Pelvic endometriosis
Disease of concern to young women
Press release of the French National Academy of Medicine1[1]
May 19, 2021
Endometriosis is an increasingly common disease among young women (prevalence estimated at 15%) and is worrying in this respect. It goes indeed beyond the field of gynecology alone with a real impact on public health
Its symptoms and consequences are well known to gynecologists, but many unknown pathophysiological or evolutionary factors and diagnosis delays make it a disease that is both disabling, singular and of an uncertain prognosis.
Characterized by the presence and diffusion of endometrial cells outside their natural site (uterine cavity), it is called
– adenomyosis, when it involves the myometrium;
– deep pelvic endometriosis, if it involves the sub-peritoneal or pelvic organs;
– superficial pelvic endometriosis, for peritoneal involvement;
– endometrioma for ovarian involvement;
– extra-pelvic endometriosis, when it affects, for example, the abdominal wall (often on old scars), the diaphragm or pleura. …
Without these extensions having a malignant character, the evolutionary process of the disease, characterized by the appearance of “benign metastases”, sometimes evokes the spread of cancers.
Endometriosis is manifested by a very suggestive set of symptoms:
– pain:
during menstruation (algomenorrhea);
during sexual intercourse (dyspareunia);
– progressing to chronicity;
– urinary or digestive symptoms occurring during menstruation;
– infertility, whose cause is multi-factorial.
These symptoms have a progressive and serious impact on the general state of health, psychological equilibrium, and then on the ability to work, with repetitive sick leaves, but also on sexual, marital or family life.
Management must be multidisciplinary, covering all the areas that may be affected. Treatments are primarily hormonal, to induce amenorrhea (absence of periods). Depending on the context, analgesic, psychological or medical care may be considered. If indicated, surgery must be performed by an experienced team in order to obtain a complete removal of the lesions. Despite a well-conducted treatment, a painful symptomatology may persist and a recurrence of the disease may occur.
The National Academy of Medicine is paying a particular attention to endometriosis,
– It is already mobilizing recognized specialists particularly involved in this singular and worrying condition, which is subject to many misconceptions and uncertainties.
– It has decided to produce a documented report, intended to enlighten the health authorities, health professionals and the public, and to provide answers to the pending questions, concerning in particular
– the epidemiological data;
– the mechanisms of onset and extension of this hormone-dependent pathology;
– the place of endometriosis among the causes of infertility;
– the development of targeted therapies using new molecules;
– the social and/or financial impact of endometriosis;
– the definition of care pathways and reference centers.
-It also more specifically calls for:
-the creation or involvement of national or regional organizations dedicated to endometriosis, involving the mobilization of health professionals and patients, the development of research, the specialization in the management and care pathways of endometriosis, the creation of databases, and the development of information and awareness on this disease
-training of students and validation of practitioner competence.
[1] Communication from the Academy’s Rapid Communication Platform approved by the members of the Board of Governors on May 19, 2021
