Endometriosis is a chronic disease characterized by the presence of tissue similar to the uterine lining (endometrium) outside the uterus. This tissue, though ectopic, reacts to hormonal fluctuations of the menstrual cycle. It thickens and bleeds, but the blood and tissue have no natural outlet. This causes inflammation of the surrounding tissues, leading to the formation of cysts, nodules, and adhesions. Endometriosis primarily affects women of reproductive age and can result in significant pain and infertility.

Causes and Risk Factors of Endometriosis

The exact cause of endometriosis is not yet fully understood. Several theories attempt to explain its occurrence. The most widely accepted is the theory of retrograde menstruation. It suggests that during menstruation, blood containing endometrial cells flows backward through the fallopian tubes and implants on other organs.

Other factors may play a role. Genetic predispositions exist, as endometriosis often affects multiple women in the same family. Also, immune system abnormalities can prevent the body from properly eliminating ectopic endometrial cells. Finally, hormonal factors, particularly overexposure to estrogen, also influence the development of the disease. Exposure to certain environmental toxins has been studied as a potential risk factor, although definitive evidence is still lacking.

Certain factors increase the risk of developing endometriosis. These include short menstrual cycles, heavy or prolonged periods, nulliparity (never having given birth), or an early onset of menstruation. In utero exposure to certain chemicals, such as diethylstilbestrol (DES), can also increase this risk.

Symptoms and Signs

The symptoms of endometriosis vary considerably from person to person. Some women have severe forms of the disease without symptoms, while others suffer from intense pain with a minimal form. Pain is the most common symptom of endometriosis. It can take several forms:

• Severe Dysmenorrhea: Intense menstrual pain that limits daily activities.
• Chronic Pelvic Pain: Pain that persists outside of menstruation.
• Dyspareunia: Pain during or after sexual intercourse.
• Pain during defecation or urination: Especially during periods, if endometriosis affects the intestines or bladder.

Infertility represents a major challenge for many women with endometriosis. Ectopic tissue and inflammation can disrupt the function of the ovaries and fallopian tubes. Other less specific symptoms may include chronic fatigue, bloating, nausea or vomiting, and digestive disorders. The presence of these symptoms does not systematically mean endometriosis, but their persistence warrants a medical consultation.

Diagnosis of Endometriosis: How is it detected?

The diagnosis of endometriosis is often complex and, unfortunately, takes time. Several steps are necessary to establish an accurate diagnosis.

The doctor begins with a detailed medical history. They ask the patient about their symptoms, their intensity, frequency, and impact on their daily life. A clinical examination is then performed, including a gynecological exam. The doctor may palpate nodules or masses in the pelvis.

Imaging tests complement this process. Transvaginal pelvic ultrasound is often the first test performed. It detects ovarian cysts (endometriomas) and, in some cases, deep endometriosis nodules. Pelvic Magnetic Resonance Imaging (MRI) offers a better visualization of deep lesions and their extent. It identifies implants on the intestines, bladder, or uterosacral ligaments. These tests detect lesions, but do not rule out the disease in case of negative results.

Historically, only laparoscopic surgery with biopsy allowed a definitive diagnosis of endometriosis. Today, this intervention is only resorted to in case of therapeutic necessity. A clinical diagnosis is often sufficient to initiate treatment. Prompt management helps limit the progression of the disease and improve the quality of life for patients.

Treatments and Management

The management of endometriosis aims to relieve pain and manage infertility issues. Treatment options depend on the severity of symptoms, the desire for pregnancy, and the location of the lesions.

Medication is often the first line of defense for endometriosis. Analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs), relieve pain. Hormonal treatments suppress the growth of ectopic endometrial tissue. These include continuous hormonal contraceptives (pills, rings, patches), progestins, or GnRH agonists. The latter induce a temporary menopause state to atrophy the lesions. They only represent a temporary solution.

Surgery is considered when pain is intense, medical treatments fail, or there is infertility associated with endometriosis. Laparoscopic surgery removes endometriosis implants, cysts, and adhesions. It offers significant symptom improvement for many patients. In the most severe cases, a hysterectomy (removal of the uterus) and/or oophorectomy (removal of the ovaries) is sometimes necessary, but this is a last resort.

Complementary approaches accompany conventional treatments. They help manage the symptoms of endometriosis. These include, for example, osteopathy, physical therapy, acupuncture, nutrition, or stress management. These approaches improve quality of life and reduce pain.

Recent Scientific Advances (June 2025)

Research on endometriosis is actively progressing, although no major revolutionary breakthroughs have been published in the first half of 2025. Efforts are currently focused on several areas. The identification of non-invasive biomarkers for early diagnosis of endometriosis represents a promising avenue. Studies are looking at specific proteins or RNA molecules in the blood or urine of patients.

The development of new therapeutic targets is another priority. Researchers are exploring drugs that act on inflammation, angiogenesis (formation of new blood vessels), or immune modulation. The goal is to offer alternatives to current hormonal or surgical treatments. The understanding of the interaction between the gut microbiota and endometriosis is also attracting attention, suggesting a potential link between an imbalance in gut flora and the severity of symptoms.

Prevention of Endometriosis

Currently, no preventive measure guarantees the absence of endometriosis. The complex nature of this disease and its multifactorial causes make prevention difficult. However, it is possible to manage certain factors that influence endometriosis. A healthy lifestyle including a balanced diet, regular physical activity, and stress management contributes to overall well-being. These practices do not prevent the onset of endometriosis. They can help reduce the severity of symptoms and improve quality of life once the disease is diagnosed.

Early screening and rapid symptom management constitute a form of secondary prevention. Recognizing the signs of endometriosis and consulting a healthcare professional without delay can limit the progression of lesions and mitigate the impact of the disease on women’s daily lives.

Living with Endometriosis

Living with endometriosis often involves managing chronic pain and its repercussions on daily life. Multidisciplinary support is essential to improve quality of life. This includes regular medical follow-up and psychological support. Sharing experiences within support groups or patient associations offers a valuable space. Women feel understood and less isolated there.

Lifestyle adaptation is sometimes necessary. This concerns diet, stress management, and physical activity. Learning to know one’s body and anticipate periods of pain helps to better manage crises. Endometriosis varies in intensity over time. A flexible and personalized approach to management is therefore essential. Open communication with healthcare professionals, family, and friends allows for a better understanding of the challenges associated with endometriosis.

Frequently Asked Questions (FAQ)

Is endometriosis a rare disease?

No, endometriosis is a common disease. It affects approximately 10% of women of reproductive age, or about 1 in 10 women. Its diagnosis is often delayed.

Can you be cured of endometriosis?

Currently, there is no definitive cure for endometriosis. Available treatments aim to relieve symptoms, reduce lesion size, and improve fertility. The disease is chronic.

Does endometriosis always cause infertility?

No, endometriosis does not systematically cause infertility. Many women with endometriosis conceive naturally. However, endometriosis is a common cause of infertility. It affects approximately 30% to 50% of women with this disease.

How does stress management influence endometriosis?

Stress is not a cause of endometriosis, but it often exacerbates pain. Chronic stress can influence the immune system. It can also increase the perception of pain. Relaxation techniques help manage symptoms better.

Can endometriosis reappear after surgery?

Yes, it can recur after surgery. Recurrence depends on the initial severity of the disease, the extent of excision, and postoperative management. Regular follow-up is recommended.

Additional Resources

• WHO

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