Endometriosis: 10 Things you should know about the disease

WHAT IS ENDOMETRIOSIS?

It is the deposits of endometrial cells outside the endometrium. These can find accommodation in the ovaries, bladder, intestines, pleura, rectum, and so on. This disease is little known even though it affects more than one in 10 women, even up to one in seven according to certain estimations.

WHAT ARE THE SYMPTOMS?

The symptoms include severe pains during the period, possibly accompanied by sciatic, pelvic or lumbar vertebrae pains almost always in rhythm with the menstrual cycle (before, during, or after). Symptoms can appear from age 15 or 16 until approximately 45 years old; that is, close to menopause. It is sometimes diagnosed during investigations into fertility disorders. Frequent pains are also experienced during sexual intercourse, which urge women to avoid intimacy.

IS IT EASY TO DIAGNOSE?

Not always. Right now, it can be 7 to 9 years before a woman obtains a diagnosis. This is too long! We sometimes have difficulty detecting this disease because many women still think that it is normal to suffer a lot during their periods. It is false. It is necessary to speak about it to our doctor. Moreover, when a woman feels that her menstrual pains are insupportable, we should immediately think about endometriosis. Further examinations will confirm the diagnosis.

WHAT EXAMINATIONS ARE NECESSARY?

It is necessary to be wary of the pelvic ultrasound, which won’t always detect the problem, especially if we are not looking specifically for endometriosis. It is better to choose a radiologist who is a specialist of the disease. We can also directly prescribe an MRI, which is a more comprehensive and reliable test.

WHAT ARE THE TREATMENTS?

To fight against the pain, we recommend taking non-steroid anti-inflammatory drugs. As it is a hormonal disease, stopping the bleeding will limit the pain. It is thus essential to block the period by continuously taking oestrogen-progesterone pill. In case of contraindication or if it does not work, we can also try a pill containing progesterone. These treatments relieve the symptoms but do not look after the disease. Approximately 60% of the patients find a better quality of life when they take this medicine.

IS SURGERY INDICATED?

Yes, in some cases. To be truly effective, it is necessary to remove all of the endometriosis, which can be a very serious operation. To be sure that nothing escaped us, a complete preoperative test is done: MRI, ultrasound, scanner of the colon and rectal ultrasound. It is necessary to know that in 1/4 of the cases the pelvic endometriosis is associated with rectal damage. There are also hormonal treatments to take several months before the intervention. In 30 to 40% of cases, women who undergone surgery report a considerable improvement in their quality of life.

CAN THE DISEASE RETURN?

Absolutely. If hormonal treatments are taken, almost all patients will experience a recurrence of the disease within 10 years. The more severe the endometriosis, the more likely it is to return.

DO WOMEN WHO SUFFER FROM ENDOMETRIOSIS ALWAYS HAVE FERTILITY PROBLEMS?

No, but it is true that when we explore the reasons for fertility disorders in women, we fall on endometriosis in approximately 40% of cases. This does not mean that it is always the unique cause of the problems, but it contributes to the difficulty of conceiving. The inflammation of the tissues damaged by endometriosis creates a climate hostile to fertilisation. When we operate, we notice that approximately half of these women are pregnant within 12 to 18 months. IVF is also a possibility, but the decision is made on a case-by-case basis.

DOES THE DISEASE STOP SYSTEMATICALLY AT MENOPAUSE?

Yes. On the other hand, it is necessary to be alert to endometriotic cysts, which elevate the risk of developing ovarian cancer.

WHY DO WE OFTEN HEAR THAT IT IS A TABOO DISEASE?

I would say little-known rather than taboo. Women have difficulty speaking out about painful periods in our society, and doctors do not always consider this pathology. Fortunately, the patients tend to group together in varied associations, and the media is increasingly reporting on the subject.

Maureen Diament