The management of endometriosis in adolescents and young adults: a systematic review

Abstract STUDY QUESTION What evidence-based strategies are used in the treatment of endometriosis-associated symptoms in adolescents and young adults? SUMMARY ANSWER The use of hormonal therapies and surgery was associated with improvements in pain symptoms in most studies; however, the certainty of evidence was very low, meaning that the true impact of these treatments remain uncertain. WHAT IS KNOWN ALREADY Endometriosis is a chronic condition estimated to affect one in ten women, with symptoms commonly present during adolescence. Current management strategies for endometriosis include analgesia, hormonal suppression and surgery, as well as non-pharmacological measures. STUDY DESIGN, SIZE, DURATION This is a systematic review of the literature. Six databases (CINAHL, Cochrane Central Database of Controlled Trials, EMBASE, MEDLINE, PsychInfo and Web of Science Core Collection) were searched from inception to May 2026. Search terms were related to endometriosis combined with terms regarding management and the adolescent age group. PARTICIPANTS/MATERIALS, SETTING, METHODS Eligible studies included participants aged under 24 years with endometriosis, and reported on outcomes in the management of endometriosis-associated symptoms. Only studies with full texts or data available in English were included. Screening and data extraction were performed independently and in duplicate by two authors. Key outcomes included pain, quality of life, recurrence and side effects. Data were reported narratively. Risk of bias was assessed according to study design (ROB2, NOS and JBI tools) and quality of evidence with the GRADE system. MAIN RESULTS AND THE ROLE OF CHANCE The search identified 14,376 records, of which 333 full texts were assessed for eligibility, and 23 studies, with a combined total of 1,561 participants, were included. There were two randomised controlled trials, one single arm open label interventional study, eleven cohort studies, and nine case series. Five studies investigated hormonal treatments, one other study assessed other pharmacological treatments, sixteen studies assessed surgical management with or without hormonal treatment, and one study investigated non-pharmacological treatments. Most studies reported improvements in pain symptoms, however there was heterogeneity in study design, length of follow up, and outcome measures. LIMITATIONS, REASONS FOR CAUTION There is limited evidence in this age group. Most studies had a moderate risk of bias, and the certainty of evidence was very low. WIDER IMPLICATIONS OF THE FINDINGS The very low certainty of evidence limits the ability to draw inferences from the data. More high-quality research is essential to understand the effectiveness of current treatments and identify how they should be tailored for this age group. FUNDING No specific external or departmental funding was received for this systematic review. DISCLOSURES CB declares research grants from US DoD, NIH, EU Horizon 2020, Bayer AG, Aspira Ltd, Exeltis Ltd, Proteomics Inc, and Serac Healthcare Ltd, and consulting fees from Gedeon Richter, Theramex, Gesynta, and Roche, (all paid to institution). CB is Chair of the ESHRE Endometriosis Guideline Group and a member of the NICE Endometriosis Guideline Group (unpaid). SAM declares research grants (paid to institution) from AbbVie and the Marriot Family Foundations, received honoraria from the University of Kansas Medical Center and received travel support from LIDEA Registry, Taiwan Endometriosis Society, SEUD, Japan Endometriosis Society, NASEM, Endometriosis Foundation of America, Gedeon Richter, WES, New York Academy of Sciences, and Asian Conference on Endometriosis. SAM is Field Chief Editor for Frontiers in Reproductive Health (personal fee) and is an advisory board member for the LIDEA Registry (personal fee) and has unpaid roles with Human Reproduction Statistical Advisory Board and the NextGen Jane Advisory Board, the Society for Women’s Health Research, WERF, WES, ASRM, and ESHRE. KV reports research grants from the NIHR, NIH, UKRI, Medical Research Foundation, and EU IMI-2, consulting fees from Gesynta and Reckitts, and speakers’ fees from Reckitts, Organon, Gedeon Richter, and Eli Lilly (all payments to institution). KV is a member of the Medical Advisory Panel of Endometriosis UK (unpaid). KTZ declares research grants from the Gates Foundation, US DoD, NIH, EU Horizon 2020, Bayer AG, Aspira Ltd, Exeltis Ltd, Proteomics Inc, and Serac Healthcare Ltd and consulting fees from Apikal Ltd, Gedeon Richter, Roche, and LIDEA, (all paid to institution), and speaker’s fees (paid to institution) from Rathlin Therapeutics and Camber Collective/Gates Foundation, received travel support for ESHRE 2025, SEUD 2024, EEC 2024, and LIDEA 2023, and is named on patent WO2024115891A1 relating to chronic pelvic pain treatment (NRG3), which is unrelated to the present manuscript. KTZ is a board member of the World Endometriosis Foundation (unpaid). UB, LM, GB, CS, EE and PM declare no conflict of interest. Some of the above companies manufacture treatments discussed in this review. REGISTRATION NUMBER CRD420251018467