Endometriosis in Adolescents: A Comprehensive Guide to Diagnosis and Management

745 Pages·2020·33.368 MB·English

by  Ceana H. Nezhat

Endometriosis
in Adolescents
A Comprehensive Guide
to Diagnosis and Management
Ceana H. Nezhat Editor
Jennifer Dietrich
Todd A. Ponsky
Joseph Sanfi lippo Associate Editors
123
Endometriosis in Adolescents
Ceana H. Nezhat
Editor
Endometriosis in Adolescents
A Comprehensive Guide to Diagnosis
and Management
Editor
Ceana H. Nezhat
Nezhat Medical Center
Atlanta, GA
USA
Associate Editors
Jennifer Dietrich
Todd A. Ponsky
Joseph Sanfilippo
ISBN 978-3-030-52983-3 ISBN 978-3-030-52984-0 (eBook)
https://doi.org/10.1007/978-3-030-52984-0
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Foreword
For more than a century, endometriosis was believed to occur after 20–23 years of
age. In a series of 400 cases published by J.V. Meigs, only 1 was less than 29 years
old. In a larger series of 884 cases of the Mayo Clinic, the youngest patient was 21,
and Sampson himself remembered no patient younger.
Fallon J. in his endometriosis series of 225 cases published in JAMA in 1946
reported 9 patients (4%) to be less than 20 years of age. He states further “4% is a
small figure, but there are grounds for suspecting that it is less than the true one.
And it is a significant, even a large percentage when weighed against the common
belief that youth does not have endometriosis.” None the less, despite this observa-
tion and warning, the practice did not change for many decades, and diagnosis and
treatment were delayed in adolescents suffering from endometriosis.
We must welcome this new book Endometriosis in Adolescents: A Comprehensive
Guide to Diagnosis and Management initiated and edited by Professor Ceana
Nezhat, who also contributed several chapters to it.
This book, with its 45 chapters, is certainly comprehensive and richly illustrated;
it is also unique in style and content. The authorship is international and well-
recognized in their own fields of expertise. The book is organized into 13 parts.
Following an interesting introduction by Dr. Ceana Nezhat, two comprehensive pre-
viously published articles composed by the Nezhat brothers are included in Part 1,
History of Endometriosis in Adolescents. Another such article “Optimal Management
of Endometriosis and Pain” is included in Part 3. An additional novelty of the book
is the inclusion of three “patient histories.” The part on etiology has chapters on
molecular mechanisms, pathophysiology, and endometriosis in the human fetus.
The text contains unexpected sections that complement the disease itself, such as
“Associated pathology in adolescents—Thyroid disease, PCOS, Adnexal tumors
etc.-; plus, “Anesthetic considerations and Patient positioning” for pediatric and
adolescent gynecologic surgery. In Part 11, Interventions, one is surprised to find
interesting chapters on topics other than surgical intervention, such as impact of
nutrition on adolescent endometriosis, effect of curcumin on endometrial stomal
cells, and holistic approach for management of the disease. In addition, a chapter on
v
vi Foreword
the approach to diagnosis of adolescent endometriosis for primary care pediatri-
cians is included in the final part of the book.
Undoubtedly, this timely and excellent book will be a must for those involved
and interested in pediatric and adolescent endometriosis.
Victor Gomel
Department of Obstetrics and Gynecology
University of British Columbia
Vancouver, BC, Canada
Foreword
Once again, the name Nezhat has been associated with an imaginative, revolution-
ary and important topic to investigate and to inform. In the past, endometriosis was
thought to be confined to older women (over 35) who were nulliparous. Described
by the Greek term Sylph.
Ceana Nezhat and his collaborators have re-defined all aspects of endometriosis
focused on the adolescent, which now is accepted to be a part of the population who
suffer from endometriosis. Still overlooked in this population, because education is
necessary to alert the practitioner, that these young women do get endometriosis
during adolescence. In fact, when examining older women with endometriosis,
many attest to the fact that their symptoms started in adolescences and endometrio-
sis was not considered a serious diagnostic option. Therefore, there is a tremendous
delay in the diagnosis of this progressive disease.
Pain and abnormal bleeding being the hallmarks. Early diagnosis is important to
allow for rapid and effective treatment and to prevent scarring from occurring.
Hormonal and non-hormonal approaches should be utilized.
Endometriosis in the adolescent has severe ramifications. Missed school days
and activities are obvious, but other social connotations are also prevalent including
psychological and social impacts. Chronic pain affects adults as far as carrying out
usual functions, well this is no different for adolescents with endometriosis.
On perusal of the contents of this text, many important questions are raised and
addressed in an erudite fashion. This is an extremely studied field now with empha-
sis on endometriosis as an inflammatory disease. In regards to diagnosis, the quest
for markers in the bloodstream is an area of active searching so that the diagnosis
can be made more precisely to remove the need for surgical intervention to diagnose
endometriosis. Although, the Lupron challenge test in today’s environment is highly
acceptable.
Much is to be learned from patients with Mullerian anomalies as far as the patho-
genesis of endometriosis is concerned and this is covered in the text.
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viii Foreword
Is a new classification paradigm necessary?
Fertility remains an important area for the patient with endometriosis. If it could
be treated early in the adolescent women, it would be extremely beneficial to the
adult women trying to conceive; because the questions arise: Are oocytes from a
patient with endometriosis normal? Are there implantation problems since the
endometrium of a patient with endometriosis is different, e.g. aromatase activity.
Still the most controversial area is the role of surgery in either laparoscopic or
open procedure to treat endometriosis.
Drugs and drug development in regards to this disease are critical.
All in all, endometriosis is a fascinating disease with basic science questions,
translational questions, therapeutic and diagnostic questions. There is a major effort
to study endometriosis in all aspects and this well written and comprehensive book
will be extremely helpful to those investigators and practitioners who deal with
endometriosis in the adolescent.
Alan H. DeCherney, MD
Branch Chief, Reproductive Endocrinology & Gynecology
Deputy Clinical Director for Academic Affairs, Eunice Kennedy Shriver
National Institutes of Child Health and Human Development
National Institutes of Health
Bethesda, MD, USA
Contents
1 Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Ceana H. Nezhat
Part I History of Endometriosis in Adolescents
2 Endometriosis: Ancient Disease, Ancient Treatments . . . . . . . . . . . . . 13
Camran Nezhat, Farr Nezhat, and Ceana H. Nezhat
3 Endometriosis in Adolescents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Erica C. Dun, Kimberly A. Kho, Vadim V. Morozov,
Susan Kearney, Jonathan L. Zurawin, and Ceana H. Nezhat
Part II E ndometriosis Definition
4 Defining Endometriosis for Doctors and Patients . . . . . . . . . . . . . . . . 145
Sara Carvalho and António Manuel Setúbal
Part III E tiology of Endometriosis
5 Molecular Mechanisms Underlying Adolescent Endometriosis
and Advancements in Medical Management . . . . . . . . . . . . . . . . . . . . 157
Saifuddin T. Mama
6 The Genetic-Epigenetic Pathophysiology of Endometriosis:
A Surgeon’s View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Philippe R. Koninckx, Anastasia Ussia, Leila Adamyan,
Jörg Keckstein, Arnaud Wattiez, Victor Gomel, and Dan C. Martin
7 Optimal Management of Endometriosis and Pain . . . . . . . . . . . . . . . . 195
Camran Nezhat, Nataliya Vang, Pedro P. Tanaka,
and Ceana H. Nezhat
8 The Presence of Endometriosis in the Human Fetus . . . . . . . . . . . . . . 205
Pietro G. Signorile and Alfonso Baldi
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x Contents
Part IV Diagnosis
9 Clinical Evaluation and Preoperative Considerations
in Adolescent Girls with Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . 217
Nkiruka Chuba and Resad Pasic
10 Neuroanatomical Insights in Adolescents with Endometriosis
and Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Marco Aurelio Pinho Oliveira, Thiers Soares Raymundo,
Jose Duvan Lopez- Jaramillo, Jorge Dario Lopez-Isanoa,
and Juan Diego Villegas-Echeverri
11 Reproductive Tract Anomalies in Adolescent Endometriosis . . . . . . . 247
Tierney Wolgemuth and Joseph Sanfilippo
12 Obstructed Mullerian Anomalies and Endometriosis
in the Adolescent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Allison Petrini, Monica Pasternak, and Samantha M. Pfeifer
13 Adenomyosis in Adolescence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
Ourania Koukoura and George Pistofidis
14 Teenage Patient Story . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Emma Henry and Ceana H. Nezhat
Part V E ndometriosis Classifications
15 Current Classifications Addressing Endometriosis in
Adolescents Related to Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Pavan Kumar Ananth and Ceana H. Nezhat
Part VI Imaging
16 Imaging for Endometriosis in Adolescents . . . . . . . . . . . . . . . . . . . . . . 315
Stefano Guerriero, Alba Piras, Silvia Ajossa, Maria Angela Pascual,
Valerio Vallerino, Luca Saba, Anna Maria Paoletti,
Maria Chiara Lucchetti, Cinzia Orazi, and Juan Luis Alcazar
17 Utility of Ultrasound in the Evaluation of Adolescents
Suspected of Endometriosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
Caterina Exacoustos, Francesco Giuseppe Martire, Lucia Lazzeri,
and Errico Zupi
Part VII Clinical Manifestations
18 Neonatal Uterine Bleeding and Adolescent Endometriosis . . . . . . . . . 359
Stephan Gordts, Sylvie Gordts, Patrick Puttemans, Rudi Campo,
and Ivo Brosens
19 H ammer and Nail Medicine: The Pervasive Ignorance of Endometrial
Pain in Adolescents by the Mental Healthcare Profession . . . . . . . . . . . . . 367
Minal Parekh Shah