Ultrasound Follow-Up in young women with severe dysmenorrhea predicts early onset of endometriosis.

Objectives: To evaluate the progression of endometriosis and painful symptoms in young women (≤ 25 years) with severe dysmenorrhea (Visual Analogue Scale score ≥ 7), with or without ultrasound-detected endometriosis, over a follow-up period of 12 to 36 months. The impact of hormone therapy was also assessed.

Methods: This retrospective observational study included 124 young women with severe dysmenorrhea: 67 had ultrasound signs of endometriosis/adenomyosis, 57 did not. All patients with ultrasound-detected endometriosis/adenomyosis received continuous hormone therapy, inducing amenorrhea; those without ultrasound findings underwent either cyclic hormone therapy or no treatment. Clinical and ultrasound assessments were performed at baseline and at follow-up visits at 12, 24 and 36 months, recording all symptoms and disease sites.

Results: In patients with ultrasound-detected endometriosis on continuous hormone therapy, all painful symptoms improved, and endometrioma size significantly decreased, with 40 % resolving completely. Utero-sacral ligament lesions also shrank, while rectal endometriosis remained unchanged. Ultrasound direct signs of adenomyosis were no longer visible in 22 % of cases. In patients without initial ultrasound evidence of endometriosis and with a regular menstrual cycle, new ultrasound-detected endometriosis emerged in 20 % of cases at follow-up.

Conclusions: In young patients with severe dysmenorrhea, clinical and ultrasound follow-up supports early detection of endometriosis and an appropriate treatment may reduce symptoms and prevent disease progression.