Dr Érick Petit, radiologist and endometriosis expert, explains to us how this pathology can affect all stages of reproduction.
- 10 to 15% of women of childbearing age are affected by endometriosis, a chronic inflammatory disease that causes tissue similar to the uterine lining to develop outside the uterine cavity.
- “It is a disease which is more general than just pelvic, because there is a significant impact in terms of pain on the entire body”, insists Dr Érick Petit, expert on the subject.
- Hydrosalpinx, ovarian endometriotic cysts, reduction in oocyte quality… Several mechanisms linked to this disease can also “disrupt fertility”, notes the specialist who also recalls that “endometriosis does not make one sterile, except in very exceptional cases” .
“Endometriosis is a chronic inflammatory disease, genetically determined and also environmental, in particular because of endocrine disruptors whose prevalence is regularly increasing”, explains firstly the radiologist and endometriosis expert, Dr Érick Petit.
How does endometriosis manifest?
When a woman has endometriosis, tissue similar to the lining of the uterus grows outside the uterine cavity. “These endometrial-like cells are found, for example, in the uterine muscle, this is officially called adenomyosis, adds the president of the endometriosis city-hospital network RESENDO. The cells also flow back through the tubes and can colonize other organs in the peritoneal cavity, the entire pelvic cavity can be affected outside the uterus, including the ovaries, tubes, digestive tissue, rectum, the urinary sphere, the bladder, etc.”In 95% of cases, this contagion remains localized in the pelvic cavity, but in 5% of cases, there are locations that we call extra-peritoneal, and we can find these cells throughout the body.
A 10-year diagnostic wandering for these women
“It is a disease that is more general than just pelvic, because there is a significant impact in terms of pain on the entire body. There are also very specific situations which largely explain the diagnostic wandering which, I remind you, is still 10 years old, underlines the founder and head of the Endometriosis Center of the Paris Saint-Joseph hospital group. This is why it is always very important to make the entire public and health teachers aware of the presence of this disease which is still diagnosed very and too late, with an incidence, a significant impact on the quality of life of patients and their possible fertility.”
For Dr Érick Petit, it is necessary to diagnose endometriosis as early as possible, from adolescence. “There are a number of very characteristic symptoms. So we must trigger the alert and the consultation quickly, with imaging techniques which make it possible to prove that endometriosis is indeed present in correlation with the clinical data.”
10 to 15% of women of childbearing age are affected by this disease. “This is more than the traditional 5 to 10%. There are even partial studies which make us think that we are closer to 20% than to 10%.”
“There are several mechanisms” that affect fertility
“As always in this disease, it is multifactorial, there are several mechanisms which can disrupt fertility”, notes the expert who still wishes to temper things: “It should nevertheless be remembered in the preamble that endometriosis does not make you sterile, except in very exceptional cases (subfertility or dysfertility).” The prevalence of these subfertilities is around 30 to 40% among patients. “So, this is not systematic, insists the doctor. Most women who have endometriosis can be pregnant naturally!”
Among the mechanisms that can lead to fertility disorders, we find the global pelvic inflammatory phenomenon.which creates adhesions, mechanical obstacles to the meeting between the oocyte and the sperm”. Inflammation, with emanating cytotoxicity, can also impair oocyte quality and ovarian follicular reserve.
This condition can also have a direct impact on the fallopian tubes which can become blocked, leading to fluid accumulation inside and dilation: “this is what we call hydrosalpinx, or even hematosalpinx when it bleeds inside”.
Ovarian endometriotic cysts can also strongly impact the chances of conceiving naturally,”especially when they are large and bilateral”.
Finally, when the adenomyosis is significant, it can disrupt implantation. “There are implantation disorders of implantation and this also promotes spontaneous miscarriages.”
The full interview with Dr Érick Petit in Question aux Experts can be found on our YouTube channel:
