Endometriosis: symptoms, diagnosis and pain management

Endometriosis is a chronic gynecological disease affecting around 1 in 10 women of childbearing age. Yet it remains under-diagnosed and poorly understood. This condition, which causes disabling pain and menstrual cycle disorders, can have a major impact on women's quality of life. This article explores the symptoms, diagnostic methods and solutions available to help manage the pain associated with endometriosis.

What is endometriosis?

Endometriosis is characterized by the presence of endometrial tissue (which normally lines the inside of the uterus) outside the uterus. This tissue can attach to the ovaries, fallopian tubes, peritoneum and, in some cases, other organs such as the bladder or rectum.

With each menstrual cycle, these tissues behave like the endometrium: they thicken, decompose and bleed. However, unlike menstruation, this blood has no outlet for evacuation, resulting in inflammation, chronic pain and lesions.

Symptoms of endometriosis

The symptoms of endometriosis vary from one woman to another. Some may be asymptomatic, while others suffer severe pain. Main symptoms include:

1. Chronic pelvic pain

Pain is the most common symptom of endometriosis. It can occur :

• During menstruation (dysmenorrhea)
• During intercourse (dyspareunia)
• During micturition or defecation (if adjacent organs are affected)
• Outside menstrual periods, in the form of chronic pelvic pain

2. Heavy, irregular periods

Women with endometriosis may experience heavy menstrual bleeding (menorrhagia) or bleeding between periods (metrorrhagia).

3. Infertility

Endometriosis is one of the main causes of female infertility. It can cause adhesions, ovarian cysts, or obstructions of the fallopian tubes, making conception more difficult.

4. Digestive and urinary disorders

Endometriosis can also cause digestive disorders, such as :

• Bloating
• Constipation
• Diarrhea
• Pain on urination

These symptoms may worsen during menstruation.

Causes of endometriosis

The exact causes of endometriosis are not yet fully understood, but several theories exist:

• Menstrual reflux: endometrial tissue ascends through the fallopian tubes and implants in the pelvic cavity.
• Genetic predisposition: endometriosis can be hereditary.
• Immune dysfunction: the immune system is unable to eliminate endometrial tissue growing outside the uterus.
• Environmental factors: certain endocrine disruptors may contribute to the onset of the disease.

How is endometriosis diagnosed?

Diagnosis of endometriosis can be long and complex. It takes an average of 7 years for a woman to be diagnosed after the first symptoms.

1. Clinical examination

The doctor begins with an interview and a gynecological examination to identify the physical signs of endometriosis, such as lumps or pain.

2. Medical imaging

• Pelvic and endovaginal ultrasound: useful for detecting ovarian cysts (endometriotic cysts).
• Pelvic MRI: the gold standard for detecting deep endometriosis lesions.

3. Laparoscopy

Laparoscopy is a surgical procedure enabling direct observation of the pelvic cavity. It remains the most reliable method for confirming the diagnosis of endometriosis and assessing the extent of lesions.

How to manage endometriosis-related pain?

Endometriosis pain management is based on medical treatments, surgical interventions and natural solutions.

1. Medical treatments

• Non-steroidal anti-inflammatory drugs (NSAIDs): to relieve pain.
• Hormonal contraceptives: to block menstruation and limit disease progression.
• GnRH agonists: to put the ovaries to rest and stop estrogen production.

2. Surgery

In cases of severe pain or infertility, surgery may be proposed to remove the endometriosis lesions.

3. Natural solutions

• CBD: recognized for its anti-inflammatory and analgesic properties.
• Anti-inflammatory diet: reduce pro-inflammatory foods such as sugar, gluten and dairy products.
• Gentle physical activity: yoga or walking can help reduce pain.

When should you consult a professional?

It is important to consult a gynecologist if menstrual pain becomes incapacitating, or if digestive, urinary or infertility symptoms appear. Endometriosis is a chronic disease that requires regular medical follow-up.

Summary

Endometriosis is a complex and often misunderstood disease. Yet it affects millions of women worldwide. A better understanding of the symptoms, causes and treatments can help improve the management of this pathology. It is essential to break the taboo surrounding this disease, and to promote faster diagnosis.

References

1. Giudice, L. C. (2010). Clinical practice: Endometriosis. New England Journal of Medicine. Available here
2. Kennedy, S., et al. (2005). Epidemiology of endometriosis: aetiological factors, diagnostic methods and risk factors. Best Practice & Research Clinical Obstetrics & Gynaecology. Available here
3. Zondervan, K. T., Becker, C. M., & Missmer, S. A. (2020). Endometriosis. Nature Reviews Disease Primers. Available here
4. Parasar, P., et al. (2017). Endometriosis: Epidemiology, diagnosis and clinical management. Current Obstetrics and Gynecology Reports. Available here