Endometriosis: Anatomy of a Silent Pain

Image of endometriosis: anatomy of a silent pain

Endometriosis is a complex chronic illness that severely impacts women's lives. Dr. Nad Narrainen-Poullé discusses symptoms, the diagnostic journey, and solutions for a multidisciplinary approach to care that is finally appropriate.

Long trivialized, endometriosis is a chronic condition that affects many women and can significantly impair their quality of life. Intense pain, delayed diagnosis, infertility: Dr. Nad Narrainen-Poullé, an obstetrician-gynecologist, provides an overview of this still poorly understood pathology.

While menstrual pain is common, it should not be considered normal in every case. Dr. Nad Narrainen-Poullé explains that "classic" pains typically manifest as uterine cramps limited to the first days of menstruation and can be relieved with simple painkillers.

"However, when these pains become more intense, persist beyond menstruation, or are accompanied by other symptoms, a pathological cause such as endometriosis should be considered," he explains.

Endometriosis can manifest in various ways. Warning signs include chronic pelvic pain, painful periods that affect quality of life, and pain during sexual intercourse.

"Gastrointestinal or urinary symptoms related to the menstrual cycle, such as pain during bowel movements, or blood in stool or urine, may also be present. In some cases, the disease is revealed by difficulties in conceiving," he emphasizes. A family history also increases the likelihood of diagnosis. The obstetrician-gynecologist points out that endometriosis manifestations are not limited to the uterus; they can affect different organs, which explains the diversity of symptoms and their varying intensity from one patient to another. In such cases, pain can greatly impact daily life, affecting professional, academic, and social activities.

One of the main challenges remains the delay in diagnosis. According to the specialist, several factors explain this situation. "On one hand, symptoms can be confused with other gastrointestinal or urinary disorders. On the other hand, the disease can present in various forms, often located in areas that are difficult to visualize," he notes.

Some patients may wander for years, multiplying consultations and treatments without obtaining clear answers. Their pain is often minimized or considered normal, contributing to delays in care.

Dr. Nad Narrainen-Poullé also emphasizes the importance of considering the patient's overall experience. Cultural context, beliefs, socio-economic status, and level of understanding influence how pain is expressed and perceived.

The diagnosis primarily relies on a clinical examination, including abdominal and pelvic assessment. Medical imaging, particularly ultrasound and MRI, subsequently helps complete this evaluation according to the doctor. "However, these tests do not always suffice to detect the disease. Some forms of endometriosis may go unnoticed, requiring additional investigations," he specifies.

There is no one-size-fits-all treatment. Management is tailored to each patient based on her symptoms, age, and pregnancy plans. "Options include pain relief treatments, hormonal therapies, and, in some cases, surgery. The latter is not systematic and depends on the severity of the disease and its impact on fertility," he clarifies.

Endometriosis can indeed affect fertility, particularly due to adhesions or ovarian cysts. In severe cases, assisted reproductive technology may need to be considered.

Beyond medical aspects, endometriosis has significant psychological and social repercussions. Chronic pain, fatigue, professional or relational difficulties: the disease impacts multiple dimensions of life. Dr. Nad Narrainen-Poullé highlights the necessity of a multidisciplinary approach that integrates pain management, psychological support, and fertility monitoring: "Recent advances, particularly in imaging and surgery, as well as the emergence of new therapies, offer promising prospects for improving care and early diagnosis."

Understanding the Stages of the Disease

Endometriosis is classified into four stages, from minimal to severe, based on the extent of lesions, their depth, and the presence of pelvic adhesions. In stage I, lesions are superficial and limited, while in stage II, they become deeper and may be accompanied by fine adhesions. Stage III corresponds to a moderate form, with larger lesions, the presence of ovarian cysts, and thicker adhesions.

In stage IV, considered severe, there are numerous and deep lesions, with large ovarian cysts, often referred to as "chocolate cysts," and dense adhesions that can cause organs to stick together. However, it is important to emphasize that the severity of the disease, as defined by these stages, does not necessarily reflect the intensity of the pain experienced by patients.

Signs That Should Raise Alarm

• Persistent pelvic pain for more than six months
• Very painful periods disrupting daily life
• Pain during or after sexual intercourse
• Gastrointestinal or urinary problems related to the menstrual cycle
• Difficulty conceiving
• Family history of endometriosis