Endometriosis, better management

Women who have a stomach ache when they have their period to the point that they have to stay in bed tend to suffer in silence. And those around them sometimes consider that they make a big deal out of it … Of course, rules are natural, but not pain! In 40% of those who experience chronic pelvic pain, especially around the time of their menstrual cycle, they have endometriosis. Between 40 and 70% also have pain during sex. A complaint that is not always understood by their partner. In some cases, even urinating or having a bowel movement becomes painful … And yet, it takes an average of seven to nine years between the first signs of the disease and its diagnosis. It must be said that women minimize the symptoms. And the intensity of the pain and the severity are not related. It is therefore often when they have difficulty in starting a pregnancy that they begin to worry.

Screening possible from adolescence

” Recently, if the first periods are very painful, we can detect the disease from the age of 10-15 years thanks to a very advanced pelvic MRI technique. This allows these young girls to be treated very early to relieve them and preserve their fertility. », Explains Dr Erick Petit, radiologist. Endometriosis is indeed the first cause of infertility. In young women who have had sex, the gold standard is an endovaginal pelvic ultrasound (the ultrasound probe is inserted into the vagina). But few radiologists are trained to diagnose endometriosis. You should therefore not hesitate to seek the advice of your general practitioner or gynecologist to contact a radiologist aware of this pathology.

Osteopathy can sometimes help

For pain relief, anti-inflammatory drugs such as ibuprofen, or even opiates, and sometimes low-dose antidepressants or neuroleptics can be taken to help with neuropathic pain. Complementary therapies such as osteopathy, acupuncture, hypnosis or sophrology often give good results. ” It is rare that a woman comes to see me only for endometriosis, but by palpating the belly, if the uterus is congested, I suspect her very quickly and advise her to do tests. », Explains Gérard Longuet, osteopath. We can offer a session before the rules or just after, for 3 to 6 months, to restart blood and lymphatic circulation and restore mobility. “I was able to help several women to have children, including a young woman who had not managed to get pregnant for five years,” adds the practitioner.

We put the hormonal system to rest

The causes of endometriosis are not yet clear. However, we know that having a close relative affected by this disease increases the risk of being affected. The basic treatment is to put the hormonal system to rest with hormonal therapy such as a birth control pill taken continuously to suppress periods. The Mirena IUD (which delivers progesterone) can also be used. “Research is underway, on the one hand to detect endometriosis by a simple blood test, and on the other hand to treat it without suppressing the rules, but it will be necessary to wait a few years before they are successful” , specifies Dr Petit.

The operation is necessary in 3 out of 10 cases

In severe cases, the operation is required. “ Surgery has progressed a lot, we can now most often remove all lesions by laparoscopy, so without opening the abdominal wall and without removing the uterus », Emphasizes Dr Petit. After the operation, pain sometimes remains, and the risk of recurrence is not completely zero. Hormonal treatment is then prescribed. Although there is no definitive treatment for endometriosis to date, the good news is that, properly diagnosed and treated, 70 to 80% of women can become pregnant, sometimes with help. assisted reproduction (medically assisted procreation).

What exactly is endometriosis?

At the end of the menstrual cycle, if there has been no fertilization, a small layer of endometrium (the lining that lines the inside of the uterus) is passed with your period. When this tissue grows haphazardly – on the ovaries, tubes, outer surface of the uterus or its supporting ligaments – it reacts to hormones and also “bleeds” every month, which can cause nodules, cysts, adhesions and sometimes very strong pain. Other parts of the body are sometimes affected: the intestine, the bladder and even the lungs.

Our experts Dr Erick Petit, radiologist and founder of the Endometriosis Center at the Paris Saint-Joseph Hospital Group
Gérard Longuet, osteopath in La Fareles-Oliviers (13)

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