Background/Objectives: Endometriosis affects up to 10% of women of reproductive age and about 47% of adolescents with pelvic pain. Symptoms include dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Adolescents often present atypical symptoms that can make endometriosis more difficult to diagnose. This study aimed to compare characteristics of pain, atypical symptoms, and the effects of hormonal treatments between adolescents and adults with endometriosis. Methods: A total of 238 women with endometriosis were included: 92 aged 12–18 (group A) and 146 over 18 (group B). Data on menarches, cycle length, comorbidities, dysmenorrhea, dyspareunia, CPP, analgesic use, pain characteristics, atypical symptoms, and endometrioma size were recorded. The efficacy, compliance, and side effects of hormonal treatments were also assessed. Quality of life (QoL) was measured using the SF-12 questionnaire at baseline and after six months of therapy. Results: Adolescents had earlier menarche (p < 0.001), longer menstrual periods (p < 0.001), and higher analgesic use (p = 0.001) compared to adults. Dysmenorrhea was more frequent (p = 0.01), lasted longer (p < 0.001), and was associated with higher pain scores (p < 0.001) in adolescents. CPP was more common in adolescents (p < 0.001), often described as “confined” (p = 0.04) and “oppressive” (p = 0.038), while adults reported it as “widespread” (p = 0.007). Headaches (p < 0.001) and nausea (p = 0.001) were also more frequent in adolescents. Both groups showed significant improvement in QoL with hormonal treatment (p < 0.001) and reported minimal side effects. Conclusions: Adolescents with endometriosis often present with earlier menarche, longer menstrual periods, more severe dysmenorrhea, and atypical symptoms. Hormonal contraceptives and dienogest are effective and safe treatments that improve pain and QoL.

Introduction: Dienogest is a synthetic fourth‐generation progestin that has been approved for the medical treatment of endometriosis, and its efficacy on pain symptoms and quality of life is well established even in the long term. Nowadays, only a few controlled trials evaluating the safety of dienogest compared with other hormonal therapies have been published. This systematic review and meta‐analysis aims to compare efficacy and tolerability data between dienogest and combined oral contraceptives (COC) in patients taking hormonal therapy for endometriosis treatment in order to inform evidence‐based guidelines.Material and Methods: PubMed (Medline), Web of Science, and Google Scholar were systematically searched from the inception of each database until October 2024. Selection criteria included any articles comparing efficacy outcomes and at least one tolerability data between dienogest and COC in patients diagnosed with endometriosis. Studies comparing COC containing Dienogest or another type of hormonal treatment were excluded. A random‐effects meta‐analysis was conducted if adequate data were available from at least three studies, reporting pooled mean differences and odds ratios between groups using Review Manager V.7.9.0. PROSPERO registration number: CRD42024598455.Results: A total of four randomized control trials and one observational study were included, showing moderate risk at bias assessment. Meta‐analysis did not show any statistical difference in improving pelvic pain after treatment [CI 95% (−1.45–1.17); I² = 86%; p = 0.84]. In contrast, dyspareunia after treatment was significantly lower in the COC group [CI 95% (0.64–1.33); I² = 0%; p < 0.00001]. No statistical difference was found in terms of vaginal bleeding [OR = 0.88; CI 95% (0.39–1.96); I² = 41%; p = 0.75], nausea and vomiting [OR = 0.51; CI 95% (0.16–1.63); I² = 67%; p = 0.26], headache [OR = 0.91; CI 95% (0.38–2.21); I² = 59%; p = 0.84], hot flushes [OR = 1.16; CI 95% (0.54–2.48); I² = 0%; p = 0.71], and hair loss [OR = 1.69; CI 95% (0.52–5.53); I² = 46%; p = 0.39]. Treatment discontinuation rate was similar between groups.Conclusions: Dienogest is comparable to COC in terms of efficacy and tolerability. The therapeutic choice should be based on the patient's preference, clinical history, and experience.

Endometriosis is linked to an increased risk of epithelial ovarian cancer (EOC), especially clear cell and endometrioid subtypes. The extent and prognostic significance of this link are still not fully understood. This systematic review and meta-analysis compiles existing evidence on ovarian cancer risk, histotype distribution, and survival outcomes in women with endometriosis. Systematic search up to August 2025 METHODS OF STUDY SELECTION: A systematic search of PubMed and Google Scholar was performed up to August 2025. Studies reporting ovarian cancer risk estimates or survival outcomes in endometriosis-associated ovarian cancer (EAOC) were included. Random-effects models generated pooled odds ratios (OR), hazard ratios (HR), and standardized incidence ratios (SIR). Risk analyses included >500,000 women; survival analyses >10,000. Sixty-seven studies met inclusion criteria. Endometriosis increased ovarian cancer risk (OR 1.82, HR 3.03, SIR 1.62). EAOC patients were younger, more often premenopausal, and more frequently diagnosed with early-stage (OR 0.29) and low-grade tumors (OR 1.71). Clear cell and endometrioid histotypes predominated. Overall survival was significantly better in EAOC (HR 0.48); recurrence and mortality were lower, while platinum resistance was similar. Endometriosis confers an increased relative but still low absolute risk of ovarian cancer. EAOC exhibits distinct clinicopathologic features and improved survival compared with non-EAOC. These findings support personalized counseling and emphasize the need for phenotype-based risk stratification and molecular markers of malignancy transformation.

Background/Objectives : Endometriosis affects up to 10% of women of reproductive age and about 47% of adolescents with pelvic pain. Symptoms include dysmenorrhea, dyspareunia, and chronic pelvic pain (CPP). Adolescents often present atypical symptoms which can make endometriosis more difficult to diagnose. This study aimed to compare characteristics of pain, atypical symptoms, and the effects of hormonal treatments between adolescents and adults with endometriosis. Methods: A total of 238 women with endometriosis were included: 92 aged 12–18 (group A) and 146 over 18 (group B). Data on menarches, cycle length, comorbidities, dysmenorrhea, dyspareunia, CPP, analgesic use, pain characteristics, atypical symptoms, and endometrioma size were recorded. The efficacy, compliance, and side effects of hormonal treatments were also assessed. Quality of Life (QoL) was measured using the SF-12 questionnaire at baseline and after six months of therapy. Results: Adolescents had earlier menarche (p<0.001), longer menstrual periods (p<0.001), and higher analgesic use (p=0.001) compared to adults. Dysmenorrhea was more frequent (p=0.01), lasted longer (p<0.001), and was associated with higher pain scores (p<0.001) in adolescents. CPP was more common in adolescents (p<0.001), often described as "confined" (p=0.04) and "oppressive" (p=0.038), while adults reported it as "widespread" (p=0.007). Headaches (p<0.001) and nausea (p=0.001) were also more frequent in adolescents. Both groups showed significant improvement in QoL with hormonal treatment (p<0.001) and reported minimal side effects. Conclusions: Adolescents with endometriosis often present with earlier menarche, longer menstrual periods, more severe dysmenorrhea, and atypical symptoms. Hormonal contraceptives and dienogest are effective and safe treatments, that improve pain and QoL.