It is hard to predict the presence of endometriosis in adolescents with pelvic pain merely from the presenting symptoms, because similar symptoms occur in patients evaluated laparoscopically for pelvic pain with and without endometriosis (Reese et al., 1996; Laufer et al., 1997).

Laparoscopy should be considered if adolescents with chronic pelvic pain who do not respond to medical treatment (NSAIDs, OCPs) since endometriosis is very common under these circumstances (Goldstein et al., 1980; Vercellini et al., 1989; Reese et al, 1996; Laufer et al., 1997; Emmert et al., 1998; Hassan et al., 1999; Kontoravdis et al., 1999; Shin et al., 2005; Stavroulis et al., 2006).

Minimal to mild endometriosis according to the rASRM classification are the most common stages of the disease in adolescents. Gynaecologic surgeons should pay special attention to red, clear or white lesions which were reported to be more prevalent in adolescents as opposed to adults who have endometriosis (Goldstein et al., 1980; Vercellini et al., 1989; Davis et al., 1993; Reese et al, 1996; Laufer et al., 1997; Emmert et al., 1998; Hassan et al., 1999; Bai et al., 2002; Marsh and Laufer, 2005).

Menstrual outflow obstructions such as Müllerian anomalies may cause early development of endometriosis in adolescents. Regression of the disease has been observed once surgical correction of the anomaly has been accomplished (Sanfilippo et al., 1986; Ugur et al., 1995; Hur et al., 2007).