Medical Management of Endometriosis in Adolescent and Young Adult Women: A Review of 91 Cases of Biopsy-Confirmed Endometriosis

To characterise contemporary trends in the hormonal management of endometriosis in adolescent and young adult patients with biopsy-proven endometriosis. Retrospective chart review of women aged 14–25 years who underwent laparoscopy for pelvic pain with biopsy-proven endometriosis between January 2011 and September 2020 at an academic tertiary hospital system. The final sample included 91 patients with biopsy-confirmed endometriosis. Combined oral contraceptives (COCs) were the most common initial treatment (64% of patients). Progestin-only formulations (low- and high-dose norethindrone acetate) were offered to younger patients (age 15.9 ± 2.7 years) than those offered COCs (19.9 ± 3.3 years) and levonorgestrel intrauterine devices (LNG-IUDs) (21.9 ± 1.7 years). Current treatments varied widely and included COCs (32%), LNG-IUDs (18%), oral progestins (low- and high-dose norethindrone, medroxyprogesterone) (14%), elagolix (9%), and leuprolide (8%). Oral adjuncts to LNG-IUD were common: usually low- or high-dose norethindrone (37% of patients with an LNG-IUD), but also included progesterone, COCs, and elagolix. Oral progestins, LNG-IUDs, and COCs were the mainstay of initial treatment. Subsequent treatments varied widely and included COCs, LNG-IUDs, oral progestins, elagolix, leuprolide, and combinations of these agents. We observed that most young women switched between therapies, suggesting that a personalised approach is often used to determine treatment plans among the wide range of options currently available. This study helps define the spectrum of treatment regimens for endometriosis in adolescent females. Caractériser les tendances contemporaines pour la prise en charge hormonale de l’endométriose chez les adolescentes et les jeunes adultes atteintes d’endométriose confirmée par biopsie. Revue rétrospective des dossiers des femmes de 14 à 25 ans ayant subi une laparoscopie en raison de douleurs pelviennes et reçu un diagnostic d’endométriose confirmé par biopsie dans la période de janvier 2011 à septembre 2020 dans un système hospitalier universitaire tertiaire. L’échantillon final comprenait 91 patientes atteintes d’endométriose confirmée par biopsie. Les contraceptifs oraux combinés (COC) constituaient le traitement initial le plus fréquent (64 % des patientes). Les préparations à progestatif seul (acétate de noréthindrone, à faible ou forte dose) ont été proposées à des patientes généralement plus jeunes (15,9 ± 2,7 ans) par comparaison aux COC (19