Endometriosis Surgery in Adolescents vs Adults: What National Surgical Data Tells Us
By Emanuela Lazzaroni Tealdi, MS
For years, severe pelvic pain in adolescents has been minimized, normalized, or attributed to “bad periods.” A new national study published in Fertility & Sterility provides critical surgical data that challenges that narrative, confirming what patients and advocates have been saying for decades.
Using large U.S. surgical databases, the authors compared how endometriosis presents and is surgically managed in adolescents (under 18) versus adults (aged 18–50), focusing specifically on uterus-sparing procedures. The findings clearly show that endometriosis is real, surgically identifiable, and distinct in adolescents—and that surgery in this age group is generally safe.
Endometriosis Looks Different in Adolescents
One of the most important findings of this study is that the “phenotype” (physical appearance) of endometriosis differs significantly by age.
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Adolescents: Were most commonly diagnosed with superficial peritoneal endometriosis, accounting for about 65% of cases.
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Adults: In contrast, showed a much broader spectrum of disease, with significantly higher rates of endometriomas (ovarian cysts) and other complex subtypes.
Notably, deep infiltrating, intestinal, or rectovaginal endometriosis was not commonly reported in the adolescent group. This reinforces the concept that endometriosis is a progressive disease that evolves over time rather than appearing “fully formed” from the start.
Why this matters: This directly contradicts the harmful belief that young patients cannot have “real” endometriosis just because their imaging is normal or the disease looks different than it does in adults.
The Problem of “Diagnostic Only” Surgery
A striking result from the data revealed a disparity in treatment: 20% of adolescents underwent diagnostic laparoscopy alone, compared with only 2% of adults.
This raises important clinical and ethical questions. While diagnostic laparoscopy confirms the disease exists, performing surgery without removing the lesions means adolescents may be left with:
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Persistent pain.
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Delayed effective treatment.
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The need for repeat surgeries later in life.
The study also noted that nearly half of adolescent surgeries were performed by non-gynecologic surgeons (such as general pediatric surgeons), which may explain why disease was identified but not treated during the same operation.
From a patient-centered perspective, this highlights the critical need for surgical expertise specific to endometriosis—not just general surgical access.
Surgical Treatment Is Common, and Safe
Despite differences in disease type and procedure selection, the study found that surgery for teens is safe.
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Low Complications: Serious 30-day postoperative complications were rare in both groups.
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Readmission: Rates were similarly low for both teens and adults.
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Duration: Surgery duration was generally shorter in adolescents, reflecting less complex anatomical distortion.
This is a crucial message for families who are often told that surgery is “too risky” for teens. National data does not support that fear when surgery is appropriately indicated and performed by experts.
What This Study Confirms
This research supports several realities that guide our practice at ESSI:
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It is Real: Endometriosis does occur in adolescents and is visible at surgery.
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It is Progressive: The disease often begins as superficial peritoneal lesions before evolving into deep nodules.
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The Window of Opportunity: Delayed diagnosis and incomplete treatment (diagnostic-only surgery) may allow progression over time.
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Safety: Surgery, when performed, is generally safe across age groups.
The ESSI Perspective: Why This Matters
Endometriosis does not suddenly “begin” in adulthood. For many patients, it starts years earlier, and how we respond at that first stage matters.
This study underscores the need for:
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Earlier recognition of endometriosis in teens (stop normalizing pain).
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Appropriate referral to experienced endometriosis surgeons who can treat, not just diagnose.
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Thoughtful decisions ensuring that when surgery is performed, it is therapeutic (excision), not just diagnostic.
Reference: Shim JY et al. Surgical management of endometriosis in adolescents versus adults: a National Surgical Quality Improvement Program study. Fertility and Sterility, 2025.
