Endometriosis : clarification welcome treatment for one disease badly treated
Published the 17.01.2018 at 20: 01
Update the 19.01.2018 at 08h48
The High Authority of Health (HAS) and the national College of gynaecologists and obstetricians French (CNGOF) published new recommendations aimed at improving the diagnosis of endometriosis and clarify the treatment strategies for this disabling disease that affect more than one in ten women between 16 and 50 years and would result in 25 to 50% of cases of infertility.
Recommendations welcome for a common disease as badly cared for as evidenced there is little time Enora Malagré. The columnist of the Key not at my post office had given it, in an interview with the newspaper Paris Match, have decided to remove the uterus because of endometriosis which has caused much suffering and several miscarriages.
Better to treat the sick
These recommendation were very expected because the previous ones died only 12 years ago, however, many advances in medical and surgical have seen the light of day, progress may remain useless for a lot of women because the time diagnosis is still too long : on average, it now exceeds 7 years !
However, this long period of diagnosis, in addition to the suffering inflicted unnecessarily to the sick, is responsible for many complications, including pain during menstruation, pain during sex and fertility.
As well, 35% to 50% of women who have pain in the pelvis at the time of the rules and at least 50% of women are affected by infertility suffer from endometriosis.
Disease poorly known
Endometriosis is a gynecological disease causing pain in the abdomen and pelvis at the time of the rules which remains very poorly known. It is an abnormal migration of endometrial cells outside the uterus. The endometrium is the tissue that is the inner lining of the uterus. The endometrium is hypertrophied in the first part of the cycle to ensure the nesting of the embryo is possible, then it is eliminated at the time of the rules. Endometriosis is caused by the development and involution of the endometrial tissue that has developed elsewhere than in the uterus, and generally in the small pelvis and abdomen.
When thinking about endometriosis ?
Rather than setting painful menstruation to a “simple hormone imbalance that is going to happen,” severe pain at time of menstruation, especially if it is a social handicap or a professional, you must be a teenager or a woman to speak to the doctor.
Similarly, if pain arise at the time of sexual intercourse, and if they persist, it is important to consult with ? It is the same thing in case of a problem of sterility in a young woman.
Other pain or signs of more “regional” can alert : difficulties and pain in urinating, traces of blood in the urine or stool, pain in the pelvis during broadcasts of stool…
What is the diagnostic strategy recommended ?
The diagnosis is based first on the examination of the physician and the physician will be oriented according to the complaints. It will be supplemented by a thorough clinical examination and ultrasound of the small pelvis.
In case of discrepancy between the complaints and examinations, the other exams are more specialized, can be performed (transvaginal scanning or MRI), and it is only in the absence of a lesion feature of a laparoscope diagnostic, more invasive, should be considered.
In the case of diagnosis, and before any surgery, it is necessary to assess the extension of the disease with the exams, which will explore the bladder and the intestines.
An individualized treatment
The main objective should be to relieve pain and the treatment is therefore based first on a contraceptive drug or an iud releasing a progestin, levonorgestrel.
Drugs that block the hormonal cycles, such as the agonists of gnrh are indicated by 2nd intention and in combination with a progestin and an estrogen. An alternative is a contraception progestogen-according to different modalities.
New treatments of endometriosis such as anti-aromatases, are not recommended in the absence of robust evaluation.
Surgery is considered after failure of medical treatment, in function of the sufferings of the sick, and in case of desire of pregnancy. It is important to provide hormone treatment in continuous post-operatively to reduce the risk of recurrence and improve the quality of life. Agonists of gnrh are not recommended post-operatively.
The anti-inflammatory non-steroidal (ibuprofen, etc) are not recommended on the long-term, because of the complications they may pose.
Support centers, experts
The authors of the recommendations emphasize the difficulty of finding scientific studies of good quality to establish the recommendations. The support should therefore be carried out in centres combining several types of doctors (gynaecologists and radiologists) and of surgeons (gynaecologists, urologists, gastrointestinal) in order to achieve a real support ” multi-disciplinary “.
In order to improve the management of difficult cases, it should also be made for centres of expertise for early identification of endometriosis.
Very expected, these recommendations represent a sound basis for improving the support of the endometriosis, this ” metastasized cancer without cancer cells “.