Endometriosis is characterized by the migration of endometrial tissue outside the uterus, usually in the pelvic region. It can remain asymptomatic, without consequences for health and therefore does not require treatment. On the other hand, in some women, endometriosis leads to inflammation, chronic or acute pain, as well as infertility. The prevalence remains difficult to affirm but it is estimated that it would touch between 10 and 15% of women of childbearing age.
A still poorly understood disease
The causes of endometrial tissue growing outside the uterus are still unclear to doctors. But researchers from Simon Fraser University in Vancouver (Canada) have just put forward a new hypothesis. According to them, the disease has its origin during fetal development. Women with endometriosis are said to have developed in their mother’s womb, under conditions of relatively low testosterone, compared to women without endometriosis.
Canadian researchers theorize that this testosterone deficiency “programs” the developing female reproductive system and its future dysfunction: short menstrual cycles, elevated sensitivity to pain, elevated inflammation, and altered levels of the hormones that control ovulation and menstrual cycle. “Low testosterone in early development is the strongest known correlate of endometriosis, and its effects may explain the majority of symptoms of endometriosis,” says Dr. Bernard Crespi, professor of biological sciences at SFU, co -author of this study which has just been published on the site Evolution, medicine & public health.
How is endometriosis treated?
Ignorance of endometriosis often leads to delay in diagnosis. Faced with this situation, the High Authority for Health (HAS) and the National College of French Gynecologists and Obstetricians (CNGOF) updated, at the beginning of 2018, the recommendations relating to the management of the disease.
“The management must be done by multidisciplinary teams including specialized radiologists, medical gynecologists and gynecological, urologist and digestive surgeons, practitioners specialized in medico-psychological assistance, pain practitioners and psychologists. It must be individualized according to the symptoms and the expectations of the patients” emphasizes the HAS. The main HAS recommendations to better manage endometriosis:
- Pelvic ultrasound is the first-line examination (after the clinical examination).
- There is no need to perform laparoscopy for the sole purpose of confirming the diagnosis when imaging shows specific signs of disease.
- Support is not required only if the disease is troublesome.
- the treatment aims to relieve pain (rules, reports, etc.). In the absence of the desire for a child, it is based on taking the pill or the installation of a hormonal intrauterine device. If it’s effective, no need for exploration. Otherwise, the therapist suggests other hormonal treatments.
- The surgery is only indicated in a certain number of cases and in some localizations of endometriosis.
- Infertility situations can be overcome with ovarian stimulation or IVF (in vitro fertilization).
- Patients should be informed the benefits but also the risks of each proposed treatment.
Sources:
- The evolutionary biology of endometriosisEvolution, medicine & public health, May 2021
- Management of endometriosisHigh Health Authority, January 2018
Read also :
- Endometriosis: 5 questions about its management
- Soon a platform dedicated to endometriosis
- Endometriosis and pregnancy: what are the obstacles to overcome?