What are the causes?
Endometriosis is a complex disease and the exact causes are not yet understood. It is thought to result from a combination of genetic, hormonal and environmental factors:
- mutations in the cells in the endometrium (the mucosa lining the uterus),
- retrograde menstruation – menstrual blood that flows back into the body, allowing uterine cells to migrate,
- the effect of hormones or endocrine disruptors,
- a poor immune response, etc.
What are the symptoms?
Endometriosis causes pain in the lower abdomen that varies in severity from one individual to another. The pain is sometimes worse during periods or sexual intercourse or when going to the toilet. The condition can also cause lower back pain, heavy periods, abdominal pain, nausea, diarrhea, fertility problems and even depression.
Endometriosis may change and develop over time, and symptoms may become worse and more frequent. In some cases it may lead to the formation of scar tissue or ovarian tumors. The symptoms may also spread to other pelvic regions such as the bladder and the rectum, and more rarely to areas outside the pelvis. The debilitating pain caused by the disease has a negative impact on quality of life.
Endometriosis may also be asymptomatic, and in these cases it is generally diagnosed during fertility testing. The biological phenomena that link endometriosis with infertility are still not fully understood.
How is endometriosis diagnosed?
Diagnosing endometriosis can be a long and difficult process. In France it takes seven years on average to be diagnosed with the condition, and 40% of women with chronic pelvic pain are believed to have endometriosis without being diagnosed.
The condition can be diagnosed via a pelvic or transvaginal ultrasound or an MRI scan. A saliva test (Endotest®) is currently under evaluation to improve diagnosis in cases where imaging is not conclusive. A surgical procedure known as a laparoscopy can also be used to examine the pelvic cavity of women experiencing symptoms but with normal findings in imaging tests.
What treatments are available?
There is currently no cure for endometriosis; the only approach is to reduce the symptoms. Anti-inflammatory and pain relief medications such as ibuprofen may be prescribed to reduce the pain. Hormonal contraceptives (the pill, implants, vaginal rings, etc.) may be used to limit the growth of abnormal endometrial tissue. In some cases, a surgical procedure may be performed to eliminate lesions and scar tissue. A multidisciplinary approach involving specialists such as gynecologists, gastroenterologists and urologists may be needed to manage the complex symptoms of the disease.
In cases where endometriosis causes infertility, alternatives such as in vitro fertilization (IVF) and ovarian stimulation with intrauterine insemination (OS-IUI) may be explored, with varying success rates.
How can endometriosis be prevented?
There is no effective preventive treatment for endometriosis. Raising awareness of the condition can facilitate diagnosis and avoid symptom normalization. Early diagnosis and regular monitoring can help reduce symptoms over the long term.
Who is affected?
Any girl or woman who has menstrual periods may be affected by the disease. It can occur at any time from the start of menstruation and may last until the menopause. 1 in 10 women are thought to have endometriosis worldwide.
November 2024