MRI may reduce time to endometriosis diagnosis for adolescents

Performing an MRI for adolescents with severe dysmenorrhea may reduce time to diagnosis of endometriosis, data published in Fertility and Sterility show.

Endometriosis affects 6% to 10% of reproductive-aged women, often causing pelvic pain and infertility, according to study background.

“The negative impact of endometriosis on patients would be less if the diagnosis and treatment were prompt and effective,” Anne-Elodie Millischer, MD, a radiologist at the Imagerie Médicale Paris Centre Bachaumont in Paris, and colleagues wrote. “However, endometriosis often goes undetected, and the time to diagnosis varies from 4 to 11 years, with 65% of women initially misdiagnosed. This delay can be three times longer for women whose onset of symptoms occurred during adolescence.”

Millischer and colleagues conducted a prospective study of girls aged 12 to 20 years who had NSAID-resistant severe dysmenorrhea who underwent MRI between September 2019 and June 2020. They excluded girls who were suspected to have superficial endometriosis without radiologic signs of endometrioma or deep infiltrating endometriosis.

Two of the researchers independently examined cases and were aware that endometriosis and/or adenomyosis were suspected. However, they were masked to previous imaging exams and clinical findings.

In total, 308 adolescents were included in the study. There were 187 (60.7%) adolescents with no visible endometriosis at MRI and 121 (39.3%) adolescents with endometriosis visible at MRI. Among girls with endometriosis, 107 (88.4%) had deep infiltrating endometriosis, 25 (20.7%) had endometrioma and 21 (17.3%) had associated adenomyosis.

There were no significant differences in clinical risk factors, use of oral contraceptives or incidence of uterine contractions between girls with and without endometriosis.

“In this cohort, it is interesting to note that gynecologists were the main prescribers (95%) compared to pediatricians and general practitioners,” Millischer and colleagues wrote. “In order to reduce the delay in diagnosing endometriosis and to avoid the major negative impact on the quality of life of adolescents during this period, pediatricians, general practitioners and school nurses should be made more aware of the possibility of the disease in case of severe dysmenorrhea.”

The prevalence of endometriosis increased linearly with age, data showed. Compared with girls aged 15 years or younger, endometriosis was more common in girls aged 15 to 18 years (OR = 2.3; 95% CI, 1.4-3.8) and girls aged 18 to 20 years (OR = 3.3; 95% CI, 1.2-8.5).

Additionally, the prevalence of adenomyosis, retrocervical lesions, intestinal lesions and uterine contractions increased with age.

“Endometriosis in adolescents is a challenging clinical problem,” the researchers wrote. “The first objective is to reduce the delay in diagnosis: the younger the patient at the onset of symptoms, the longer the duration until a diagnosis is made. ... There is a need for a specific approach from a diagnostic and treatment perspective for adolescent endometriosis patients.”