June 2021: First patients treated at IFEM Endo with HIFU for rectal endometriosis
Endometriosis is a chronic pathology, with a menstrual rhythm that covers the period from puberty to menopause. It can present in many forms, with no close correlation between the severity of lesions and symptoms. These characteristics of the disease are arguments in favor of individualized patient management, based on symptoms, lesion location, desire for pregnancy, but also the risks and adverse effects of treatment.
The management of painful endometriosis can be achieved using drug treatments alone or in combination with surgery.
The management of infertility due to endometriosis can be managed using assisted reproduction techniques and/or surgery.
Endometriosis can be treated either by surgery or medical therapies, but most often by a combination of the two.
As the origin and mechanisms of evolution of endometriosis are insufficiently elucidated, there is no medical treatment specifically directed against endometriosis cells.
The only principle of medical treatment today is to block menstruation, using drugs that mimic either pregnancy or menopause (the two physiological periods of absence of menstruation in the life of an adult woman).
In the vast majority of cases, this strategy makes it possible tohalt the evolution of endometriosis lesions and reduce painful symptoms, without however making them disappear.
On the other hand, because it blocks ovulation, medical treatment is also contraceptive and should be discontinued in women who wish to become pregnant.
Medical treatment requires amenorrhea and has 2 main objectives:
There is little scientific data on the long-term efficacy of medical treatment. In other words, if a 25-year-old woman with endometriosis is prescribed medical treatment, it is impossible to know what the probability is that she will avoid surgery forever. The subsequent appearance of adenomyosis may alter the results of medical treatment, and make it difficult to achieve amenorrhea. The MESURE (MEdical versus Surgical management of Rectal Endometriosis) randomized trial, which compares the results of medical versus surgical treatment in women with rectal endometriosis, was launched in 2014 at the Rouen University Hospital by Prof. Roman, and results are expected in 2022.
Nevertheless, medical treatment is not the ideal solution for all patients. Some women may experience side-effects that force them to stop taking their hormonal medication, others may have medical contraindications to hormonal treatment (cardiovascular or haematological conditions, meningiomas, hormone-dependent tumours), and still others may be unable to achieve amenorrhoea (despite continuous hormonal treatment, frequent or incessant uterine bleeding persists). In all these situations, curative surgery becomes the only alternative treatment.
The aim of surgery is to resect or destroy endometriosis lesions and repair affected organs, in order to treat pain and infertility. Long-term amenorrhea after surgery helps prevent recurrence.
As the medical treatment of endometriosis resulting in amenorrhea is necessarily contraceptive, the desire to become pregnant requires the interruption of this treatment. A full work-up should then be carried out rapidly, to look for other possible causes of infertility (dysovulation, spermatic alterations, etc.), and an active approach should be adopted on a case-by-case basis (natural fertilization, surgery and/or assisted reproduction) to avoid aggravation or recurrence of the disease.
80%
of women operated on for colorectal endometriosis become pregnant within 5 years of surgery
47-56%
of women operated on for colorectal endometriosis have no dysmenorrhea 5 years after surgery
66-72%
of women operated on for colorectal endometriosis have no dyspareunia 5 years after surgery
Source: Roman et al, Hum reprod 2020
For multidisciplinary endometriosis management, IFEM Endo supports you throughout your journey: medical and surgical treatment, medical follow-up, pain management.
Last updated on
