Endometriosis: Anatomy of a Silent Pain
Endometriosis is a complex chronic illness that severely impacts women's lives. Dr. Nad Narrainen-Poullé explains the symptoms, the diagnostic journey, and the solutions for a finally appropriate multidisciplinary approach.
Long trivialized, endometriosis is a chronic condition that affects many women and can significantly alter their quality of life. With intense pain, delayed diagnosis, and infertility, Dr. Nad Narrainen-Poullé, an obstetrician-gynecologist, sheds light on this still largely unknown pathology.
While menstrual pain is common, it should not automatically be considered normal. Dr. Nad Narrainen-Poullé explains that "classic" pain typically manifests as uterine cramps limited to the first days of menstruation and is relieved by simple analgesics.
"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 states.
Endometriosis can present in various forms. Signs that should raise concern include chronic pelvic pain, painful periods impacting quality of life, or pain during sexual intercourse.
"Digestive or urinary symptoms related to the menstrual cycle, such as pain during bowel movements, blood in the stool or urine, may also be present. In some cases, the disease is revealed by difficulties in conceiving," he points out. Additionally, a family history increases the likelihood of a diagnosis. The obstetrician-gynecologist notes that endometriosis manifestations are not limited to the uterus; they can affect various organs, explaining the diversity of symptoms and their varying intensity from patient to patient. In severe cases, the pain can significantly impact daily life, affecting work, school, and social activities.
One of the main challenges remains the diagnostic delay. According to the specialist, several factors explain this situation. "On the one hand, symptoms can be confused with other digestive or urinary disorders. On the other hand, the disease can present in different forms, often located in hard-to-visualize areas," he indicates.
As a result, some patients may wander for years, undergoing numerous consultations and treatments without obtaining a clear answer. There are still instances where their pain is 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, socioeconomic situation, and level of understanding influence how pain is expressed and perceived.
Diagnosis primarily relies on a clinical examination, including abdominal and pelvic evaluation. Medical imaging, particularly ultrasound and MRI, further complements this evaluation according to the physician. "However, these tests do not always suffice to detect the disease. Some forms of endometriosis may go unnoticed, requiring additional investigations," he clarifies.
There is no one-size-fits-all treatment. Management is tailored to each patient based on her symptoms, age, and pregnancy plans. "Options include analgesics, 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 notes.
Indeed, endometriosis can affect fertility, particularly due to adhesions or ovarian cysts. In severe cases, assisted reproductive techniques may be considered.
Beyond medical aspects, endometriosis has significant psychological and social repercussions. Chronic pain, fatigue, professional or relational difficulties: the disease impacts several dimensions of life. Dr. Nad Narrainen-Poullé underscores the need for a multidisciplinary approach that includes pain management, psychological support, and fertility monitoring: "Recent advances, particularly in imaging and surgery, as well as the emergence of new therapies, now offer encouraging 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 adhesions in the pelvis. At Stage I, lesions are superficial and minimally extensive, while at Stage II, they become deeper and may be accompanied by fine adhesions. Stage III corresponds to a moderate form with more significant lesions, the presence of ovarian cysts, and thicker adhesions.
At 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's crucial to note that the severity of the disease, as defined by these stages, does not necessarily reflect the intensity of pain experienced by patients.
Signs That Should Raise Concern
- Persistent pelvic pain for more than six months
- Very painful periods disrupting daily life
- Pain during or after sexual intercourse
- Digestive or urinary disorders related to the menstrual cycle
- Difficulties in conceiving
- Family history of endometriosis