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What are the indications and goals of surgery to treat endometriosis in the adolescent?

The surgical treatment of endometriosis in adolescents is based on small studies with low-quality evidence. Management is similar to that in adults, focusing on long-term health and reproductive function. Surgery may be considered for adolescents with endometriosis-related symptoms unresponsive to medical treatment.

Diagnostic laparoscopy is an option when symptoms suggest endometriosis but imaging is non-conclusive. After surgery, 80% of patients report symptom improvement but recurrence is common and as high as 56% within five years. International guidelines recommend laparoscopic surgery by experienced surgeons, with excision being more effective than ablation. Postoperative hormonal therapy is crucial to reduce recurrence and disease progression.

The Role of Complementary Therapies in Endometriosis Management

Complementary therapies, like diet changes and physical therapy, offer additional support in managing endometriosis, addressing chronic pain and improving overall well-being.

The Role of Hormonal Therapy in Managing Endometriosis

Hormonal therapy is key in managing endometriosis, reducing estrogen to control symptoms and slow disease progression, offering significant relief to many women.

The Impact of Endometriosis on Adolescent Girls: Early Diagnosis and Management Strategies

Early diagnosis of endometriosis in adolescents is crucial to managing pain and preventing long-term complications, ensuring better reproductive health and quality of life.

Medical therapy indications timing and goals

Medical therapy for endometriosis in adolescents aims to provide pain control, suppress disease progression, and protect future fertility. Endometriosis, a benign, chronic, estrogen-dependent, inflammatory, and recurrent disease, causes chronic pelvic pain, dysmenorrhea, dyspareunia, dyschezia, dysuria, and infertility, significantly impacting quality of life. Hormonal therapy reduces ectopic endometrial tissue, ovulation, and inflammation, decreasing pain and menstrual flow.

Long-term administration is necessary as lesions do not disappear, and pain recurrence is common after stopping therapy. Medical treatment is the first choice for symptomatic endometriosis, with surgical approaches reserved for selected cases or those unresponsive to medical treatment. Ensuring compliance and frequent follow-ups is crucial for effective management.

Living well with endometriosis is possible with the right diagnosis, comprehensive treatment, and support—empowering women to lead fulfilling and vibrant lives despite the challenges

Therapeutic options

Medical therapy for endometriosis in adolescents prioritizes pain relief, suppression of disease progression, and protection of future fertility. Progestogens and combined oral contraceptives are the first-line treatments, used continuously rather than cyclically to maximize effectiveness. If symptoms persist after four months of continuous therapy, a surgical approach may be considered. GnRH agonists, combined with hormonal ‘add-back therapy,’ are a second-line option for those not responding to initial treatments.

The choice of therapy should be tailored to individual needs, taking into account factors like efficacy, safety, tolerability, and route of administration. Compliance and regular follow-ups are essential for monitoring therapy effectiveness and disease progression. For persistent or severe symptoms, long-term treatment is necessary, and alternative administration routes (oral, transdermal, vaginal) may be considered to improve patient comfort and adherence.

Complementary therapies

Complementary therapies are essential in managing endometriosis, providing long-term support alongside medical and surgical treatments. A multidisciplinary approach is crucial, addressing psychological, sexual, and physical factors to improve quality of life. Despite their potential, research on non-medical strategies is limited. Diet and inflammation play roles, but current studies offer no clear dietary recommendations, although fish oil with vitamin B12 may help.

Physical therapies like physiotherapy and massage can relieve chronic pain and dyspareunia. Exercise is beneficial for overall health, but its specific impact on endometriosis pain is unclear. Psychological support is vital due to the condition’s mental health impact, yet no specific recommendations exist. Acupuncture and traditional Chinese medicine show no conclusive evidence for pain or quality of life improvement. More research is needed to validate these complementary approaches.

Follow-up

Endometriosis is a chronic, relapsing disease requiring follow-up throughout a woman’s life. The latter are essential to monitor patients compliance, therapy effectiveness and tolerance. Therapeutic can be adjusted treatments as needed. Follow-ups will also allow to diagnose disease progression early and consider surgical options for persistent pain. For non-surgical patients, follow-ups assess overall condition, therapy appropriateness and indications for surgery.

Post-surgery follow-ups evaluate short-term outcomes and adjust treatment based on clinical goals, with subsequent visits monitoring overall condition, quality of life, and long-term complications. Although specific guidelines for follow-up timing are lacking, recommended intervals include 3, 6, and 12 months for various management approaches, with annual check-ups thereafter.

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