(101) Risk Factors and Associations of Endometriosis Diagnosed by Laparoscopy in Adolescents and Young Adults at a Single Institution Over a Ten-Year Period

Background: Studies assessing prevalence and characteristics of endometriosis in adolescents are limited and have been small in sample size. This study aims to assess prevalence, risk factors for and associations with endometriosis diagnosis in patients undergoing diagnostic laparoscopy for dysmenorrhea and pelvic pain

Methods: IRB-approved chart review was performed of post-menarchal females under age 26 who underwent diagnostic laparoscopy by a pediatric and adolescent gynecologist for dysmenorrhea or chronic pelvic pain between 7/2013 and 6/2023. Clinical characteristics, endometriosis diagnosis, pathology results, and major surgical complications were collected. Descriptive statistics and univariate linear regression analysis with risk difference assessment of variables were performed.

Results: Of 268 patients included, 75.7% had intraoperative findings suggestive of endometriosis and 60.1% were ultimately diagnosed with endometriosis. The majority were white (81%). Dysmenorrhea (96%) was the most common symptom followed by chronic pelvic pain (66%). Our cohort is further described in Table 1, and includes high prevalence of AUB, pain disorders, mood disorders, and migraines. There was a 0.7% major operative complication rate. There was no statistically significant relationship between the diagnosis of endometriosis and presence of bleeding disorder or gender identity (p=0.29 and 0.12, respectively). There is an increased risk of endometriosis in those with migraines, AUB, autoimmune disorders and mood disorders (Figure 1). Patients with pain disorders had a decreased risk of endometriosis. Race and family history of endometriosis did not affect the risk of having a diagnosis of endometriosis.

Conclusions: We demonstrate a high rate of endometriosis consistent with previously reported rates among adolescents undergoing laparoscopy (49-75%) along with low operative risk, reiterating the importance of considering diagnostic laparoscopy for endometriosis in adolescents with dysmenorrhea or chronic pelvic pain. The increased likelihood of endometriosis diagnosis in those with AUB, migraines, autoimmune and mood disorders is consistent with previously reported mechanisms of endometriosis development, and association with multi-systemic hyperalgesia and immune mediated processes. We demonstrate that patients with endometriosis have multifaceted clinical presentations and associated comorbidities, requiring the clinician to think broadly in terms of risk of endometriosis diagnosis.