This review discusses the challenges of diagnosing and managing deep infiltrating endometriosis (DIE) in adolescents. Endometriosis is a common condition in premenopausal women, but its early onset in adolescents is often underdiagnosed due to limited symptoms and diagnostic challenges. DIE is a more aggressive form of endometriosis that can lead to severe complications. The review highlights the importance of early diagnosis and treatment to prevent disease progression and improve quality of life and fertility. Dysmenorrhea is a common symptom in adolescents with DIE, often accompanied by dyspareunia and chronic pelvic pain. Ultrasound is the first-line imaging technique for diagnosing DIE, although it may miss early-stage disease. Magnetic resonance imaging (MRI) is preferred in certain cases, such as in virgins or when ultrasound is not accepted. Diagnostic laparoscopy is considered acceptable when other treatments fail. The review emphasizes the need for early medical or surgical treatment to reduce disease progression and improve quality of life. However, surgical treatment may lead to persistent or recurring symptoms. The pathogenesis of DIE in adolescents is not fully understood, with various theories proposed, including stem cell involvement and genetic factors. The prevalence of DIE in adolescents is uncertain, with studies showing varying results. MRI and ultrasound are commonly used for diagnosis, but their accuracy in adolescents is still under investigation. The review also discusses the role of imaging in diagnosing DIE, noting that US is preferred due to its lower cost and wider availability. Adenomyosis, a related condition, is also discussed, with a focus on its prevalence and management in adolescents. The review highlights the importance of early diagnosis and tailored treatment approaches, including hormonal therapies and, when necessary, surgical interventions. The management of DIE in adolescents should aim to reduce symptoms, control disease progression, and preserve fertility. The review concludes that early diagnosis and appropriate treatment are crucial for managing DIE in adolescents.This review discusses the challenges of diagnosing and managing deep infiltrating endometriosis (DIE) in adolescents. Endometriosis is a common condition in premenopausal women, but its early onset in adolescents is often underdiagnosed due to limited symptoms and diagnostic challenges. DIE is a more aggressive form of endometriosis that can lead to severe complications. The review highlights the importance of early diagnosis and treatment to prevent disease progression and improve quality of life and fertility. Dysmenorrhea is a common symptom in adolescents with DIE, often accompanied by dyspareunia and chronic pelvic pain. Ultrasound is the first-line imaging technique for diagnosing DIE, although it may miss early-stage disease. Magnetic resonance imaging (MRI) is preferred in certain cases, such as in virgins or when ultrasound is not accepted. Diagnostic laparoscopy is considered acceptable when other treatments fail. The review emphasizes the need for early medical or surgical treatment to reduce disease progression and improve quality of life. However, surgical treatment may lead to persistent or recurring symptoms. The pathogenesis of DIE in adolescents is not fully understood, with various theories proposed, including stem cell involvement and genetic factors. The prevalence of DIE in adolescents is uncertain, with studies showing varying results. MRI and ultrasound are commonly used for diagnosis, but their accuracy in adolescents is still under investigation. The review also discusses the role of imaging in diagnosing DIE, noting that US is preferred due to its lower cost and wider availability. Adenomyosis, a related condition, is also discussed, with a focus on its prevalence and management in adolescents. The review highlights the importance of early diagnosis and tailored treatment approaches, including hormonal therapies and, when necessary, surgical interventions. The management of DIE in adolescents should aim to reduce symptoms, control disease progression, and preserve fertility. The review concludes that early diagnosis and appropriate treatment are crucial for managing DIE in adolescents.