Gynaecologist Dr Thomas Perez talks about endometriosis

Dr Thomas Perez, a gynaecologist in Aubagne, talks to us about endometriosis

What is endometriosis?

Endometriosis is the abnormal presence of endometrial tissue (endometrium) outside the uterine cavity. This endometrial tissue is sensitive to cyclical variations in ovarian hormones, which are responsible for the onset of menstruation. Endometriosis, like the endometrium, is sensitive to these hormonal variations and will react by inflammation leading to fibrosis and adhesions inside the pelvic-abdominal cavity. Endometriosis can affect the ovaries, fallopian tubes, uterus, digestive tract, urinary tract and the entire surface of the peritoneum.

The disease affects around 10% of women of childbearing age and 50% of women in the perimenopause.

What are the symptoms of endometriosis?

Endometriosis is a periodic inflammation, and the main symptom is the existence of painful periods which doctors call dysmenorrhoea. This inflammation and the fibrous adhesions it creates are also responsible for fertility problems. There are also other possible symptoms depending on the location of the endometriotic implants (digestive or urinary symptoms, etc.).

When should people talk to a professional? At what age can the disease occur?

The onset of painful, disabling periods that can even disrupt a woman's social and professional life, and that are resistant to basic painkillers, should prompt women to seek professional help.

Very rarely, the disease may appear with the first menstrual period. More often, it appears around the age of 20 or 30. The disease will disappear on its own at the menopause. It therefore mainly affects women of childbearing age.

How is endometriosis detected?

There is no organised screening for endometriosis. However, the first symptom, painful periods, should lead to early diagnosis. In diagnosing this disease, we should mention MRI, which is now a precious aid in the care of our patients.

Do you think that some patients don't dare discuss their problem with a health professional out of embarrassment or fear? What advice would you give them?

Yes, some patients have grown up with the idea that women's periods are always painful and that they have to accept this. The advice is not to resign yourself to the pain and to talk to your doctor or gynaecologist about it. There are solutions!

Does treating the disease as early as possible increase the success rate of treatment?

Yes, of course. As with many other diseases, it's easier to treat a disease that's in its early stages than one that's advanced or out of date.

What are the different ways of treating this disease (drugs, surgery, etc.)?

Firstly, treatment with painkillers to reduce the pain, but also hormone treatments to slow the progression of the disease.

In some cases, surgery is also proposed. This is often highly effective in treating the pain and halting the progression of the disease. In infertile patients, medically assisted reproduction (MAP) will of course be offered.

When is surgery required?

Surgery is most often performed by laparoscopy. This is sometimes useful for diagnosing endometriosis. Laparoscopy will also be proposed for the removal of deep lesions (in the form of nodules) and sometimes ovarian lesions (cysts).

Today, this surgical management is carried out in consultation with reproductive specialists through multidisciplinary meetings (expert centres).

What is the surgical procedure like? What is the average length of stay in hospital? Is it painful? Are there any scars?

Surgery can be performed by laparoscopy or robotic surgery(minimally invasive techniques). Hospitalisation can last up to 3-4 days, but many operations can be performed on an outpatient basis. There are scars, but they are discreet.

Are there any risks of recurrence after surgery? What are the after-effects?

There is a risk of recurrence after surgery, particularly when the first operation was performed on a young patient and in certain forms where the disease is very aggressive.

Do operated patients need to continue taking medication? Regular check-ups or examinations?

In patients who have undergone surgery, there is certainly a fear of recurrence. Various hormone treatments (progestins, oestro-progestins) have been shown to significantly reduce the rate of recurrence and are strongly recommended after surgery. Patients who have undergone surgery should receive rigorous follow-up at least once a year.

What progress has been made in treating the disease? Have there been any significant medical advances in this disease?

A great deal of work and research has been devoted to this condition, which has a very high incidence. One of the major recent advances is the possibility of oocyte conservation (oocyte vitrification), which should be offered in cases where there is a risk of ovarian failure in young women, and particularly prior to surgery for ovarian endometriosis. These oocytes can be used secondarily if necessary.

What advice would you give to a woman who has just been diagnosed?

To see an endometriosis specialist as soon as possible!