Endometriosis is a chronic inflammatory condition resulting from the presence of endometrial tissue, glands, and stroma in extra-uterine sites. It is a common condition affecting approximately 1% to 5% of women, although this is a likely underestimation, with symptoms often beginning in teenage years.1 The 2022 European Society of Human Reproduction and Embryology (ESHRE) Guideline for the first time has new recommendations for the diagnosis and management of endometriosis in adolescents (<20 years).2 This clinical practice article provides an update on best practice for the assessment and management of likely endometriosis in young people up to 25 years.

Endometriosis impacts on all areas of a young person’s life: education or work life, social life, and relationships.3 Young women have experienced substantial disruption to careers and education from symptoms of severe pain, tiredness, and side effects of analgesia such as nausea. Pain has been described as ‘crippling’ and ‘horrific’ with duration of pain important.3 Young women have described GPs normalising endometriosis-related pain and be reluctant to refer to a specialist.3 Patients have described preferring surgical treatments over pharmacological treatments because there were perceived to be fewer side effects and enhanced symptom relief.3

For young people, the consideration of endometriosis as a diagnosis may be overlooked for painful periods, for example, …