Endometriosis: definition, symptoms, forms, treatments

What is endometriosis?

Endometriosis is a chronic disease that affects 1 in 10 women of childbearing age. This figure relates to women for whom the diagnosis has been made. It is therefore likely that endometriosis affects more people. This condition is characterized by the presence of endometrial-like tissue outside the uterine cavity. During menstruation, as a result of uterine contractions, some of the blood is regurgitated through the tubes and into the abdominal-pelvic cavity. This blood contains endometrial cells, fragments of uterine lining, which, instead of being destroyed by the immune system, will implant themselves and then, under the effect of subsequent hormonal stimulation, proliferate on neighboring organs (peritoneum, ovary, proboscis, intestine, bladder, ureter, diaphragm…).

"These fragments will be sensitive to fluctuations in the cycle", says Dr. Isabella Chanavaz-Lacheray. "This first stage of endometriosis is called superficial endometriosis which refers to the presence of ectopic endometrial implants located on the surface of the organs". The growth of these lesions leads to increasingly larger lesions, nodules, which can infiltrate and invade organs. This is called deep or subperitoneal endometriosis. “There are women who stay their entire lives with superficial endometriosis and there are others who get worse. The rate of escalation and severity are unpredictable ", specifies the obstetrician-gynecologist.

The different types of endometriosis

We are talking about 3 types of endometriosis:

• Superficial (or peritoneal) endometriosis which refers to the presence of ectopic endometrial implants located on the surface of the peritoneum;
• Ovarian endometriosis : ovarian endometrioma is an ovarian cyst characterized by its chocolate-colored fluid content;
• Deep pelvic (or subperitoneal) endometriosis corresponds to lesions that infiltrate deeper than 5 mm below the surface of the peritoneum. Deep endometriosis can typically affect the uterosacral ligaments, the posterior vaginal cul-de-sac, the intestine, the bladder, the ureters and beyond the pelvic cavity, the sigmoid, the right colon, the appendix and the terminal ileum for the most frequent locations.

What are the symptoms of endometriosis?

Symptoms appear with the first period or later. They are mild, acute, occasional, chronic depending on the person, or even completely absent in asymptomatic forms. Endometriosis lesions are responsible for painful symptoms that initially appear during menstruation. "But when the lesions are deep, they are also painful outside of menstruation", adds Isabella Chanavaz-Lacheray. "The most common symptom of endometriosis is a painful period"

• Painful periods (dysmenorrhea)
• Pain during intercourse (dyspareunia)
• Pain outside your period
• Frequent pelvic pain
• Digestive disorders
• Difficulty urinating (dysuria)
• Fertility problems

"The symptoms of endometriosis depend on the location of the lesions", indicates the gynecologist. This disease is polymorphic, meaning that there is not one but "endometriosis" because every woman is different. Furthermore, there is no correlation between the severity of the lesions and the severity of the symptoms. "You can have 'only' superficial endometriosis with lots of little lesions in the stomach and be in excruciating pain. And there are women who have very severe endometriosis and not that painful ”, notes Isabella Chanavaz-Lacheray.

Painful periods: is it endometriosis?

Period pains are the first sign that should alert you. "It's not normal to have a stomach ache during your period", insists Isabella Chanavaz-Lacheray. "The problem is, everyone is convinced it's okay, women first", she notes. The gynecologist specifies that these are very strong pains, which are resistant to analgesics. Fortunately, not all women who have period pain have endometriosis. The pains should especially alert when they come back each month, more and more severe, and they are incapacitating to the point of preventing them from going to school or working. If the pain subsides with a simple paracetamol, do not be alarmed. In any case, when the pain becomes debilitating, you should talk to a doctor.

Because it is sometimes difficult to rate pain on a clinical scale of 1 to 10, Nana creates the first Pain Dictionary and Pain Museum to illustrate and voice women's pain. For this, the brand has collected testimonials and descriptions of people with endometriosis, inviting them to use the metaphors of their choice. This gives sometimes surprising formulations such as "painful", "pinch-ovaries", "path to hell" or "body of thorns", but they really speak for the people concerned who suffer from it. If you too want to share your story, you can on #racontetadouleur.

Endometriosis and fertility

While endometriosis is often diagnosed during an infertility workup, not all women with it are infertile. “The majority of women with endometriosis have no fertility problems. In contrast, one-third of infertile women have endometriosis. This nuance is very important ”, insists Dr. Chanavaz-Lacheray. "When I tell a woman about endometriosis, she automatically hears infertility", regrets the expert, who wants to be reassuring: "You can have severe endometriosis and have children."

How is the disease diagnosed?

" The specific signs of superficial endometriosis cannot be seen on any examination, neither MRI nor pelvic ultrasound can detect it ", explains Dr Chanavaz-Lacheray. Deep endometriosis is visible on an endovaginal pelvic ultrasound or MRI, "Provided that the radiologist is specialized", insists the gynecologist. This is what explains the diagnostic delay of 7 to 10 years (between the onset of the first symptoms and the diagnosis). "Unfortunately, it is often when there is already deep endometriosis that the diagnosis is made, but when we go back to the woman's story, she has had symptoms since adolescence", explains the expert. "The diagnosis of endometriosis is mainly made on examination, imaging is mainly used to assess the severity of the disease or to rule out deep endometriosis."

What are the existing treatments?

“Today, there is no cure for this disease. We only know how to treat her ”, says Isabella Chanavaz-Lacheray. "The first treatment is amenorrhea (stopping menstruation, editor's note). By eliminating the rules, we have a first immediate benefit is that we eliminate the associated pain ", she adds. It also prevents the disease from getting worse, by blocking it where it was. “Once we put a patient in amenorrhea, we wait a few months and see what happens. There are some for whom it is not enough, especially those with deep lesions ", details the gynecologist. This is when the question arises of surgery to remove deep endometriosis lesions that cannot go away. “Surgery is not systematic; it serves two purposes: to improve pain and / or to improve fertility ”, inform the specialist. Since all medical treatments for endometriosis allowing amenorrhea are contraceptives, the desire to become pregnant requires their interruption.