Risk Factors of Adolescent Endometriosis Onset and Recurrence: A Retrospective Study

Yang Jin,1,* Yongchao Pan,2,* Yilai Bao,1 Fei Xu,1 Yun Yang,1 Jingwen Fan,1 Yidan Jin,1 Yong Zhou,1 Ruijin Wu1,3 1Department of Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, People’s Republic of China; 3Department of Obstetrics and Gynecology, Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology, Hangzhou, Zhejiang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ruijin Wu, Department of Obstetrics and Gynecology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China, Tel +86 13757187083, Email [email protected]: This study aimed to identify adolescent-specific risk factors for endometriosis onset and postoperative recurrence to facilitate early identification and risk stratification.Patients and Methods: A retrospective study analyzed adolescents (10– 19 years) undergoing diagnostic laparoscopy for suspected benign gynecological conditions at Zhejiang University Women’s Hospital (2002– 2024). Cases were 242 laparoscopy-confirmed EMs patients; controls were 242 age-matched laparoscopy-negative adolescents. Comprehensive clinical/laboratory variables were collected. Multivariable logistic regression identified onset risk factors. Cox regression analyzed recurrence predictors in followed EMs patients, with recurrence defined by symptomatic, imaging, or surgical confirmation.Results: Dysmenorrhea (aOR 3.61; 95% CI 1.97– 6.63), genital tract malformation (aOR 16.15; 95% CI 3.29– 79.31), and elevated CA125 (aOR 1.02; 95% CI 1.01– 1.04) were independent risk factors of the onset of adolescent endometriosis. Hyperfibrinogenemia (aOR 2.13; 95% CI 1.17– 3.89) and dyslipidemia (hypotriglyceridemia, hypercholesterolemia, low LDL) showed significant associations. Among followed patients (median follow-up 56 months), recurrence rate was 25.3% (23/91). Significant predictors included larger ovarian cyst diameter (aHR 1.24; 95% CI 1.03– 1.49), elevated CA125 (aHR 1.01; 95% CI 1.00– 1.01), and shortened activated partial thromboplastin time (APTT) (aHR 0.77; 95% CI 0.60– 0.99), indicating intrinsic hypercoagulation.Conclusion: This study identifies dysmenorrhea, genital tract malformations, and elevated CA125 as independent risk factors for adolescent EMs onset, with hypercoagulability and metabolic disturbances as key associations. Beyond traditional recurrence markers (cyst size, CA125), shortened APTT emerges as a novel predictor of postoperative recurrence. These findings underscore the need for enhanced screening in high-risk adolescents and intensified postoperative monitoring, particularly for those with coagulation abnormalities.Keywords: endometriosis, adolescent, recurrent endometriosis, dysmenorrhea, risk factors