Case Study; patient aged 16

In this picture you can see endometriosis mainly on the left uterosacral ligament, but close to the rectum.  

There are numerous areas of endometriosis over the diseased peritoneum, but note the inflammation with bright red blood vessels coursing out from the classic dark lesions..

This endometriosis has been here for some time. There are small pink blisters, larger black areas, but also white areas representing scarring.

Case Study; patient aged 13

Although opinions may differ, if a young teenage girl presents to a gynaecologist, often having been unsuccessfully treated with the Pill or Pills by the GP, including high dose progesterone, there is in my mind, no question she should have a laparoscopy.  Before that we really would NOT have a definitive diagnosis and will be treating her speculatively. We would have no idea of the location or extent of her endometriosis, and no idea whether she also has early adenomyosis.