Endometriosis: symptoms and treatments

What are the symptoms of endometriosis?

The most common symptom of endometriosis is “dysmenorrhea”. It’s about a pain during menstruation which is accompanied by cramps sometimes very intense in the lower abdomen. Sometimes this dysmenorrhea is sometimes accompanied by nausea and vomiting, and often causes women to lie down for several days. Dysmenorrhea is present in eight out of ten women with endometriosis.

Over time, the frequency of pain will intensify. These start for example before menstruation and they continue after, for several days and then several weeks, until they become chronic.

Often, if we interview young girls or women with endometriosis, we see truancy and repeated time off work because of the pain.

Other symptoms of endometriosis

The pain during sex (dyspareunia), although less common, are a classic sign of the disease. Especially pain in some positions, which makes intercourse impossible.

Symptoms that can also suggest endometriosis include dyschezia (painful bowel movements) during menstruation, pain during ovulation, pain in the ovaries and chronic fatigue.

The symptoms of endometriosis are different for each woman, because they depend in particular on the location of the lesions. Often, endometriosis is difficult to diagnose, because many of its symptoms are similar to those of a disease that is not gynecological, such as certain pathologies of the gastrointestinal system.

Endometriosis: when do the first symptoms appear?

In some women, symptoms may begin from the first period and progress for several years before endometriosis is diagnosed, as the pain during menstruation are classically regarded as something normal or psychological. Often from the age of 15-20 years, young girls suffer from pain during menstruation and sexual intercourse. Endometriosis can develop over several years before being diagnosed by additional examinations, such as a endovaginal ultrasound or MRI. For this reason, a young girl who complains of pain during her teenage years should be watched. She should consult a gynecologist at least once a year.

There are also women who start to suffer later, often when stopping the pill and / or a desire for pregnancy. Difficulty conceiving and / or pain during menstruation necessitates a visit to a gynecologist. 

This chronic disease is responsible for 30% to 50% of infertility cases.

Treatments for endometriosis

It is a fact, there is a relationship between endometriosis and female infertility. Often times, doctors diagnose this disease during a infertility assessment. In women with endometriosis, there is a subfertility, that is, lower than average fertility. However, the link between disease and infertility is not easy to understand for health professionals. Adhesions present in the uterine cavity, as well as inflammation of the peritoneum can be the cause of this infertility. One thing is certain, when the disease is treated, fertility returns to “normal” ! It is for this reason that an operation is sometimes considered in order to put all the chances in his side.

Not treating endometriosis can be problematic: disease progresses and your chance of conception decreases. In addition, pain can sometimes prevent you from having good sex with your partner. It is not easy in these conditions to start a baby.

Doctors can offer you a medical and surgical strategy (if necessary). This strategy is decided case by case, and above all, it is important that your companion is present. The final decision must indeed be taken jointly between the couple and the specialists.   

• Surgical treatment

The surgical operation is performed by laparoscopy. Il n’y a (a priori) no ablation organs. On the other hand, the surgery must be complete in order to avoid any risk of recurrence. This involves removing all the cysts, adhesions and other nodules that have formed outside the uterine cavity. This support allows couples to increase their chances of conceiving naturally a child after the operation.

• Medical treatment

If surgery is not possible, or the patient does not wish to be operated, medical treatment may be offered. This allows you to rest the ovaries. Sometimes it also helps shrink lesions. The doctor prescribes continuous progestins, continuous estrogen-progestogen pills, or even injections of Gn-RH analog (artificial menopause), for about 3 to 4 months. This support can be followed by in vitro fertilization (IVF). Sometimes ovarian function is impaired, and IVF is unsuccessful. In this case, the doctors will direct you to egg donation.

How to relieve the symptoms of endometriosis?

Getting pregnant with endometriosis is (often) possible

Good news, most women with endometriosis get pregnant, because pregnancy and endometriosis are not incompatible! The success rate is high if you decide on the right treatment strategies! Pregnancy, sometimes so hard achieved, is experienced as a miracle for women with endometriosis.

Note: postnatal follow-up is often necessary in order to take stock of contraception and to check that there is no recurrence.

For more information:

•  The Endofrance, one of the French associations for the fight against endometriosis.
•  The site of National College of French Gynecologists and Obstetricians (CNGOF) => recommendations on endometriosis dated 2006.