Endometriosis: welcome clarification of treatment for under-diagnosed disease

New recommendations on endometriosis have just been published, a common disease in teenagers and young women. They aim to improve the early diagnosis and optimized treatment of this disease that can turn the lives of young women into a plight. Reference centers regrouping several specialists will be created.

The Haute Autorité de Santé (HAS) and the French National College of Gynecologists and Obstetricians (CNGOF) have published new recommendations aimed at improving the diagnosis of endometriosis and clarifying treatment strategies for this debilitating disease that affects more than one woman in ten between 16 and 50 years and would cause in 25 to 50% of cases infertility.
Welcome recommendations for a common illness as poorly treated as was recently reported by Enora Malagré. The columnist Touche not at my post had told in an interview with the newspaper Paris Match, have decided to be removed the uterus because of an endometriosis that caused him many sufferings and miscarriages.

Better treat the sick

These recommendations were eagerly awaited, as the previous ones were 12 years ago, but many medical and surgical advances have been made, which may be unnecessary for many women because the diagnostic delay remains too long. now exceeds 7 years!
However, this long diagnostic delay, in addition to the suffering it inflicts unnecessarily on patients, is responsible for many complications, including pain during menstruation, pain during intercourse and fertility disorders.
Thus, 35% to 50% of women who have pelvic pain at the time of menstruation and at least 50% of women who are affected by infertility suffer from endometriosis.

A poorly known disease

Endometriosis is a gynecological disease that causes abdominal and pelvic pain during menstruation, which remains poorly understood. This is an abnormal migration of endometrial cells outside the uterus. The endometrium is the tissue that covers the inner lining of the uterus. The endometrium is hypertrophied in the first part of the cycle to ensure the nesting of the eventual embryo, then it is eliminated at the time of menses. Endometriosis is caused by the development and involution of this endometrial tissue that has developed elsewhere than in the uterus, and usually in the small pelvis and belly.

When to think of endometriosis?

Rather than assign painful rules to a "simple hormonal imbalance that will pass", significant pain at the time of menstruation, especially if it is a social or professional disability, must lead a teenager or a woman to talk to her doctor .
Similarly, if pain occurs at the time of intercourse and if it persists, it is important to consult? It is the same thing in case of infertility problem in a young woman.
Other "regional" pains or signs can alert you to: difficulties and pains to urinate, blood in urine or stools, pains in the pelvis during stool emissions ...

Which diagnostic strategy is recommended?

The diagnosis is based first on the questioning of the doctor and it will be oriented according to complaints. It will be completed by a complete clinical examination and an ultrasound of the small pelvis.
In case of discordance between complaints and examinations, other more specialized examinations may be performed (endovaginal ultrasound or MRI), and it is only in the absence of a characteristic lesion that a diagnostic, more invasive, laparoscopy should be performed. considered.
In case of diagnosis, and before any surgery, it is necessary to evaluate the extension of the disease with examinations that will explore the bladder and the intestines.

Individualized treatment

The main objective must be to relieve pain and the treatment is therefore based primarily on estrogen / progestin contraception or a progestin-releasing device, levonorgestrel.
Hormone blocking drugs, such as GnRH agonists, are indicated as 2nd-line and in combination with progestin and estrogen. An alternative is progestin-only contraception in different ways.
New treatments for endometriosis such as anti-aromatases are not recommended in the absence of a solid evaluation.
The surgery is considered after failure of the medical treatments, according to the sufferings of the patient and in case of desire of pregnancy. It is important to provide continuous hormonal treatment postoperatively to reduce the risk of recurrence and improve quality of life. GnRH agonists are not recommended post-operatively.
Non-steroidal anti-inflammatory drugs (ibuprofen, etc.) are also not recommended in the long term because of the complications they can cause.

Support in expert centers

The authors of the recommendations stress the difficulty of finding good quality scientific studies for making recommendations. Management should therefore be carried out in centers associating several types of physicians (gynecologists and radiologists) and surgeons (gynecologists, urologists, digestive patients) in order to carry out real "multidisciplinary" care.
In order to improve the management of difficult cases, expert centers for the early detection of endometriosis should also be provided.

These long-awaited recommendations represent a solid foundation for improving the management of endometriosis, this "metastatic cancer without cancer cells".

Video: SECOND OPINION. Endometriosis. BCBS. Full Episode (April 2020).