Which treatments for endometriosis?

There are treatments that can be used to treat endometriosis, however, there is no cure for endometriosis yet. It is a chronic disease that can recur even after complete surgery.

Treatment options vary from case to case. It is above all the objective pursued that determines the choice. Is it to treat infertility or to fight pain? Is it to eliminate the disease as radically as possible and reduce the risk of recurrence? These questions should be discussed during a meeting with your doctor in order to choose a specific, tailor-made treatment. Depending on the situation, a treatment or a combination of different treatments is proposed.

It is often said that there is as much endometriosis as there are endometriosis patients... so for each woman, there is an individual solution to the problem.

First of all, there are treatments to fight against pain:

Hormone Therapy

Hormonal treatment is the main treatment. Endometriosis is a hormone-dependent disease (endometriosis foci are stimulated by hormones during the cycle). Hormonal treatment to regulate or prevent the effect of these hormones on the endometriosis lesions must first be started in order to render them inactive. The basic idea is to suppress menstruation (therapeutic amenorrhea). Amenorrhea induces a marked decrease in local inflammation and prevents the proliferation of endometrial cells to small blood vessels and nerves. Hormone therapy also stops the reflux of menstrual periods through the fallopian tubes. The choice of hormones is wide, which makes it possible to find the molecule that is the most suitable for you: the one that will have a maximum of effectiveness for a minimum of side effects:


This choice includes estrogen-progestin contraceptive pills (which offer very good tolerance), progestins, vaginal rings, hormonal IUDs. The treatment will be evaluated and adapted according to the response and your tolerance, several times if necessary, until the most suitable treatment for you is found.


Sometimes, an artificial menopause is proposed. GnRH analogues block the pituitary gland and strongly inhibit estrogen synthesis, which causes a transient artificial menopause. This treatment dries up the endometriosis sites. The pain can thus be relieved and the formation of new foci can be avoided. However, this treatment induces numerous side effects: hot flashes, decreased bone mass (osteoporosis), mood fluctuations, and vaginal dryness. In order to prevent complications and side effects, hormonal treatment with low doses of estrogen is administered.

Analgesics

Endometriosis is a disease that is treated hormonally, but which also requires the use of painkillers because of the pain it causes. Paracetamol, non-steroidal anti-inflammatory drugs, and more powerful pain killers called "level 2" drugs (tramadol, codeine, opiates) are mainly used to reduce pain. Their long-term use must remain limited because of their side effects on the stomach and kidneys.

Complementary medicine

Allopathic treatments that act on pain conduction can be complemented by complementary therapies that can block painful stimuli (acupuncture, mesotherapy, skin neurostimulation (TENS (of the Livia type for example)). Osteopathy, fascia-therapy, physiotherapy, psychotherapy, hypnosis, sophrology, ... etc. are other effective ways to take care of oneself and one's pain. Sports activity and diets to reduce inflammation are also useful tools.

Surgery

Surgical treatment may be necessary when the medical treatment is not (or is no longer) effective on pain or dyspareunia, when there is a significant impact on quality of life, in some cases of infertility or in the presence of complications (large ovarian cyst, intestinal obstruction, damage to the ureters, bladder etc ...). The decision to operate must be discussed, especially for complex forms, on a case-by-case basis (after validation if possible in a multidisciplinary consultation meeting). The operation is performed by laparoscopy or robot (for complex cases). The surgeon carefully removes all visible foci of endometriosis, without damaging neighboring organs if possible. This microsurgical technique is precise and delicate. It uses electric current or laser. Although benign, severe endometriosis makes surgery difficult for several reasons: adhesions between organs, changes in normal anatomical relationships, the need to remove all endometriosis lesions. Complications are possible after surgery: bladder dysfunction, recto-vaginal fistula, digestive suture release, transient digestive diversion (stoma), ureteral fistula, decreased ovarian reserve ... Surgery improves pain in 70-80% of patients and pregnancy within 12-18 months in 50% of cases.

Special cases of severe chronic pain :

Pain depends on 3 main elements that interact with each other and are at the origin of a vicious circle.

The lesion :

The endometriosis will irritate the injured area, it is the departure of the painful message that will be sent to the brain, which will analyze it and induce spontaneous or more reflexive reactions to try to get better. The real initial mechanism responsible for the pain is the nerve that is, as it were, trapped or "suffocated" in the lesion, which is sensitized over time and its local endings suffer. This pain is equivalent to "neuralgia".

The body :

The irritated nerve causes a reflex reaction of the tissue it innervates: immobilization. The tissue (muscles, tendons, ligaments) retracts and becomes painful in turn. An organ that moves little or not at all will stop functioning properly and this can cause disorders, dysfunction (constipation, pain when urinating, pain during intercourse ... ). All the tissues of the pelvis that normally train each other can begin to have dysfunctions, immobility progresses causing pain of increasing immobility (progression) until sometimes causing blockage of the pelvis, lower back pain and sometimes a painful sensation throughout the body.

The brain:

If the pain is not in the head, the head has an influence on the pain: the brain is a modulating agent. It does not invent pain, but it modulates the feeling of pain, which explains the individual aspect of the pain phenomenon. Our heart and our brain have a memory of pain. This memory of our past painful experiences is likely to lead to an amplification of the painful messages to come. The brain can then cause a "magnifying glass effect" that increases the pain sensation.

Une fatigue dans l’endométriose est multifactorielle : La douleur qui fatigue et absorbe beaucoup d’énergie, le stress, les traitements et leurs effets secondaires, un mauvais sommeil, le manque de dynamisme qui empêchent toute activité physique bénéfique pour un bon sommeil. La fatigue diminue notre capacité à supporter, gérer la douleur.

Infertility treatments :

La prise en charge assurée par des spécialistes, varie en fonction des cas, afin de poser les meilleures indications de traitements. Tout d’abord, il faut s’assurer qu’il n’existe pas une autre cause d’infertilité associée (bilan hormonal, perméabilité tubaire, spermogramme). Dans certains cas un traitement de stimulation ovarienne avec rapports sexuels ou inséminations intra-utérine peut être proposé. En cas d’échec de plusieurs cycles de traitement, ou en cas de présence d’endométriose sévère ou d’autre cause sévère d’infertilité, on aura recours à la fécondation in vitro (FIV). La FIV consiste en une stimulation médicamenteuse des ovaires, puis la ponction à l’aide d’une aiguille pour prélever les ovules dans les ovaires. Ces ovules sont fécondés au laboratoire puis les embryons obtenus sont réimplantés quelques jours plus tard dans l’utérus.

Dans les formes légères à modérées : la chirurgie semble pouvoir améliorer la fertilité naturelle ainsi que les chances de grossesses en FIV. Dans les cas d’endométriose sévère/profonde : les résultats de la chirurgie sur la fertilité n’ont pas pu être comparés de façon satisfaisante aux résultats de la FIV sans chirurgie préalable. Les choix doivent être discutés au cas par cas (en fonction de différents critères : âge, forme très douloureuse ou à risque de complications, autres facteurs associés etc) pour le choix de la meilleure proposition. En cas d’hydrosalpinx (dilatation de la trompe avec du liquide ou du sang) la chirurgie est indiquée avant la FIV pour augmenter les chances de grossesse et diminuer le risque infectieux de la ponction.

Source : Nous remercions la clinique Mons Endométriose d’avoir mis à notre disposition ces informations médicales.