OP07.02: Adolescents with severe dysmenorrhea need specific ultrasound evaluation to detect endometriosis and to start adequate medical treatment

To diagnose endometriosis in adolescents (12-20yrs) with severe dysmenorrhea through specific ultrasonographic findings and to correlate the symptoms to its different forms: ovarian, deep infiltrating endometriosis (DIE) and adenomyosis. This study included 267 adolescents (12–20 yrs) with severe dysmenorrhea (visual analog scale (VAS) score ≥7). Ultrasound (US) pelvic examination (transvaginal or transrectal in pre-sexually active girls) was performed on all adolescents. Medical history and symptoms were collected for each adolescent before the scan. All possible locations of endometriosis, isolated or combined occurrence, were evaluated and recorded. Painful symptoms besides dysmenorrhea associated with endometriosis or adenomyosis were evaluated by VAS and correlated to the different endometriosis forms. At least one US endometriosis feature was identified in 105 (39.3%) patients, while the pelvic US of 116 (43.4%) was normal despite the referred dysmenorrhea. Of the 105 adolescents with endometriosis, ovarian endometrioma was found in 26 girls (24.8%) and 14 (13.3%) had an isolated endometrioma. Adenomyosis was detected in 47 (44.8%) patients and 23 (21.9%) showed its isolated findings. Posterior DIE was found in 60 (57.1%) patients and uterosacral ligament (USL) fibrotic thickening was found in 58 (55.2%). In 31(29.5%) adolescents, the USL lesion was completely isolated. The combined occurrence of dysmenorrhea with dyspareunia, bowel symptoms, and heavy menstrual bleeding increases the presence of endometriosis up to 55%, 56%, and 46%, respectively. In adolescents with severe dysmenorrhea, the US-based detection rate of pelvic endometriosis was 39%. USL fibrotic thickening and mild adenomyosis are often the only findings, so an accurate pelvic US scan can provide an early diagnosis by identifying small endometriotic lesions. Adolescents with dysmenorrhea should be referred to an expert sonographer to minimise the delay between the onset of symptoms and diagnosis.