81. Medical management of endometriosis in adolescent women: a review of 91 cases of biopsy-confirmed endometriosis

Background Endometriosis is a debilitating disease affecting reproductive-aged women. While a broad array of endometriosis treatments exist, optimal regimens are not well-established. We sought to characterize the most common treatment modalities for endometriosis in adolescent and young adult females with biopsy-proven endometriosis. Methods This is a retrospective medical record review of 91 women aged 14-25 who underwent laparoscopy for pelvic pain with biopsy-proven endometriosis at a tertiary hospital system between January 2011 and September 2020. Patients were identified by appropriate CPT and ICD-9/10 codes. Initial and current hormonal treatments (defined as first treatment offered within 6 months of initial presentation, and treatment at most recent follow-up visit, respectively), along with age and BMI were summarized with descriptive statistics. This study was approved by the institutional review board. Results Oral contraceptives (OCPs) were the most common initial treatment (64%), followed by levonorgestrel IUD (LNG-IUD) (10%). Progestin-only formulations (low- and high-dose norethindrone) were offered to younger patients (age 15.9 ± 2.7 years), compared to those offered OCPs (19.9 ± 3.3 years) and LNG-IUD (21.9 ± 1.7 years). Median follow-up time was 36.7 (IQR 14.9-64.3) months from initial presentation and 17.9 (IQR 4.6-39.1) months from laparoscopy. Current treatments varied widely, and included OCPs (32%), LNG-IUD (18%), oral progestins (low- and high-dose norethindrone, medroxyprogesterone) (14%), elagolix (9%), leuprolide (8%), and one patient who underwent TLH-BSO at age 22. Oral adjuncts to LNG-IUD were common: usually low- or high-dose norethindrone (37% of patients with an LNG-IUD), but also included progesterone, OCPs, and elagolix. There was no apparent association between BMI and initial or current treatments. While 33% of patients had trialed elagolix or leuprolide at some point in their treatment, only 17% were currently taking these medications, suggesting a significant rate of discontinuation. Conclusions OCPs, LNG-IUD, and oral progestins were the mainstay of initial treatment, with progestin-only formulations offered to younger patients more frequently, likely due to concern of impaired skeletal growth with estrogen-containing therapy. Current treatments varied widely and included OCPs, LNG-IUD, oral progestins, elagolix, and leuprolide. Regimens combining these agents were common. While one third (33%) of patients had tried elagolix or leuprolide at some point in their treatment course, there was a high rate (50%) of discontinuation possibly due to side effects or insurance coverage. This pilot study may help define the spectrum of optimal treatment regimens for endometriosis in adolescent females.