In France, endometriosis affects one in seven women of childbearing age. Pelvic pain, heavy periods, extreme fatigue … The consequences of this gynecological disease on quality of life and fertility can be significant. How do you detect its symptoms? How do you treat it? We take stock of this chronic disease.
1. It is a common disease
It is estimated that about 15% of women, or one in seven women, is affected by endometriosis. In France, this represents around three million people. The prevalence is increasing steadily, in particular due to the gradual improvement in the time to diagnosis.
2. The causes of endometriosis are poorly identified
Several factors come into play. In more than 10% of cases, there is a genetic origin. But environmental factors are also important, especially chemicals. As for the phenomena that can explain the occurrence of this disease, let us quote in particular the theory of reflux (the blood of the rules which flows back towards the tubes), which is more and more criticized, that of an anomaly of the immune system (which does not fails to eliminate the lesions), or the embryonic origin (poor differentiation of cells or lesions inherited from the mother).
Endocrine disruptors singled out
Of endocrine disruptors, such as bisphenol A or dioxins which cause hyperestrogenia, are found in the food chain. This could explain, along with other factors, the increase in endometriosis cases.
Researchers confirm in the review Environmental Research published in early April 2021 that endocrine disruptors are present in several cosmetic products, and they claim that the use of these cosmetics (such as face masks, lipsticks, face creams, nail polish, hair dyes, etc.) could be linked to an increased likelihood of developing endometriosis because some of the their chemical ingredients mimic or block the action of hormones.
Researchers quantified the levels of two types of endocrine disruptors widely used in the beauty industry, parabens and benzophenones, in 124 women (with and without endometriosis), before gathering information on their use of several types. of cosmetics. The results showed a clear link between greater use of different types of cosmetics and higher internal levels of parabens and benzophenones. In addition, the researchers also claimed to have “observed that the internal levels of some of these endocrine disruptors were linked to the risk of endometriosis. ”
Read also : Are cosmetic products dangerous?
The influence of testosterone
In two separate scientific articles, published in 2021 in the journal Evolution, Medicine and Public Health, and Evolutionary Applications (1 and 2), a team of researchers puts forward another theory: endometriosis is due to too low exposure to testosteronein utero.
“A flow testosterone levels in early development is the strongest known correlation with endometriosis, and its effects may explain the majority of symptoms of endometriosis”, Affirmed Bernard Crespi, co-author of the two studies, in a communicated. “This work defines endometriosis as an endocrine disorder of development, with roots in early childhood”, he continued.
3. Endometriosis can affect multiple organs
The disease is mild, but it can cross certain boundaries of the body. Initially, cells in the lining of the uterus (the endometrium) start to proliferate. They are then diffused in the tubes and can penetrate the surrounding organs: the ovaries, the bladder, the rectum, the colon …
These endometrial cells start to bleed, which causes bruises. To defend itself, the body makes inflammatory tissue. This is what explains chronic inflammation and pain.
4. This gynecological disease impacts daily life
Two thirds of women with endometriosis complain of pain. But their intensity is very variable. These arise mainly during menstruation. They can also interfere with intercourse. These pains have a major impact on daily life and the couple. Work stoppages are frequent.
5. It should not be neglected in adolescents
Pain can occur from the first period. A young girl who can no longer attend college or high school because she is in too much pain around menstruation should see a doctor. These pains are too often overlooked and considered normal.
6. Endometriosis is responsible for infertility
Depending on their location, the lesions may interfere with the meeting of an egg and a sperm or prevent nesting. This is why endometriosis is responsible for infertility in 30 to 50% of cases.
But the disease is puzzling. Some women are greatly affected by this disease and will, however, have no difficulty in getting pregnant.
7. The diagnosis is often made late
We must listen to women who complain of having pain and think systematically about endometriosis. A endovaginal ultrasound, carried out by a specialized radiologist, allows the lesions to be accurately mapped. But few radiologists are sufficiently trained to detect this disease. At least, a MRI must be performed.
In terms of endometriosis, the delay in diagnosis is considerable: seven years on average. However, this delay can have very important consequences in terms of fertility.
Endometriosis: a national strategy launched in 2021
On March 12, 2021, the Minister of Health announced the launch of work on the national strategy against endometriosis. These will be carried out in partnership with patient associations, health professionals and researchers interested in this complex pathology.
Goal : respond to the five major challenges surrounding this disease, namely its detection, its course of care, its management, research and communication about it. The specific ministry that several lines of thought have been initiated. Let us mention in particular strengthening training and awareness of health professionals, from the general practitioner to the gynecologist via the school nurse, in order to reduce the time between the first symptoms and the diagnosis. Let us also quote the generalization of dedicated care channels, and support for research into endometriosis.
8. Surgery only concerns a minority of cases
The main treatment for endometriosis consistsat stop bleeding by suppressing periods. For this, a pill is prescribed and must be taken continuously.
As soon as a desire for pregnancy is expressed, this contraception is stopped. The menstrual cycle then resumes normally. If the pain returns, it is combated with analgesics.
Without pregnancy after one year, medically assisted procreation is considered. As a last resort, after the failure of all hormonal treatments or in the presence of large cysts on the ovaries, a surgical operation will remove the annoying lesions and, very often, lead to pregnancy. The operation only affects about 10% of cases and is usually performed by laparoscopy.
9. We can get by
Pain and / or fertility problems are solved in 70% of cases. It is also necessary to be diagnosed in time and correctly taken care of, which implies work in a multidisciplinary team (gynecologist, urologist, etc.).
In recent years, labeled centers specializing in endometriosis (Paris, Rouen, Bordeaux, etc.) are created.
10. Symptoms disappear with menopause
When your period stops, the symptoms go away, especially the pain. But the lessons remain. It is recommended to remove endometriotic cysts from the ovary because they increase the risk of cancer by 1.5 times.
The EndoFrance association organizes each year in March, on the occasion of the European endometriosis week, conferences open to all and free in various cities of France. Registration required. Information on the association’s website: www.endofrance.org.