Painful periods and pelvic pain, two of the hallmark symptoms of endometriosis, are the most common gynecologic complaints. Endometriosis affects up to 10% of women, migrating throughout the abdomen, affecting the ovaries, fallopian tubes, bladder and bowels. Despite the debilitating nature of this condition, most women are not diagnosed with the disease for seven years after they seek treatment. Lesions may approximate and form substantial nodules, which may proliferate similarly to tumors, invading other organs and contributing to bowel and bladder dysfunction.

Endometriosis Stages and Endometriosis Symptoms

The pathology of the disease varies from woman to woman and the severity of a woman’s symptoms are rarely correlated with the severity of the disease. During a woman’s menstrual cycle, endometrial lesions cause physiological modifications that exacerbate the disease. Often cavities in the abdomen develop and are then covered in endometrial tissue, leading to internal bleeding during periods.

“It’s currently impossible to predict if a mild form of endometriosis will transition into moderate or severe. Prof Horace Roman

Many women with mild endometriosis suffer from unmanageable pain, while some with the most severe forms of the disease are only mildly symptomatic. Additionally, it is impossible to predict if a mild form of endometriosis will transition into moderate or severe. The American Society for Reproductive Medicine has coined a surgical staging scoring system that separates the progression of the disease into four stages: from stage I (the most minimal form of the disease) to stage IV (the severest form of the disease, with deeply invasive endometrial cells implants).


Endometriosis and Fertility

Women with severe endometriosis often experience troubling infertility because endometrial tissue has compromised the ovaries. Women who struggle to conceive due to endometriosis often pursue in vitro fertilization (IVF) to achieve pregnancy. IVF is a costly, tedious and both emotionally and physically painful process that is unfortunately not always successful and may require many attempts.

Fertility is often a warranted concern for women with endometriosis, as the most severe forms of the disease may require aggressive surgeries like hysterectomy that abolish the potential of future pregnancy. Hysterectomy for endometriosis prevents future fertility and has additional consequences. In the cases in which complete hysterectomy is performed, the woman will enter immediate surgical menopause that is both emotionally and physically shocking.

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A New Approach to Endometriosis Treatment

Professor Horace Roman, MD, PhD, practices at Rouen University Hospital in Rouen, France, focusing on the laparoscopic and robotic management of severe endometriosis. His clinical research areas include ovarian endometriomas ablation and conservative surgery of rectal endometriosis. Under his guidance, a new approach toward the treatment of endometriosis has been adopted at the Rouen University Hospital.

This treatment approach focuses on identifying endometriosis at an early age to prevent the evolution of the disease. Surgical treatment is offered to patients much earlier in the diagnostic process so that surgeries may be less invasive. Surgeries are as conservative as possible, aspiring to leave organs intact and preserve digestive and bladder function.

“In Rouen, we maximize the chance of spontaneous pregnancy and focus on improving women’s quality of life.” – Prof Horace Roman

Women who are diagnosed with severe endometriosis who desire pregnancy are offered surgical endometriosis treatment followed by IVF if necessary. A woman living with severe endometriosis has about a ten percent chance of conceiving without medical assistance. The Rouen approach results in a three to four times higher likelihood of achieving pregnancy naturally. In addition to aiming to maximize a chance of spontaneous pregnancy, the approach also focuses on improving quality of life in general.


What’s Next in Endometriosis Treatment?

Non-surgical treatment for endometriosis has historically involved hormone therapy that blocks ovarian function. This treatment is problematic for women who want to conceive because they cannot become pregnant while on the hormones, yet the endometriosis continues to evolve, possibly reaching a level of severity that will prevent pregnancy even when the hormone therapy is ceased.

“The future of endometriosis treatment relies on finding a way to target the problematic cells without blocking the ovarian cycle.” – Prof Horace Roman

As our understanding of endometriosis evolves, medical treatments are needed that prevent lesions from spreading, effectively negating the need for surgical treatment. The future of endometriosis treatment relies on the discovery of a molecule that can target the problematic endometriosis cells without blocking the ovarian cycle, allowing women to conceive while on the treatment. Additionally, it will be important to identify the genetic and environmental factors that contribute to the development of endometriosis, a content area that is currently poorly understood.

Revolutionize the Way You Treat Endometriosis

Register for the upcoming training with Pf Roman and observe two live cases, one rectal endometriosis and one rectal and bladder endometriosis with bladder resection using Plasmajet.

Learn how to operate on severe endometriosis

Posted by Ranim Chaban

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