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Endometriosis

There is the European week of prevention and information on endometriosis to inform and raise awareness among women about this disease.

My true story!

How many times have I heard: "your pains are due to stress" "do you eat a balanced diet? ...

My answer: "No, it's not "normal" to have so much pain during your period! "

And one day I met a gynecologist who began with : "Madam, a woman never says she is in pain. for no reason and stress is not a symptom! "And he explained to me what I had, he put words to my pain, my suffering...

Today I thank Dr Bouquet de Jolinière because I have two wonderful daughters ;-)

What is endometriosis?

Endometriosis is a fairly common gynecological disease since it affects one in ten women. It is related to the presence of tissue similar to the uterine lining outside the uterus. Different organs can be affected. The disease can be asymptomatic. But in some cases, it causes severe pain (especially during menstruation) and/or infertility. Researchers are trying to better understand the mechanisms of this disease and its links to infertility.

Symptoms:

  1. recurrent pelvic pain, sometimes very acute, especially during menstruation. This cyclic character is suggestive of the disease. The lesions are indeed sensitive to female hormones and behave like uterine tissue. The lesions will therefore proliferate, bleed and leave fibrous scars with each menstrual cycle. In some patients, significant innervation of the lesions could contribute to the extreme pain sometimes experienced.
  2. pain during sexual intercourse (dyspareunia) or still during defecation or urination.

The disease may also be asymptomatic completely. In this case, it is generally discovered fortuitously when the patient consults because of difficulty in conceiving a child. A significant proportion of endometriotic patients are indeed infertile. The scientific explanation for this link is not fully clear. The presence of tissue clusters, and in particular that of ovarian cysts, can create a mechanical barrier to fertilization in the case of severe lesions. Recent studies also show that the endometrium of endometriotic patients presents abnormal hormonal and gene expression profiles (see below). It could therefore be that the uterus of the patients has characteristics that are unfavorable to the implantation of an embryo.

Mechanisms to be clarified

The mechanisms that lead to endometriosis remain poorly understood.

However, the main hypothesis is that of the implantation of uterine material from retrograde menstruation.< /p>

During menstruation, blood can indeed pass through the fallopian tubes and reach the abdominal cavity, carrying with it fragments of endometrium, or even pluripotent cells capable of generating new endometrial foci.

Treatment only in case of symptoms

A clinical and ultrasound examination, or even an MRI, can detect endometriosis. But the definitive diagnosis is based on the analysis of the endometrial tissue taken during a laparoscopy (minimally invasive surgery).

Asymptomatic endometriosis, not painful and which does not pose fertility problems and is generally not detected and therefore not treated. When a patient discovers her endometriosis because of pain, she is most often offered first-line hormonal treatment intended to induce amenorrhea (continuous monophasic estrogen-progestogen contraceptives, progestogens, danazol or analogues of Gn-RH), thus reducing pain related to the hormonal response of endometriotic lesions. Nevertheless, if this treatment masks the pain, it does not prevent the progression of the lesions, however slow it may be.

Surgery is the gold standard treatment for endometriosis because it allows the lesions to be removed as completely as possible. Thus, the painful symptoms may disappear for many years, or even completely. The surgical difficulty is however amplified in the case of small disseminated lesions or when the intervention induces an unfavorable risk/benefit ratio, with for example a risk of incontinence.

Better understand the links between endometriosis and infertility

Researchers suspect that there are also biological and physiological differences between women with endometriosis and others, which may be the cause of the decline in fertility often associated with this disease</strong >.

Research conducted at Cochin Hospital, for example, recently showed that three out of four genes coding for prostaglandin receptors, chemical mediators of inflammation, are 10 to 20 times more expressed in the uterine endometrium of patients with endometriosis than in that of women without the disease. This rate is even multiplied by forty in the endometrial tissues extracted from lesions. At the same time, the expression of a key enzyme in prostaglandin synthesis, PTGS2, is increased nearly 10 times in the endometrium of endometriotic patients. Other biological avenues seem relevant to explore in order to understand the infertility of these patients, such as that of ovarian function and reserve in women with endometriosis.

Several studies also point the finger at the existence of environmental risk factors. Researchers are wondering, for example, about the possible role of endocrine disruptors or that of the influence of polyunsaturated fatty acids and other food components that can cause epigenetic abnormalities. A study carried out in mice, for example, shows that prenatal exposure of mice to Bisphenol A could promote a pathology resembling endometriosis in female mice.

A hope of treatment against endometriosis!

A team of Japanese researchers has found the presence of a bacterium in women who suffer from endometriosis and which they believe could be treated with an antibiotic >.

A tremendous hope in the fight against this disease which affects 1 in 10 women

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