Endometriosis is a chronic condition, the evolution of which is linked to menstrual cycles, covering the period from puberty to menopause, which can present itself in multiple forms, with little correlation between the severity of lesions and symptoms. These characteristics of the disease are arguments for personalized treatment of patients, based on symptoms, location of lesions, desire for pregnancy, but also the risks and adverse effects of the treatments.
The management of painful endometriosis can be achieved by using medication alone or combined with surgery.
Infertility due to endometriosis can be managed with assisted reproductive technology and/or surgery.
Endometriosis can be treated either by surgery or by medical therapies, but most often by a combination of both.
As the origin and mechanisms for the development of endometriosis are not yet fully understood, there is no medical treatment specifically directed against endometriosis cells.
Only one medical treatment approach is used at present, which blocks menstruation, using drugs that mimic either pregnancy or the 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 to stop the progression of endometriosis lesionsand to reduce painful symptoms, without however making them disappear.
Due to the blocking of ovulation, medical treatment is also contraceptive and its administration must be halted in women who wish to become pregnant.
Medical treatment involves achieving amenorrhea and has 2 main objectives:
There is little scientific data on the long-term effectiveness of medical treatment. Consquently for a young woman aged 25 with endometriosis and prescribed medical treatment, the probability that she will avoid future surgery is presently unknown. The subsequent appearance of adenomyosis may alter the results of the 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, started in 2014 at Rouen University Hospital by Prof. Roman, with results expected in 2022, will provide more precise information on the effectiveness of each treatment in a given situation.
Nevertheless, medical treatment is not the ideal solution for all patients. Some women may experience side effects that cause them to discontinue taking hormonal medications, others may have medical contraindications to hormonal treatments (cardiovascular or hematological diseases, meningiomas, hormone-dependent tumors), and others may not be able to achieve amenorrhea (despite continuous hormonal treatments, frequent or constant uterine bleeding persists). In all these situations, corrective surgery remains the only alternative treatment.
The purpose of surgery is to resect or destroy endometriosis lesions and repair the affected organs for the purpose of treating pain and infertility. Long-term amenorrhea after surgery helps to prevent recurrence.
The medical treatment of endometriosis allowing amenorrhoea is automatically contraceptive, and a desire to conceive requires interruption of the treatment. A complete check-up should rapidly be carried out to look for other possible causes of infertility (dysovulation, sperm alterations, etc.) and an active approach should be taken on a case-by-case basis (natural fertilization, surgery and/or assisted reproduction) in order to avoid aggravation or recurrence of the disease.
80%
of women undergoing surgery for colorectal endometriosis become pregnant within 5 years of surgery
47-56%
of women undergoing surgery for colorectal endometriosis have no dysmenorrhea 5 years after surgery
66-72%
of women operated for colorectal endometriosis have no period pain 5 years after surgery
Source : Roman et al, Hum reprod 2020
For multidisciplinary management of endometriosis, IFEM Endo accompanies you throughout your care journey of medical and surgical treatment, medical follow-up and pain management.
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