الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Endometriosis is defined as a progressive gynecological disorder and a chronic estrogen-dependent condition characterized by the growth of normally endometrial tissue in sites other than the uterine cavity but adenomyosis is the invasion of the myometrium by endometrial tissue. This tissue, possessing the same steroid receptors as normal endometrium, is capable of responding to the normal cyclic hormonal milieu. Microscopic internal bleeding, with the subsequent inflammatory response, neovascularization, and fibrosis formation, are responsible for the clinical consequences of this disease. Endometriosis is the common cause of chronic pelvic pain in adolescent girls unresponsive to treatment of oral contraceptives and non steroidal anti inflammatory drugs. The most common symptoms are: acquired or progressive dysmenorrhea, acyclic and cyclic pain, dysparunia, urological symptoms, and gastrointestinal symptoms. When evaluating an adolescent with suspected endometriosis gynecological examination (rectal or vaginal examination) and imaging studies (ultrasonography, magnetic resonance) should be performed. More over, in diagnostic process laparoscopy should be carried out in all girls and teenagers with chronic pelvic pain unresponsive to medical treatment. Initial therapy of endometriosis in adolescents involves: surgical methods (laparoscopy, laparotomy), hormonal therapy (combined contraceptives, progestin-only protocols), GnRH agonist (adolescents over 16 years of age), non- steroidal anti-inflammatory drugs, alternative pain therapies and psychotherapy. Early diagnosis and treatment during adolescence may decrease disease progression and prevent subsequent infertility.