This gynecological disease concerns more than one in almost ten females but is rarely diagnosed.
What is it?
Endometriosis is the migration of pieces of endometrium (superficial layer of uterus) towards places where it should not be: ovaries, myometrium, bowel, bladder, etc. These ectopic implants are subject to be influenced by the sex hormonal cycle and behave like the normal endometrium. Therefore, it grows and bleeds every month.
Why, How does it appear?
It could be a flow back of menstrual blood through the tubal towards the pelvic cavity rather than through the cervix towards the vagina, as usually. Endometrial cells settle on peritoneum and pelvic organs. Nevertheless, not everybody is affected by this pathology and it seems that an immunity deficiency would be involved but it remains mysterious and uncertain.
How can it be diagnosed?
The main symptom is pelvic pain, in particular during periods, but also, during sexual intercourse.
Sometimes, it is revealed bowel or bladder disorders, but the constant sign of this disease is the relapse of pain and disorders every month when the periods occur. Intolerable periodic pain must make you think about this diagnosis. The MRI is the best way to confirm endometriosis. It could appear very early in age, as soon as a teenager. In the end, it may be unappearant and diagnosed by a check-up for infertility.
Mainly, it is infertility Dr. Endometriosis is involved in half the cases of infertility and a lot of women affected by endometriosis have to move to IVF, especially after 35 years old.
What treatments exist and how efficient are they?
The treatment depends on what you want to treat first:
If the main complaint is the pain, it is possible to take contraceptive or hormonal treatments which stop the natural influence of sex hormones and stop the painful menstrual bleeding. Sometimes, it is inefficient and, in case of infertility, the treatment is surgical.
Thus, when the pain becomes intolerable or the infertility may not be resolved by IVF, surgery is essential and is the only tool to be efficient. However, sometimes, the procedures are heavy and risky, for instance, when the depth of implants is significant. Relapse occurs in 30% to 50% of these cases.
This is why it seems essential to diagnose this disease as early as possible to enable doctors to deliver the most efficient treatment to eradicate this benign disease.
Dr Christine FRAYRET
Gynecologist and surgeon
The Harley street Clinic
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