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Diagnosis

The diagnosis of endometriosis still faces certain limitations in France. According to the French association for the fight against endometriosis (EndoFrance), the diagnosis is generally made 7 years after the first signs of the disease.

If you are unable to get pregnant, or if you have severe pain during and/or between periods, your doctor will ask you to have a gynaecological examination.

He will prescribe an ultrasound scan of the pelvis to identify any lesions of endometriosis. This may be a tansrectal or transvaginal ultrasound, or even an MRI if the first ultrasound is insufficient.

General information on the
treatment of endometriosis

Medically, the treatment of endometriosis is mainly through medication prescribed by the doctor or through surgery. While the aim of medication is to calm the pain by blocking the production of female hormones, the aim of surgery is to remove the lesions that are the direct cause of the pain.

The treatment adopted, however, differs according to the organs affected by the fragments of endometrial tissue (endometrium) present outside the uterine cavity. It is adapted to meet the needs of each case effectively and varies from patient to patient.

The management of this disease must be done by a multidisciplinary team. It must also be personalised to adapt to the symptoms and expectations of the patient. In order to optimise this care and shorten the time to diagnosis, France has set up multidisciplinary health centres for early detection of endometriosis.

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Various treatments

There is no definitive treatment for endometriosis. However, there are some medicines and natural tips that can help relieve the pain associated with this disease. These solutions can also help prevent the onset of symptoms in some cases.

Here are the different treatments that can help ease the pain:

Pain Relief With Hormone Treatments

Hormonal treatments reduce the pain of endometriosis. However, they have no influence on fertility and do not solve the problem permanently. However,
they do block the secretion of ovarian hormones, which reduces bleeding.
The most common hormone treatments include

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Mirena® IUD

This intrauterine device is completely covered by a progestin and is inserted directly into the uterus. The Mirena® IUD significantly reduces menstrual periods and endometriosis pain. It is replaced every 5 years.
The use of this IUD can lead to undesirable effects: uninterrupted periods, particularly during the first few months after its insertion.

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The contraceptive pill

The contraceptive pill is taken every day, continuously and without interruption. It is used to relieve pain in some patients, prevent oestrogen deficiency, reduce menstrual cycles and provide a contraceptive solution.
It releases hormones which then inhibit ovulation and prevent the release of hormones from the pituitary gland which stimulate the ovaries.

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Danazol (Cyclomen®)

This hormonal treatment blocks the production of oestrogen by the ovaries, thus causing an artificial menopause. It abolishes menstruation in most cases, thus relieving the pain associated with endometriosis.
Treatment with danazol may last 6-9 months and there may be side effects, but these will disappear when the treatment is stopped:
- Hot flashes
- Acne and facial hair outbreaks
- Weight gain
- Vaginal dryness

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Medroxyprogesterone acetate (Depo-Provera®)

This is a progestogen that your doctor injects into your buttocks every 3 months. It contains a hormone that blocks ovulation and abolishes or reduces the periods and pain caused by endometriosis.

Possible side effects of Medroxyprogesterone Acetate Injectable Suspension (MPS) include weight gain (in some women) and the appearance of small spots during the cycle. In addition, its use can cause mood changes. Finally, in some patients ovulation does not always return immediately after stopping the treatment.

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GnRH analogues (Lupron®,
Zoladex®, Synarel®)

These treatments prevent the activation of the pituitary gland by Gn-RH (hormones from the hypothalamus), which causes a menopause. The treatment is taken by injection, every month and the treatment should not last longer than 6 months.
Possible side effects:
- Vaginal dryness
- Headaches
- Mood swings
- Hot flashes

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Analgesic drugs

Anti-inflammatory drugs (ibuprofen (Advil®, Motrin®) or aspirin, etc.) or acetaminophen (Tylenol®) can help to relieve pelvic pain caused by endometriosis. If necessary, the doctor can directly prescribe certain anti-inflammatory drugs such as Naprosyn®.
The use of a heating pad is sometimes sufficient to reduce the pain.

Use of surgery

In the following cases, the doctor may decide to use surgery to remove cysts and lesions caused by fragments of endometrial tissue in the abdomen:

  • Severe endometriosis
  • Insufficient drug treatment
  • Lesions causing infertility and/or other serious consequences : This surgery can be conservative or radical. Conservative surgery is limited to the removal of the lesions only, while preserving the uterus and ovaries. Radical or total surgery, on the other hand, involves the removal of the uterus and ovaries, which leads to menopause and renders the patient permanently infertile. Radical surgery is the only option that can cure endometriosis permanently. In fact, it is possible to observe recurrences a few months or years after conservative surgery, right up to the menopause. The surgical techniques have evolved considerably in recent years and can vary from one case to another.

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Natural alternatives

At present, there are no comprehensive studies on the various natural health products that can be used to treat endometriosis. To relieve the symptoms, some professionals sometimes recommend that their patients use ash or viburnum bark, dandelion root and chasteberry. It is best to consult a recognised naturopath or herbalist for more information. Here are the most common natural solutions:

  • The practice of yoga and tai chi, which can help women cope better with everyday pain.
  • The use of traditional Chinese medicine, whose virtues are no longer in evidence. This combines natural plants and acupuncture to tone up the Qi (your vital energy) and the kidneys, and thus promote better blood circulation in the body.
  • The use of castor oil (Ricinus communis). Applied to the lower abdomen, it helps to relieve pelvic pain.
  • Adjusting the diet. The American doctor Andrew Weil particularly recommends adopting a diet with anti-inflammatory properties that includes more fruit, vegetables and a variety of fresh foods, and a little less refined food. Finally, he advises giving preference to dairy products and meat from organic farms.

Living with endometriosis

More or less intense pain, constant fatigue... endometriosis leads to a number of factors that make life difficult for patients, both in terms of intimacy and socially and professionally. However, it is possible to live with this disease.

For example, instead of concentrating your household chores on one day, you can spread them out over the week. Also, don't hesitate to rest whenever you feel the need.

There are many symptoms to identify the endometriosis. To know more, you can find a list at endometriosis-symptoms.com

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Frequently asked questions

The causes of endometriosis remain poorly identified to date. However, 3 hypotheses seem to emerge to try to explain the presence of endometrial fragments outside the abdominal cavity: - During menstruation, the cells of the uterine mucosa (endometrium) would pass through the lymph or bloodstream to move elsewhere, like cancer cells forming metastases.
- The so-called "metaplastic" hypothesis, which is based on a possible transformation of peritoneal cells into endometrial tissue cells, without however explaining the cause.
- Endometrial fragments and blood leaking from the fallopian tubes during menstruation: this is called "retrograde menstruation".

Although the use of the contraceptive pill significantly reduces the occurrence of endometriosis, the general trend is that the disease cannot be prevented. Some women are even more likely to develop endometriosis if :
- They come from a family with a history of endometriosis
- They have a malformation of the cervix
- They have shorter than average periods, etc.

Unless you have radical surgery that causes infertility, there is no cure for endometriosis today.

Women with endometriosis can have children, although it is not always easy for them to get pregnant. In general, it just takes more time and patience to get pregnant. Although the success rate is lower in this case, in vitro fertilisation (IVF) is also an alternative to consider.