What is endometriosis? Endometriosis is a chronic disease that affects 10% of women of childbearing age. It is characterized by the abnormal presence of tissue similar to the uterine lining (the endometrium) outside the uterus, for reasons still not well understood by science.
Physiologically, the endometrium develops inside the uterus each month in preparation for a potential pregnancy, and if fertilization does not occur, it is subsequently shed at the end of each cycle as menstruation. The development of this endometrium in the uterus may cause some pulling sensations, but not pain. However, in women with endometriosis, this tissue can grow very painfully in the endometrium, as well as elsewhere in the body, such as on the ovaries, fallopian tubes, bladder, around the rectum, on the peritoneum (the membrane covering the pelvic organs), and even on other distant organs like the lungs.
The symptoms of endometriosis vary greatly from one patient to another. Common symptoms include intense pelvic pain during menstruation, pain during sexual intercourse (dyspareunia), often the pain occurs during deep penetration preventing certain sexual positions, chronic abdominal or lower back pain, heavy or irregular menstrual bleeding, digestive disorders such as pain during defecation, and in some cases, fertility problems.
Diagnosing endometriosis can be difficult. In France, it takes an average of 7 years to obtain an informed diagnosis, as the symptoms can be similar to other medical conditions such as pelvic infections or gastrointestinal disorders. However, this delay is already decreasing, thanks to the awareness of patients and medical professionals. A comprehensive evaluation of the patient's medical history, a physical examination, and imaging tests such as ultrasound or MRI performed by specialists may be necessary to confirm the diagnosis. In some cases, a laparoscopy, a minimally invasive surgical procedure, may be recommended to directly visualize endometriosis lesions, confirm them, and even remove them.
Different forms of the disease There are several forms of the disease based on the appearance of the lesions and clinical impact. Here are the definitions from the recommendations of the French National Authority for Health (HAS), which classify endometriosis into three forms:
Superficial peritoneal endometriosis Superficial peritoneal endometriosis (or peritoneal) refers to the presence of endometrial tissues located on the surface of the peritoneum.
Ovarian endometrioma Ovarian endometrioma refers to the presence of endometrium at the level of the ovary, constituting an "endometriotic cyst," characterized by its chocolate-colored liquid content.
Deep pelvic endometriosis Deep pelvic endometriosis (or subperitoneal) corresponds to lesions that infiltrate deeply more than 5 mm under the surface of the peritoneum. By extension, this definition corresponds to the presence of lesions affecting organs in the abdomen and pelvis, the vagina, the bladder, the ureter, or the digestive tract.
Other forms There are also forms of extra-pelvic endometriosis (notably at the thoracic level).
Often, these different forms are connected to each other, and the classification is never directly related to the intensity of the clinical symptoms. Indeed, superficial endometriosis can be the most painful if it is located near important nerve endings.
A multidisciplinary approach involving gynecologists, pain specialists, and, in some cases, psychologists, may be necessary for a comprehensive management of the disease. If you suffer from endometriosis and are seeking the opinion of a healthcare professional, our general practitioners and gynecologists are available to listen from 6 am to midnight on Livi.