneal endometriosis for managing women with chronic pelvic pain: time for a rethink?.
        BJOG. 2019;
        • Kennedy S.
        • Bergqvist A.
        • Chapron C.
        • et al.
        ESHRE guideline for the diagnosis and treatment of endometriosis.
        Hum Reprod. 2005; 20: 2698
        • Chapron C.
        • Souza C.
        • Borghese B.
        • et al.
        Oral contraceptives and endometriosis: The past use of oral contraceptives for treating severe primary dysmenorrhea is associated with endometriosis, especially deep infiltrating endometriosis.
        Hum Reprod. 2011;
        • Staal A.H.J.
        • Van Der Zanden M.
        • Nap A.W.
        Diagnostic delay of endometriosis in the Netherlands.
        Gynecol Obstet Invest. 2016;
        • ACOG: ACOG committee opinion no. 760
        Dysmenorrhea and endometriosis in the adolescent.
        Obstet Gynecol. 2018;
        • Culley L.
        • Law C.
        • Hudson N.
        • et al.
        The social and psychological impact of endometriosis on women’s lives: a critical narrative review.
        Hum Reprod Update. 2013; 19: 625