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Dr Odile Bagot (Gynecologist-obstetrician)
Medical validation:
March 07, 2023
Although many efforts have been made in recent years to improve the management of the disease, endometriosis is still poorly diagnosed. How can this medical wandering be explained? What tools can better detect the disease? On this Women’s Day, Dr. Odile Bagot, gynecologist, sheds light on the subject.
According to the Ministry of Solidarity and Health, endometriosis affects approximately 10% of women worldwide, or 1.5 million people in France. However, today still, the ignorance of the symptoms and many stereotypes generate a delay of diagnosis of 7 years on average. Another startling finding: 40% of women with chronic pelvic pain are actually suffering from endometriosis.
Endometriosis: a disease that affects 1 in 10 women
Endometriosis is a complex inflammatory disease characterized by the growth of tissue similar to the uterine lining (endometrium) outside the uterus, resulting in the appearance of small nodules.
Over time, these nodules grow and lead to inflammation, responsible for chronic and debilitating pain, especially during menstruation.
According to the High Authority for Health and the National College of Gynecologists and Obstetricians of France (CNGOF), three forms of endometriosis are to be differentiated:
- superficial (or peritoneal) endometriosis: this refers to the presence of ectopic endometrial implants located on the surface of the peritoneum (membrane that lines the inner walls of the abdomen);
- ovarian endometriosis: it is manifested by the presence of an ovarian cyst, with chocolate-colored content;
- deep pelvic endometriosis: this corresponds to lesions that infiltrate deeply more than 5 mm below the surface of the peritoneum. Deep endometriosis can affect the uterosacral ligaments (50% of cases), the posterior vaginal cul-de-sac (15%), the intestine (20-25%), the bladder (10%)…
There are also forms of extra pelvic endometriosis (diaphragmatic and thoracic endometriosis in particular).
The problem ? Whatever form it takes,It takes an average of 7 years to diagnose the disease“, confirms the EndoFrance association.
A delay in diagnosis linked to the many stereotypes that still weigh on women.
“Under the influence of many taboos related to menstruation and female pain, women often delay consulting. At the same time, doctors, who are generally poorly trained in this pathology, tend to underestimate the pain of patients and prescribe pills that can mask the symptoms of the disease.“, specifies the association ENDOmind France.
Diagnosis of endometriosis: clear improvements
Despite the facts cited, the picture is not all black.
“The delay in the management of the disease is being filled today“says Dr. Bagot.”MRI scans continue to be performed on young women with painful periods to detect disease.”
The expert therefore wants to be rather positive. “Yes, all female pain should be taken seriously, but these are not inevitable.”
On the treatment side, the management of the symptoms is rather simple.
“The first treatment is the pill. It should indeed be remembered that endometriosis is a pathology of the cycle. Without the pill, women with natural cycles therefore run the risk of seeing their endometriosis worsen.warns Dr. Bagot.
Sometimes endometriosis is silent and therefore more difficult to diagnose. It can also be painful but invisible during an MRI.
“There is not always a correlation between pain and lesions“, says Dr. Bagot.
If endometriosis ultrasound is therefore not “always easy“, new high-performance tools, soon to be available on the market, should make it possible to improve diagnosis.
“We are looking forward to the endo-test, a saliva test that makes it easy and quick to diagnose the disease.“, concludes the expert with enthusiasm.