根据一致的流行病学数据，子宫内膜异位症发病曲线的斜率在25岁左右迅速急剧上升。据报道，成年女性的诊断延迟通常为 5 至 8 年，但青少年的诊断延迟似乎超过 10 年。如果这是真的，那么许多年轻女性子宫内膜异位症的实际发病时间将出现在月经初潮早期。排卵和月经是炎症事件，如果多年重复发生，理论上可能有利于子宫内膜异位症和子宫腺肌病的早期发展。此外，初潮后反复出现的急性痛经不仅可能是子宫内膜异位症或子宫腺肌病的征兆，而且还可能通过中枢敏化机制促进急性盆腔疼痛向慢性盆腔疼痛的转变，以及慢性重叠疼痛病症的发作。因此，旨在减少痛苦、限制病变进展和保留未来生殖潜力的二级预防应重点关注最能从干预中受益的年龄组，即症状严重的青少年。即使体检和超声检查结果为阴性，也应立即怀疑早发性子宫内膜异位症和子宫腺肌病，并可能建立长期排卵抑制直至寻求受孕。如今，这可能意味着使用激素疗法数年，因此药物安全性评估至关重要。在没有公认的雌激素主要禁忌症的青少年中，使用极低剂量的复方口服避孕药与个体发生血栓栓塞事件的绝对风险略有增加有关。含有雌二醇而不是乙炔雌二醇的口服避孕药可能会进一步限制这种风险。口服、皮下和肌肉注射孕激素不会增加血栓栓塞风险，但可能会干扰年轻女性达到峰值骨量。对于青少年来说，左炔诺孕酮宫内缓释装置可能是一种安全的替代方案，因为闭经经常是在不抑制卵巢活动的情况下引起的。关于肿瘤风险，长期雌激素-孕激素组合使用的净效应是整体癌症风险小幅降低。对于患有慢性盆腔疼痛症状的年轻女性来说，是否应将手术视为一线治疗方法似乎值得怀疑。特别是当骨盆成像未检测到大的子宫内膜异位瘤或浸润性病变时，腹腔镜检查应保留给拒绝激素治疗或一线药物无效、不耐受或禁忌的青少年。提出了针对临床怀疑患有早发子宫内膜异位症或子宫腺肌病的年轻个体的诊断和治疗算法，包括自我报告的结果测量。© 作者 2023。由牛津大学出版社代表欧洲人类生殖学会出版和胚胎学。

According to consistent epidemiological data, the slope of the incidence curve of endometriosis rises rapidly and sharply around the age of 25 years. The delay in diagnosis is generally reported to be between 5 and 8 years in adult women, but it appears to be over 10 years in adolescents. If this is true, the actual onset of endometriosis in many young women would be chronologically placed in the early postmenarchal years. Ovulation and menstruation are inflammatory events that, when occurring repeatedly for years, may theoretically favour the early development of endometriosis and adenomyosis. Moreover, repeated acute dysmenorrhoea episodes after menarche may not only be an indicator of ensuing endometriosis or adenomyosis, but may also promote the transition from acute to chronic pelvic pain through central sensitization mechanisms, as well as the onset of chronic overlapping pain conditions. Therefore, secondary prevention aimed at reducing suffering, limiting lesion progression, and preserving future reproductive potential should be focused on the age group that could benefit most from the intervention, i.e. severely symptomatic adolescents. Early-onset endometriosis and adenomyosis should be promptly suspected even when physical and ultrasound findings are negative, and long-term ovulatory suppression may be established until conception seeking. As nowadays this could mean using hormonal therapies for several years, drug safety evaluation is crucial. In adolescents without recognized major contraindications to oestrogens, the use of very low-dose combined oral contraceptives is associated with a marginal increase in the individual absolute risk of thromboembolic events. Oral contraceptives containing oestradiol instead of ethinyl oestradiol may further limit such risk. Oral, subcutaneous, and intramuscular progestogens do not increase the thromboembolic risk, but may interfere with attainment of peak bone mass in young women. Levonorgestrel-releasing intra-uterine devices may be a safe alternative for adolescents, as amenorrhoea is frequently induced without suppression of the ovarian activity. With regard to oncological risk, the net effect of long-term oestrogen-progestogen combinations use is a small reduction in overall cancer risk. Whether surgery should be considered the first-line approach in young women with chronic pelvic pain symptoms seems questionable. Especially when large endometriomas or infiltrating lesions are not detected at pelvic imaging, laparoscopy should be reserved to adolescents who refuse hormonal treatments or in whom first-line medications are not effective, not tolerated, or contraindicated. Diagnostic and therapeutic algorithms, including self-reported outcome measures, for young individuals with a clinical suspicion of early-onset endometriosis or adenomyosis are proposed.© The Author(s) 2023. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.