In a healthy woman, the endometrium thickens during each menstrual cycle, then detaches and is shed in the form of periods (menstruation) if fertilization does not take place. Endometriosis develops when some of the cells of this mucous membrane go up into the fallopian tubes*The fallopian tubes are part of the female reproductive system. These two symmetrical tubes link each ovary to the uterus. and become lodged in the reproductive organs, the stomach, the urinary system, and the cellular membrane that covers the abdomen (peritoneum). This means there are several possible locations for endometriosis.
These endometrial cells can cause inflammation, adhesions, and ovarian growths (cysts*A growth that forms on the surface of an organ or a tissue and is filled with a liquid or semisolid substance. Generally noncancerous, a cyst can nevertheless disrupt the functioning of an organ and cause pain.) or other lesions. In the tissues where they become established, they form what are called endometriosis foci, which behave like the normal uterine lining, in other words, they bleed in a cyclical manner.
Symptoms of Endometriosis
The disease essentially results in widespread pain and/or cramps in the lower stomach similar to period pain, sometimes accompanied by a heavy feeling. At the beginning, the symptoms of endometriosis mainly appear during the menstrual period, when ovulation happens, during sexual intercourse (dyspareunia*A condition characterized by pain during sexual intercourse. These pains can occur before, during, or after intercourse.), when urinating, during a bowel movement, or when inserting a tampon.
Later on, when the disease has caused lesions, symptoms may occur at any time in the menstrual cycle. People may also experience low energy, low mood, fatigue, and mood swings.
The intensity of the pain generally increases as the condition progresses. 50–91% of women affected experience pain, which means that a significant number of people have almost no symptoms. This is why it often takes several years to receive an endometriosis diagnosis. What is more, the degree of disease progression does not necessarily correlate to the severity of symptoms. Some women feel severe pain despite being in the early stages of the condition, while others feel no pain despite endometriosis affecting several areas of their body.
Causes of Endometriosis
In simple terms, endometriosis occurs when endometrium, the uterine mucous, grows outside the uterus. Instead of flowing out of the body as happens in a normal menstrual period, part of this mucous migrates into the abdominal cavity via the fallopian tubes. We do not fully understand why this occurs, and endometriosis seems to be caused by a number of factors.
Endometriosis can occur in any woman who menstruates. Women with the condition often report experiencing painful periods in puberty. It is possible that women who have undergone surgery such as a caesarian section have a higher risk of developing it. Genetics, epigenetics, and hormonal and immune-system factors can also play a role.
The main approach is to address the painful symptoms of endometriosis. Non-steroidal anti-inflammatories (NSAIDs) are normally prescribed to be taken during periods. Drugs to regulate hormone levels (progestogen, the contraceptive pill, or intrauterine systems (IUS)) are also used to slow the growth of the endometrial tissue.
Surgery is often also performed, with the treatment strategy depending on the severity and location of the pain, the patient’s age, and whether they want to have children, among other factors.
Surgery for endometriosis takes the form of a laparoscopy*An operation to examine the inside of the abdominal cavity, in particular the ovaries, fallopian tubes, and the uterus. Several small incisions are made in the abdomen so that a camera and surgical instruments (scissors, pliers, etc.) can be inserted. which is a minimally invasive type of surgery. When accompanied by long-term medication to prevent relapses, this surgery has good results.
The symptoms of endometriosis can be mitigated by living a healthy lifestyle, which means:
- exercising regularly,
- eating a healthy diet,
- limiting the amount of alcohol consumed,
- not taking up smoking, or stopping if you already smoke.
Warm baths and hot water bottles may help relieve pain quickly. Used alongside other treatment, relaxation techniques, hypnosis, pelvic floor physiotherapy, homeopathy, and traditional Chinese medicine, in particular acupuncture, can sometimes help.
Several studies have demonstrated a link between diet and the severity of endometriosis symptoms. A healthy diet should include lots of fresh fruit and vegetables, white meats, and wholegrains, while intake of red meat and dairy products should be limited.
Progression and Possible Complications
Endometriosis is often discovered by chance after a women has had the condition for several years. There is therefore a risk that lesions will have already formed on organs when the diagnosis is received. The formation of ovarian cysts (endometriomas) in particular can affect fertility, which explains why 50% of women who seek medical help for infertility issues are found to have endometriosis. It is the leading cause of female infertility.
Due to the risk of relapse, even after effective treatment, long-term medical monitoring is needed. Moreover, the impact that endometriosis can have on mental health and relationships means that sometimes psychotherapeutic support is needed. Many women report that the disease has a negative impact on how they communicate with their partner.
It is worth noting that after medication and surgery, 80% of women who were unable to conceive due to endometriosis go on to have a healthy pregnancy the following year.
Care at Hôpital de La Tour
An analysis of the patient’s description of their symptoms (medical history) and a gynecological examination may point to endometriosis, but this alone is not enough for a diagnosis. An MRI scan (magnetic resonance imaging) can be used to detect cysts or other lesions.
The most reliable method for establishing a definitive diagnosis is to perform a laparoscopy, which involves making three small incisions in the navel and lower stomach to insert a tube equipped with a camera (endoscope) and surgical instruments into the abdominal cavity to take samples biopsy*Part of a tissue or organ is removed so that a number of tests can be performed on it..
Laparoscopy is performed under general anesthetic, so that surgical treatment can be performed at the same time. The surgeon can therefore remove the growths of endometrial tissue.
Treatment for endometriosis depends on the severity of the disease and the needs and expectations of each patient. Hôpital de La Tour offers multidisciplinary care specialized in this disease thanks to our comprehensive, state-of-the-art facilities and on-site specialists with the necessary expertise.
Our specialized gynecology-obstetrics doctors are all able to support you in finding a diagnosis and, if necessary, prescribe you the medication you need.
Surgery for endometriosis is complex and therefore must be performed by a surgeon specialized in the disease for the best chances of success.
Doctor specialized in endometriosis surgery at Hôpital de La Tour: PD Dr. med. Jean-Marie Wenger.
When Should You Contact a Doctor?
Talk to your doctor if you experience the following symptoms:
- particularly painful periods
- abdominal pain when you are not menstruating
- pain during sexual intercourse, while urinating, or during bowel movements