“Endometriosis”, we hear about it more and more often! But what are its mechanisms, what are the symptoms, how serious can it be and what can be done?
Endometriosis is a common disease that affects one in 10 women. It is starting to be less misunderstood since women have taken up the subject, especially on social networks. It is most often manifested by pelvic pain, especially during menstruation. This dysmenorrhea worsens from cycle to cycle and resists conventional treatments with analgesics and/or anti-inflammatories.
Conversely, and this is fortunate, not all menstrual pain is a sign of endometriosis! However, other pains can occur outside of the menstrual period, especially during sexual intercourse, manifesting as deep pain in the lower abdomen. These symptoms correspond to pelvic endometriosis, the most common, but atypical signs can also indicate extra-pelvic, urinary or digestive endometriosis, for example. Apart from pain, endometriosis can also affect fertility either by obstruction of the fallopian tubes or by ovulation disorders.
The endometrium is the tissue that lines the inside of the uterine cavity. Throughout the cycle, from the end of the period to the eve of the next one, it thickens, then evacuates with blood at the time of menstruation. In endometriosis, endometrial cells will grow in an ectopic location, in other words, outside the uterine cavity, thus forming endometriotic islands.
One can thus find, for the most frequent pelvic endometriosis, grafts of endometrial cells in the uterine muscle (it is then called adenomyosis), the ovary (in the form of cysts called endometriomas), or in the recto- vaginal. The nodules can also sit outside the pelvis, on the intestine, the peritoneum, the bladder, the perineum or more rare locations.
However, the endometrium, wherever it is, will grow throughout the cycle and bleed at the time of menstruation, exactly as it does physiologically in the cavity of the uterus. In the ovary, for example, the endometriotic cyst will fill with blood every month; in solid tissues, the nodules formed by these islands of ectopic endometrium will be under tension, waking up often intense pain, especially in the septum that separates the vagina from the rectum.
When endometriosis is external (on the cervix, vagina, perineum, a scar) it typically appears as a bluish nodule whose size varies with the cycle (obviously not to be confused with hemorrhoids or a varicose vein!).
They are still little known, apart from a genetic predisposition and hormonal factors. Indeed, the endometrial cells are under the dependence of the estrogens of the menstrual cycle. Logically, early menstruation and late menopause, contraception not doing not use of the pill, the absence or low number of pregnancies and breastfeeding periods are situations that increase the risk of developing endometriosis. In addition, endocrine disruptors are suspected to have increased the frequency of this disease.
We start with a complete gynecological examination, which we complete with an ultrasound, performed by a doctor trained in the diagnosis of endometriosis because the images are often discreet and difficult to interpret. Endovaginal ultrasound is preferred for its accuracy and reliability. If the ultrasound suspects endometriosis, it will be confirmed by an MRI. In some cases, especially if surgery is planned or in an infertility assessment, it may be necessary to perform a laparoscopy (i.e. exploration under general anesthesia of the abdomino-pelvic cavity with a camera, sometimes associated with a surgical procedure ).
We proceed step by step according to the symptoms. Initially, dysmenorrhea will be treated with anti-inflammatories, analgesics and spasmolytics, but this is rarely enough and above all, it will not slow the progression of endometriosis. Indeed, in order to prevent the endometrium from thickening, wherever it is, it is imperative to block the cycle by giving a pill either low in estrogen or progestin, if possible continuously to avoid menstruation.
In the case of isolated adenomyosis (i.e. endometriosis of the uterine muscle), we can also propose the insertion of a progesterone IUD, which most often suppresses menstruation. If this is not enough, as in advanced endometriosis or if an operation is planned, an LHRH analogue is injected every month (i.e. drugs that block the cycle at the level of the hypothalamic command) to cause a transient artificial menopause.
In the event of a large endometriotic cyst, if it is necessary to establish the stage of severe endometriosis, or in the event of exploration of infertility, it will then be necessary to go through the surgery box with the realization of a laparoscopy.
Endometriosis affects many women and significantly affects their quality of life and sometimes their fertility. If the diagnosis is made early, before the lesions extend into the pelvis in particular, medical treatment by blocking the cycle can stabilize or even cause the lesions to regress. So do not hesitate to talk about your symptoms with your gynecologist in order to avoid a delay in diagnosis which is still too frequent.
