Screening for endometriosis risk in adolescents

Researchers from Belgium have designed a self-report questionnaire for the purpose of identifying adolescent girls at risk for developing endometriosis.

As described in a recently published article, the instrument was constructed based on a systematic review of published self-report questionnaires aiming to identify adult women with endometriosis.¹ It is comprised of 6 main questions.

“Diagnostic delay is a major problem for endometriosis patients as a longer delay is associated with more advanced stages of endometriosis and with a higher likelihood of fertility problems. While other investigators have proposed a series of questions to ask adolescents presenting with pelvic pain, this approach does not address patient-related diagnostic delay in which symptomatic patients seek medical attention too late,” said Brecht Geysenbergh, MD, lead author and gynecologist, Leuven University Fertility Centre, Leuven, Belgium.

“Our questionnaire was developed for screening all female adolescents. First, however, it needs to undergo pilot testing and validation in a large population-based sample before it can be implemented as a screening tool.”

The literature search was conducted using several electronic databases to find relevant articles published in English or French. It initially identified 206 articles, of which 5 were included in the final review based on the a priori eligibility criteria.

The first two questions in the self-report questionnaire ask about age at first period and number of days on average between the start of one period and the next. These 2 questions were selected based on evidence from one study showing that both earlier age at menarche and shorter cycle length during late adolescence were associated with increased incidence of endometriosis.

The third question asks about presence or absence of pelvic pain accompanying periods within the past 3 months.  The fourth question asks for a description of the pain and lists 26 choices. The fifth question asks about painful bowel movements because one of the included studies found it predicted stage III and IV endometriosis. The sixth item is a seven-part query asking about urinary symptoms and frequency as this information was reported useful for identifying bladder endometriosis.

As additional background to support the importance of a self-report endometriosis screening tool for adolescents, Dr Geysenbergh and colleagues cited a paper that found two-thirds of adult women with a surgically confirmed diagnosis of endometriosis first had pain symptoms during adolescence. Another report found the average interval between symptom onset in adolescents and endometriosis diagnosis was 12.1 years.

Reference

1. Geysenbergh B, Dancet EA, D’Hooghe T. Detecting endometriosis in adolescents: why not start from self-report screening questionnaires for adult women? Gynecol Obstet Invest. 2016 Nov 5. [Epub ahead of print]