Endometriosis: finally recognized, better managed

Endometrial tissue outside the uterus

Endometriosis is characterized by the presence of endometrium-like tissue outside the uterine cavity (ovaries, peritoneum, bladder, intestine). This tissue reacts to hormones and causes inflammation, adhesions, and pain.

Symptoms

Debilitating dysmenorrhea, chronic pelvic pain, deep dyspareunia, cyclic digestive or urinary disorders, infertility (30-40% of cases).

Diagnosis

Clinical examination, transvaginal pelvic ultrasound, pelvic MRI. Diagnostic laparoscopy reserved for complex cases. Diagnostic delay still too long (7 years on average).

Treatments

• Analgesics and anti-inflammatory drugs
• Continuous birth control pill, progestins (dienogest), levonorgestrel IUD
• GnRH analogues ± add-back therapy
• Conservative surgery by laparoscopy for severe lesions
• ART in case of infertility

Global approach

Pelvic-perineal physiotherapy, osteopathy, psychotherapy, anti-inflammatory diet: useful complementary approaches.