Endometriosis (2): Prevention and Management

Dr. Claude Allouche, gynecologistEndometriose2 general engl
Ahuza Clinic, Raanana, Israel
058 726 02 64

Which Prevention?

Prevalence
Endometriosis affects 10 to 15% of women of childbearing age, representing around 180 million women worldwide.

Prevention of Endometriosis
Unfortunately, there is no effective prevention for endometriosis. This condition is multifactorial, involving both genetic and environmental factors.

  • Hereditary Factor: A family history, especially in first-degree relatives (mother to daughter), can increase the risk.
  • Suspected Genes: Several genes are suspected of contributing to endometriosis, but none have been definitively identified.
  • Environment and Chemicals: Environmental or cosmetic-related chemical exposure is sometimes blamed, but no conclusive evidence has been found.
  • Uterine Interventions: Procedures involving the endometrium, such as curettage or cesarean sections, may also be linked to the development of endometriosis.

Endometriosis: What Management?

Endometriosis is a benign but common gynecological condition that requires prompt management as soon as it is suspected.

Medical Treatment
Medical treatment is the first-line approach:

  • Pain Relief: Through painkillers and anti-inflammatory drugs.
  • Ovarian Suppression: Hormonal treatments are used to stop menstruation, as the condition is hormone-dependent. The goal is to prevent the ovaries from secreting estrogen, which contributes to the development of endometriosis.
  • Estrogen-Progestogen Pills: These block ovarian function and limit the growth of endometriosis while alleviating pain. They can be taken continuously to eliminate menstrual periods and associated symptoms. This is often the first treatment option for young girls, even if they do not yet need contraception.
  • Hormonal IUD: Effective in treating endometriosis, even in patients without children.

Surgery
If medical treatments fail repeatedly, surgical intervention may be necessary to remove endometriosis lesions:

  • Laparoscopy (coelioscopy): The most commonly performed procedure.
  • Laparotomy: Rare and only used for the most advanced lesions. This major surgery is avoided for mild forms as it can create adhesions, worsening the condition.
  • Multidisciplinary Approach: May involve specialists other than the gynecologist, such as a digestive surgeon for bowel lesions or a urologist for urinary lesions.

Comprehensive Care
For severe cases, early intervention is necessary and must be tailored to the specific needs of each patient and couple.

  • Fertility Treatment: Should always be adapted to the individual.
  • Removal of Uterus and Ovaries: May be suggested for patients nearing menopause.

The management of endometriosis is multidisciplinary and may require the involvement of:

  • General practitioners
  • Gynecologists
  • Psychologists
  • Digestive surgeons
  • Urologists
  • Pain specialists
  • Social workers
  • Patient associations

Endometriosis can impact various aspects of a woman's life, including her body, relationships, work, and social life. Specialized hospital services dedicated to endometriosis are being developed globally, including in France and Israel, aiming to improve comprehensive care and increase social recognition for patients.

Other Publications on the Same Topic:

  • Endometriosis (1): What is it?
  • Endometriosis (2): How to identify it?
  • Endometriosis (3): What are the consequences?
  • Endometriosis (4): What prevention?
  • Endometriosis (5): What management?