In the often stifling silence surrounding women's suffering lies a complex and still largely unknown disease: endometriosis. This condition is much more than just menstrual pain. It is a daily reality for millions of women around the world.
According to recent estimates from the World Health Organization (WHO), endometriosis affects approximately 10% of women of reproductive age, or nearly 200 million women worldwide. This equates to 1 in 10 menstruating women, according to the EndoFrance association. This statistic does not take into account undiagnosed individuals, who represent approximately 2 in 10 menstruating women, or 3 in 10 women affected by endometriosis (diagnosed and undiagnosed combined). These figures reflect not only a high prevalence, but also the urgent need for awareness and research to understand this multifaceted disease.
Yet, despite its profound impact on women's quality of life, endometriosis remains a disease that is still largely misunderstood, underdiagnosed and poorly managed.
Learning about the disease is essential to begin the fight. Understanding your own body, listening to its signals, supporting each other, and taking appropriate action are crucial steps. This approach is especially important when you consider that currently, diagnosing endometriosis can take an average of up to 7 years. Furthermore, nearly 70% of those affected by this condition suffer from chronic, debilitating pain, preventing them from going to school, working, and living their daily lives as fulfilled women. This also means that 30% of affected women, who experience no alarming pain, may ignore their condition due to lack of diagnosis, thus delaying proper treatment and risking complications such as infertility.
After reading this article, you will understand what endometriosis is, what actually happens in the body of a woman affected by it, the different forms the disease can take and the associated symptoms.
The endometrium is the lining that lines the inner surface of the uterus, called the uterine cavity. Endometriosis occurs when cells similar to the endometrium are located outside the uterus. It is therefore the abnormal location of endometrial tissue that produces endometriosis. Be careful, by definition, endometriosis is outside the uterus, but in rare cases, endometriosis can affect the uterus itself. This is then called intrauterine endometriosis or adenomyosis.
To clarify these notions, let us consider an illustrative diagram: 
Like the endometrium, endometriosis is sensitive to hormonal variations, so it will increase in size and thickness under estrogen stimulation (the time in your menstrual cycle when the endometrium prepares to receive an embryo), and will deteriorate during menstruation (if there has been no fertilization).
The endometrium that lines the uterine cavity will break down and bleed, then will be evacuated through the vagina: this is menstruation.
While the endometriosis breakdown product remains trapped in the abdominal cavity. Being outside the vagina, it cannot escape through it. It will then induce a reaction in the body, resulting in local inflammation.
Cycle after cycle, endometriosis lesions develop, grow, multiply and therefore inflammation increases.
So let's go over the process again: During menstruation, the endometrium will bleed, and endometriosis, which has the same characteristics, will also bleed, causing damage to the organs on which it has grafted itself.
And cycle after cycle, these cells will create other lesions, nodules, cysts, adhesions... preventing the proper mobility of the organs.
There are 4 forms of endometriosis:
Peritoneal or superficial endometriosis:
This is the most common form of endometriosis. It involves the presence of endometrial tissue outside the uterus, often on pelvic organs such as the ovaries, fallopian tubes, bladder, or peritoneum (the membrane that lines the abdominal cavity).
This tissue can cause inflammation, adhesions, endometriotic cysts (also called chocolate cysts), and chronic pelvic pain.
Ovarian endometriosis or endometrioma:
It occurs when endometriotic implants form on or within the ovaries. These implants can form blood-filled cysts, called endometriotic cysts or chocolate cysts, due to their dark brown contents.
This form of endometriosis can cause severe pelvic pain, irregular bleeding, and potentially affect ovarian function and fertility.
Deep endometriosis:
Deep endometriosis involves the growth of endometrial tissue in deep pelvic tissues, such as the uterosacral ligament, rectum, sigmoid colon, or bladder.
This form of endometriosis can cause severe symptoms, including deep pelvic pain, pain during intercourse that may be only at the entrance, deep, or both, bowel and urinary disturbances, and can present a challenge for treatment due to its deep location and its involvement on adjacent organs.
Extrapelvic endometriosis:
Extrapelvic endometriosis is less common and occurs when endometriotic implants form outside the pelvic region, such as on the diaphragm, lungs, brain, or other parts of the body.
Although less common, this form of endometriosis can cause symptoms such as chest pain, breathing difficulties, and neurological symptoms, which can sometimes lead to delayed or misdiagnosis due to its unusual location.
In addition to these 4 forms, there is adenomyosis: A condition in which endometrial tissue develops inside the muscular wall of the uterus (myometrium).
This condition can cause thickening of the uterine wall, severe pelvic pain, heavy menstrual bleeding, and symptoms similar to those of endometriosis.
Although adenomyosis can coexist with other forms of endometriosis, it is often treated and considered separately due to its specific location within the uterus.
As this case is a complex variant of endometriosis, it will be the subject of an entire article to go into detail.
Lower back pain is common in people with endometriosis and can sometimes radiate into the legs, causing symptoms similar to sciatica and cruralgia. Sciatica presents as pain in the back of the leg due to compression of the sciatic nerve, while cruralgia causes pain in the front of the leg due to compression of the femoral nerve. This pain can be particularly persistent and disabling in patients with endometriosis, with symptoms that can include acute or chronic pain in the lower back and legs, limiting mobility and affecting quality of life.
In the upcoming articles, we aim to offer you more than just an analysis of the diagnostic methods and treatments available for endometriosis. We also want to convey a message of hope and assure you that you are not alone in this fight.
Endometriosis is a complex condition and often difficult to identify due to symptoms that can be confused with other common gynecological conditions. But we're here to guide you through this medical maze, helping you understand and navigate your health journey.
We'll detail the latest diagnostic methods and medical advances. Techniques such as the saliva test developed in 2022 by Lyon-based startup Ziwig to quickly and non-invasively diagnose endometriosis give us new hope for more accurate diagnosis and more targeted treatments.
We'll also look at natural approaches that can complement traditional medical treatments, giving you a wider range of options to relieve symptoms related to endometriosis.
By combining these diverse perspectives, our goal is to provide you with a comprehensive and insightful perspective on understanding and managing endometriosis. We are committed to supporting you in your fight against this disease and providing the necessary support so you can move forward with confidence toward a better future.