Adolescent Endometriosis: From Clinical Management to an Early Recognition and Prevention-Oriented Paradigm—A Narrative Review

Background: Adolescent endometriosis remains underrecognized, although symptoms often begin after menarche and diagnosis may be delayed for years. Severe dysmenorrhea, chronic or acyclic pelvic pain, school absenteeism, and impaired functioning should not be normalized. This narrative review synthesizes evidence on adolescent and early-onset endometriosis, focusing on early recognition, non-invasive assessment, individualized care, and function-preserving follow-up. Methods: A structured narrative review search supported by PubMed/MEDLINE was updated on 9 August 2026, focused mainly on the last decade, with selected older studies included when relevant. Adolescent-specific evidence was prioritized; adult or mixed-age data were used only when applicable to diagnosis, imaging, treatment safety, or pathophysiology. Evidence was synthesized descriptively; no meta-analysis, formal risk-of-bias assessment, or formal evidence grading was performed. Results: The synthesis included 58 unique publications. Direct adolescent evidence supports early suspicion in severe dysmenorrhea, refractory or acyclic pain, functional impairment, family history, and obstructive Müllerian anomalies. Imaging may identify endometriomas, deep endometriosis, adhesions, or adenomyosis-related features, but normal imaging does not exclude superficial disease. Biomarkers remain investigational in adolescents. Hormonal treatment is primarily supported for pain, bleeding, and functional outcomes. Conclusions: Early recognition, timely referral, expert imaging when appropriate, individualized treatment, and follow-up centered on functional impact may reduce symptom burden in adolescents. Hormonal suppression is a clinically plausible strategy for symptom control and preservation of functioning, but it is not a proven disease-modifying or fertility-preserving intervention in adolescents.