Neuropathic pain

Important reminder: Endometriosis suffers from a diagnosis delay of 7 years on average.

Several reasons explain this frequent delay in diagnosis:

- The lesions which testify to the presence of this disease are often invisible on examinations. Recent registration of the pathology in the medicine program (2020)
- The complexity of the disease , there is not one but several endometrioses, with very diverse clinical translations, locations and developments.

- The shortage of gynecologists in France , a recent study by UFC que Choisir shows that 23.6% of women live in a gynecological medical desert. (According to a Senate report published in October 2021)

Important information : If you have suffered physical or psychological medical violence/mistreatment during a medical examination, you can contact the associations: Stopvog and/or Justice Endo.

Symptoms of endometriosis can vary from woman to woman, including:

- menstrual pain:

- heavy or irregular periods

- digestive disorders

- urinary problems

- lower back pain

- chronic fatigue

- neuropathic pain

- pain during intercourse

of infertility.

Pelvic MRI is considered one of the best imaging tests for detecting the presence of endometriosis because it provides detailed images of the pelvic organs and can identify endometriotic lesions that are not detectable by other methods imaging such as ultrasound.

To find a contact for an expert gynecologist/radiologist, you can go to the Mapatho, Gynandco directory, or send an email to the endometriosis associations which have lists of practitioners.

To have your exams reread by an endometriosis specialist, you can send your file to the Second Opinion website.

The 3 therapeutic pillars to target the cause of your pain and hope for long-term relief are:

1. Nutrition/lifestyle (via naturopathy, micro-nutrition, etc.)

2. Stress reduction (via breathing, meditation, sophrology, hypnosis, psychotherapy, etc.)

3. Body mobility (via physical activity, yoga, stretching, osteopathy, physiotherapy, self-massage, etc.)

Given that the disease is hormonal, immune and inflammatory dependent, these are the bases of multidisciplinary treatment of endometriosis to target:

rebalancing the hormonal system

strengthening the immune system

reducing oxidative stress and inflammation

They are complementary to medical treatments.

As there is no curative medical treatment today to treat endometriosis, the pill is "the first-line treatment" in France that gynecologists prescribe to patients to help ease their pain. This recommendation is made by the HAS to doctors, based on the observation that periods and pain are linked.

On the other hand, no scientific study proves that the pill prevents endometriosis from progressing. This is why even if the pain is relieved, to prevent the disease from progressing silently, it is essential to benefit from the therapeutic support mentioned above.

Besides the pill, other hormonal treatments are sometimes prescribed according to medical records, such as:

the Mirena IUD (hormonal)

or even artificial menopause.

In all cases, whether the patient is on hormonal treatment or not, regular monitoring of the disease with imaging remains necessary.

We have collected testimonials from women on hormonal treatments for endometriosis on our Media site (media.lelabdelendo.com, testimonials section).

If you are offered surgery, it is important that you are surrounded by a team of endometriosis experts, and that you study the benefit/risk balance of endometriosis surgery well in advance.

Not all endometriosis can be treated.

Do not hesitate to consult several opinions because sometimes an operation allows you to get better, but sometimes it may not lead to improvements; on the contrary, patients complain of symptoms which have worsened. This may come from a poorly assessed benefit/risk balance, or from a doctor not competent in endometriosis surgery (officially on the medicine program since 2020).

We have gathered testimonials from women on endometriosis surgeries on our Media site (media.lelabdelendo.com, testimonials sections)

Translation of the scientific study: “ Molecular and biochemical mechanism of cannabldiol in the management of inflammatory and oxidative processes associated with endometriosis ”

Okten SB, Cetin C, Tok OE, Guler EM, Taha SH, Ozcan P, Ficicioglu C.

Reprod Biomed Online. 2023 May;46(5):865-875. doi: 10.1016/j.rbmo.2023.01.018. Epub 2023 Feb 2.

PMID: 36997400"

Endometriosis is usually associated with inflammation and chronic pelvic pain.

This article focuses on the anti-inflammatory, antioxidant and analgesic effects of cannabldiol (C8D) and its potential role in endometriosis.

Administration of C8D markedly reduced the diameter, volume and surface area of ​​the lesions.

In particular, C8D was able to modify the morphology of the lesions, reducing epithelial glands and stroma. C8D showed anti-oxidant effects reducing lipid peroxidation, expression of Nox-1 and Nox-4 enzymes. C8D restored the oxidative balance of endogenous cellular defense, as shown by SOD activity and GSH levels in lesions. C8D also showed significant antifibrotic effects, as shown by Masson's trichrome staining and reduced expression of MMP-9, iNOS, and TGF-β. C8D was able to reduce inflammation both in the sampled lesions, as shown by the increase in Ikb-α and the reduction in cytosolic expressions of COX2 as well as the reduction in nuclear localization of NFkB, and in peritoneal fluids, as shown by reduced levels of TNF-α, PGE2, and IL-1α. C8D has significant analgesic effects, as shown by reducing mast cell recruitment to the spinal cord and reducing the release of neurosensitizing and pro-inflammatory mediators.

In conclusion, the collected data showed that CBD has effective and coordinated effects in suppressing endometriosis.

Research question: “ Can cannabldiol (C8D) be used in the treatment of endometriosis for its anti-inflammatory, antioxidant and antiangiogenic effects ?” (against the proliferation of endometriotic cells)

Okten SB, Cetin C, Tok OE, Guler EM, Taha SH, Ozcan P, Ficicioglu C.

Reprod Biomed Online. 2023 May;46(5):865-875. doi: 10.1016/j.rbmo.2023.01.018. Epub 2023 Feb 2.

PMID: 36997400

Results: Significant reductions in endometriotic implant surface area (P = 0.0213), serum concentrations of TOS (P = 0.0491), OSI (P = 0.0056), IL-6 (P = 0.0236), TNF-α (P = 0.0083) and OSI (P = 0.0401), IL-6 (P = 0.0205) and TNF-α (P = 0 .0045) in peritoneal fluid were observed in the CBD5 group compared to the saline group. Compared with the saline group, increased TAS concentrations in serum (P = 0.0012) and peritoneal fluid (P = 0.0145) were observed in the CBD5 group. The CBD5 and leuprolide acetate groups were similar with respect to inflammatory and oxidative stress parameters of serum and peritoneal fluid samples. The CBD5 group showed significantly lower mean intensity in surface epithelium and stromal cells for VEGF (both P = 0.002) and only in surface epithelium cells for IL-6 (P = 0.0108), compared to the leuprolide acetate group.

Conclusion: Due to its anti-inflammatory, antioxidant and antiangiogenic effects, C8D could be a candidate therapeutic agent for endometriosis.