In the space of a few years, endometriosis, whose world day against this disease is being held this Thursday, March 28, 2024, has received more and more media attention. However, the French still have gaps in this pathology responsible for the infertility of many women.
In France, endometriosis affects 1 in 10 women, or between 1.5 to 2.5 million of childbearing age. Worldwide, 190 million people could be affected by this very debilitating condition and responsible for the infertility of many women. An update on this still little-known disease on the occasion of World Day Against This Pathology.
What is endometriosis?
Endometriosis is characterized by a migration of cells from the endometrium (the uterine lining) to other organs in the abdomen where they cause an inflammatory reaction and damage. These cells, “which have the same characteristics as those of the uterine mucosa (the endometrium) behave like them under the influence of ovarian hormones”, explains Inserm. Thus, with each cycle, the lesions proliferate, bleed and leave scars.
According to Inserm, fragments of the endometrium could be transported, during periods, to the abdominal cavity (retrograde bleeding). “Nevertheless, while clinicians estimate that 90% of women experience retrograde bleeding, only 10% develop endometriosis lesions.” Genetic and environmental factors could be involved. They are currently the subject of research.
Which organs are most frequently affected?
The organs can be affected in various ways, sometimes several are affected in the same woman. The most commonly affected organs are the uterus, ovaries, uterine tubes and ligaments, rectum and other digestive organs.
More rarely, they are found at the cervix, vagina, vulva, colon, small intestine, bladder, etc.
What is the first symptom of endometriosis?
Intense pain during periods is the first symptom of endometriosis. If the pain is cyclical and returns at the time of menstruation, if it does not go away with a simple analgesic such as paracetamol, if it prevents the woman from carrying out her usual activities, such as getting up, walking, then we must think about endometriosis.
Besides dysmenorrhea, heavy periods that last more than seven days and have blood clots are also a sign. As well as metrorrhagia and rectal bleeding during menstruation.
What are the other signs of endometriosis?
Chronic pelvic pain is common in a person who suffers from endometriosis. The pain is sometimes very acute at the time of menstruation, this cyclical nature is suggestive of the disease.
The pain, sometimes of extreme intensity, can also manifest itself in the abdomen, the lumbar region, during sexual intercourse (this is then called dyspareunia).
They may be due, according to Ameli.fr:
- to the endometriosis lesions themselves;
- to the invasion of nerves by these lesions;
- inflammatory reactions of the body;
- fibrous and scarring adhesions that sometimes develop between affected organs.
The intensity of pain is not correlated with the volume and quantity of lesions. A small lesion can be much more painful than several lesions.
Other symptoms include digestive problems, chronic fatigue and urinary problems.
Why are many patients infertile?
30 to 40% of patients are infertile, according to the Endofrance association, without the mechanism being precisely established at this stage. “The presence of clumps of tissue, and in particular that of ovarian cysts, can create a mechanical barrier to fertilization in the case of serious lesions,” says Inserm.
Sometimes asymptomatic, endometriosis is then revealed during an infertility assessment.
How is endometriosis diagnosed?
In the presence of intense pain during periods and chronic pelvic pain, imaging of the pelvis (ultrasound or even MRI) to look for endometriosis lesions is performed. When the lesions are superficial or minimal, the imaging is not necessarily conclusive.
The Endotest is now available to diagnose endometriosis. It is only recommended when MRI and ultrasound have yielded nothing and the pain persists despite treatment. This saliva test allows you to look for several markers of the disease.
What are the treatments for endometriosis?
There is no specific treatment for endometriosis. “The only principle of medical treatment today is to block periods, using medications that mimic either the state of pregnancy or that of menopause (the two physiological periods of absence of periods in the life of an adult woman )”, details the multidisciplinary Franco-European Institute of Endometriosis. However, this treatment is contraindicated or ineffective in some women. The treatment is of course stopped if the woman wants a child.
Surgical treatment aims at the resection or destruction of endometriosis lesions and the repair of the affected organs. In cases of deep endometriosis, surgery requires the expertise of a specialist endometriosis surgeon.
What are anti-inflammatory foods?
Many women report a reduction in symptoms, thanks to an anti-inflammatory diet. Dietician and nutritionist Cindy Louvet indicates which foods to favor, avoid, or even proscribe.
Foods to favor:
- Foods rich in omega 3 (oily fish, certain oils, etc.)
- Foods rich in anti-oxidants: fruits, vegetables, green tea, etc.
- Foods rich in micronutrients such as magnesium, vitamin D, zinc, iron
- Foods rich in fiber and prebiotics: legumes, whole starches, fruits, vegetables, etc.
- Foods and drinks rich in probiotics (present in fermented foods and drinks)
Among the products to limit, we find: alcohol, red meat, cold meats, certain oils, excess sugars and sweet products, meals rich in omega 6 (fried foods, burgers, etc.), processed products.
