Endometriosis at the extremes of reproductive life: A life-course perspective on age-specific phenotypes in adolescents and postmenopausal women

OBJECTIVE: To summarize current evidence on endometriosis in adolescents and postmenopausal women and to compare age-specific clinical characteristics, diagnostic approaches, and management strategies. STUDY DESIGN: A narrative review was conducted following SWiM principles. A comprehensive search of PubMed, MEDLINE, Web of Science, Scopus, Embase, and the Cochrane Library was performed from database inception to December 2024. Studies reporting clinical or diagnostic data in adolescents or postmenopausal women with endometriosis were included. A total of 64 studies were analyzed (41 adolescent, 23 postmenopausal). RESULTS: Adolescent endometriosis is typically characterized by pelvic pain, reported in 40-55% of cases, with peritoneal lesions being the most common form. Recurrence rates range from 20 to 30%, and diagnostic laparoscopy remains central to evaluation. In contrast, postmenopausal endometriosis often presents with less specific symptoms, including gastrointestinal complaints, while pelvic pain is less frequently reported (18-25%). Recurrence appears lower (3-8%), although this may be influenced by differences in follow-up. Imaging modalities are more commonly used for diagnosis in postmenopausal women, particularly to exclude malignancy. Pathophysiological mechanisms differ between groups, with estrogen-dependent inflammation predominating in adolescents and local estrogen production contributing to disease persistence in postmenopausal women. CONCLUSION: Endometriosis demonstrates age-related differences in clinical presentation, diagnosis, and underlying mechanisms. Recognition of these variations may support more tailored diagnostic and management approaches across the reproductive lifespan.