Members of the Gynecology Obstetrics Reproductive Medicine department of Foch hospital and the French Society for the Study and Treatment of Pain (SFETD) take stock of the origins, consequences and management of pain due to endometriosis.
- Endometriosis is a gynecological disease that affects at least 2 million French women.
- Endometriosis affects at least one in 10 women of childbearing age and in the majority of cases causes recurrent and/or chronic pain, sometimes very disabling,” explains the French Society for the Study and Treatment of Pain (SFETD).
- “Today, the treatment of endometriosis must be offered by a multidisciplinary team, with multimodal actions,” indicates Professor Pierre Marres.
The Gynecology Obstetrics Reproductive Medicine service Foch hospital organized its congress at the beginning of March “Gynfoch”. The opportunity to take stock of the state of fertility and the latest medical developments. Endometriosis has been at the heart of debates, particularly on the management of the pain it causes.
Endometriosis: at least 2 million French women affected
Endometriosis is a gynecological disease that affects at least 2 million Françaises. His particuliarity ? Pain, of course! Which can range from simple period pain to much more intense pain, disabling and making daily life more complicated than one imagines.
“Endometriosis affects at least one in 10 women of childbearing age and in the majority of cases causes recurrent and/or chronic pain, sometimes very disabling,” thus confirms the French Society for the Study and Treatment of Pain (SFETD).
What prompts the consultation is this common denominator of pain: “Srelieving pain is expected by women, therefore the treatments offered must be multiple and varied. And this prolixity of the disease will lead to physical, psychological and above all social consequences, with quite significant disturbances, particularly in the couple”, says Dr. Olivier Bredeau, specialist in pain assessment and treatment.
While explaining the physiological mechanisms of pain, Dr. Bredeau explains the consequences of chronic pain which are quite significant in patients who have suffered from endometriosis for a long time: “It is the increase in sensitivity painful but also elements of muscular contractions which will appear. But also, fatigability phenomena, psychological phenomena in particular anxiety/depression, with social repercussions.”
Why does endometriosis hurt?
But ultimately, the question is legitimate: why does endometriosis hurt? “It is because there is pain linked to inflammation, it is inflammatory pain. Because there is either neurological compression or organ pain and this is visceral pain with specific treatment. There are chronicity factors: the greater the inflammation, the greater the pain and the more the risk of chronicization will be significant”, replies Dr. Bredeau. He informs that “there progesterone is a powerful anti-inflammatory, a basis for treating back pain. endometriosis”.
It is the turn of Professor Pierre Marres, Obstetrician Gynecologist and head of the center woman/child from Nimes University Hospital to enlighten us with her expert eye: “We can consider that finding Pain treatments are almost mission impossible. So, is it really mission impossible? Yes, if we continue to think that pain can be cured by simply operating or administering an ovulation blockade.”
What has changed is the awareness of professionals health in the face of this disease: ”The lesions linked to endometriosis are multiple. There’s no that endometriosis, there are inflammations, there are phenomena of secondary fibrosis, this means that everything hurts! Which should require global, holistic care, but this is not the case, why? Because we have learned to deal with pain but with pain, I would say, stupidly! That is to say, we try to break the pain without understanding either the meaning of the pain for the patient, or the complex etiology. which causes this pain. And as long as we don’t understand that, we can’t do it.” adds Prof. Fed up.
“The treatment of endometriosis requires a multidisciplinary team”
The Obstetrician Gynecologist from Nimes indicates: “Which means that today, the treatment endometriosis must be proposed by a multidisciplinary team, with multimodal actions. We must move away from the endocrinologist surgeon who treats, we are no longer in this era which is the Middle Ages. As has been said, there are progestins, but you also need to know about progesterone. Sometimes switching to progesterone can reduce pain when progestins do not reduce pain by blocking ovulation.” The specialist also explains that it is no longer necessary to operate without a pain assessment carried out beforehand, with tested pain treatments. It is only when all therapeutic solutions have been exhausted that the question of surgery can arise.
Endometriosis: what is the point of “chronic pain structures”?
Same story with the SFETD. “In the event of chronic pain with significant repercussions, comprehensive care according to the biopsychosocial model is recommended: it can be done in conjunction with a chronic pain structure. completes the association. “Since 2023 and the new labeling of chronic pain structures, some of them have in fact been notified as referents in endometriosis pain due to their experience and their belonging to a regional sector set up within the framework of the national strategy to combat endometriosis”, she adds.
“Suffering for life from endometriosis and its complications is not inevitable, as long as the therapeutic arsenal ranging from hormonal therapy to surgery is deployed in an appropriate manner for each patient,” continue the experts.
More generally, the non-profit organization deplores that “pain is a human experience that is still poorly understood, poorly evaluated, poorly treated. In this experience that everyone can go through, which is overwhelming, and which we sometimes have difficulty explaining to others, many questions emerge, about the origin of pain, the mechanisms involved, but also the way of communicating it. , and above all the possibilities of treatment, medicinal or not. Not understanding often adds to the distress caused by the illness.”
In conclusion, “the SFETD therefore wishes to improve the knowledge of health professionals but also of the general public on chronic pain, their mechanism, their clinical implications in order to improve the care of adolescents and women with abdominal-pelvic pain”.