The patient is experiencing severe symptoms so expectant management is not an option.
• Adolescents younger than age 18 who have failed NSAIDs and OCP therapy should be offered a diagnostic laparoscopy to confirm the diagnosis of endometriosis and to treat the disease surgically if noted at that time.
• As both subcutaneous medroxyprogesterone and GnRH agonists decrease bone density, these are not suitable options for an adolescent patient younger than age 18 who does not have a definitive diagnosis of endometriosis.
- Once endometriosis has been diagnosed, either of these medications may be considered if the benefits are felt to outweigh the risks.
•Aromatase inhibitor with oral contraceptive pills has not been studies in the adolescent population and its use is still mainly investigational.