Endometriosis: what you need to know

Endometriosis is a gynecological disease characterized by the formation of cells of the uterine lining or endometrium outside the uterus.

During the menstrual cycle, under the effect of estrogen, the endometrium thickens in preparation for a possible pregnancy. If there is no fertilization, it disintegrates. These are the rules.

Naturally, the immune system destroys cells that are out of place. However, in women who suffer from endometriosis, these cells which develop outside the uterus are not destroyed. They remain disseminated on the other organs and bleed at the same time as the uterus during the menstrual period, which causes lesions, nodules, adhesions, ovarian cysts as well as inflammatory reactions with the formation of fibrous scars.

This chronic inflammatory disease affects 10% of women. The symptoms differ from one to another. They can be multiple because they are related to the localizations of the endometriotic lesions.

Symptoms of endometriosis

The pain can manifest itself in different ways, namely:

• During menstruation with severe pain, this is called dysmenorrhea.
• During sex (dyspareunia)
• Frequent pelvic pain that may radiate to the leg
• Pain during defecation, presence of blood in the stool (hematochezia)
• Painful urination, presence of blood in the urine (hematuria)
• Abdominal pain (bloating)
• Lower back pain ( low back pain , sciatica, cruralgia)
• Fatigue, irritability or depression
• Other symptoms may occur in women with endometriosis such as loss of consciousness and vomiting.
• Infertility can manifest as a symptom in 40% of women with endometriosis.

The cyclic nature of these pains is suggestive of endometriosis. Generally, the pain does not pass even after taking an analgesic. They can be continuous or occasional and sometimes very violent. The pain is linked to the female cycle and therefore often more acute at the time of ovulation or menstruation.

The treatment of endometriosis

Currently, there is no definitive treatment for endometriosis.

To treat the pain associated with endometriosis, gynecologists use three types of treatment, namely:

Analgesics and nonsteroidal anti-inflammatory drugs or NSAIDs

The goal of these treatments is to decrease inflammation to reduce endometrial bleeding and lesions.

Gynecologists use either:

• Combined oral contraceptives (estrogen + progestin) associated with NSAIDs
• Or to Progestins only which are included in IUDs.

Hormone treatments (hormone therapy)

Always with the aim of alleviating the pain of the patients, the gynecologists have recourse to a hormonal medical treatment whose goal is to suppress the rules. In other words, they are aimed at amenorrhea, that is, the absence of menstruation.

The IUD : The gynecologist places an IUD covered with a progestogen which reduces menstruation and the painful symptoms associated with endometriosis. A treatment that has proven its effectiveness!

The progestogen pill : It blocks ovulation and prevents the release of hormones that nourish the cells of the endometrium (outside the uterus) namely estrogen. The goal is to prevent periods.

The continuous estrogen-progestogen pill : The packs of pills are consumed without respecting the 7-day period between two packs. This continuous taking of the pill causes a weakening of the endometrium, and therefore endometriosis, and prevents the onset of painful periods.

The artificial menopause cure

When the previous treatments do not prove to be effective, the gynecologist proceeds to an artificial menopause cure coupled with hormonal therapy in order to compensate for the undesirable effects linked to the menopause.

Danazol : Danazol is a synthetic hormone close to testosterone. It blocks the secretion of the ovaries, in other words, it blocks the activity of estrogen and progesterone and induces an artificial menopause. And as a result, endometriosis is weakened.

GnRH (or LHRH) analogues or agonists : these are injectable drugs (in monthly injection) that suppress menstruation by artificially lowering estrogen levels and therefore causing artificial menopause.

Anti-aromatases : which transform androgens into estrogens.

Surgical treatment of endometriosis

In the event of ineffectiveness of medical treatments or following undesirable effects of the latter, the gynecologist may have recourse to surgery.

Conservative surgery: to preserve fertility in women wishing to have children or in the case of pain refractory to medication, this “conservative” surgery (which preserves the uterus and ovaries) is preferred. It aims to remove endometrial growths and scar tissue that are usually the cause of infertility.

Radical surgery: In the most severe cases of the disease, it is sometimes necessary to remove the uterus (hysterectomy) and the ovaries to avoid hormonal stimulation. This surgery is considered as a last resort since it involves menopause and permanent sterility.