Adolescents with suspected endometriosis should first try anti-inflammatory medications before considering surgery, according to a new clinical strategy presented at this year’s North American Society for Pediatric and Adolescent Gynecology conference.
Pattern-based care starts with medication
Heather Appelbaum, director of Pediatric and Adolescent Gynecology at K. Hovnanian Children’s Hospital, explained the approach begins with a pattern-based diagnosis. Girls experiencing cycle-related pain should start with anti-inflammatory drugs. If symptoms continue, hormonal therapy follows.
Surgery should only be considered for patients who do not improve with either treatment. Even then, a diagnostic laparoscopy must be performed by a surgeon prepared to remove any endometriosis found during the procedure.
“When we perform a surgical evaluation, the surgeon must recognize endometriosis in adolescence,” Appelbaum said. “That requires understanding the subtlety of the disease process in younger patients. Simply identifying it isn’t sufficient—it must be excised.”
Surgery alone isn’t the answer
Appelbaum stressed that surgery does not cure endometriosis. The condition is chronic, and without continued medical management afterward, it often returns. Even experienced surgeons can remove lesions, but long-term treatment is needed to stop recurrence.
“If treatment stops after surgery, the endometriosis will return,” she said. “Surgery is only one part of the plan for patients whose quality of life is severely compromised despite medical therapy.”
Appelbaum’s presentation expanded on earlier talks about separating clinical symptoms from surgical findings. While laparoscopy remains the most reliable diagnostic tool, it should not be the first choice for most adolescents. Instead, the focus is on managing symptoms while watching for signs that surgery might become unavoidable.
Parents and patients can also play a role. Keeping a pain diary—tracking when symptoms occur and how severe they are—can help doctors spot patterns that suggest endometriosis.
While the new guidelines aim to reduce unnecessary surgeries, they don’t rule them out entirely. For some adolescents, surgery remains the best option. The key is ensuring it’s done by a surgeon with experience in pediatric endometriosis, as the procedure requires precision.
Families handling this diagnosis often feel overwhelmed. Support groups and online communities can provide valuable information and emotional relief. One mother described finding a group for parents as a turning point in her daughter’s treatment journey.
The shift toward medication-first treatment reflects broader changes in how chronic conditions are managed. By prioritizing less invasive options, doctors hope to improve long-term outcomes while minimizing risks.
