Neuropathic pain

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

There are several reasons for this frequent delay in diagnosis:

- Lesions that indicate the presence of this disease are often invisible on examinationsThe recent inclusion of pathology in the medical curriculum (2020)
- The complexity of the disease, there is not one but several endometriosis, with very diverse clinical translations, localizations and evolutions.

- 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 released in October 2021)

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

The symptoms of endometriosis can vary from woman to woman, including:

- Menstrual pain:

- heavy or irregular periods

- Digestive problems

- urinary problems

- lower back pain

- chronic fatigue

- neuropathic pain

- pain during intercourse

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 imaging methods such as ultrasound.

To find an expert gynaecologist/radiologist contact, you can go to the Mapatho, Gynandco directory, or send an email to endometriosis associations that have practitioners' lists.

To have your exams reviewed 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 hormone-dependent, immune and inflammatory, these are the basis of multidisciplinary endometriosis treatment to target:

Rebalancing the hormonal system

Strengthening the immune system

Reduction of 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 them soothe their pain. This recommendation is made by the HAS to doctors, based on the observation that menstruation and pain are linked.

On the other hand, there are no scientific studies to prove that the pill prevents endometriosis from progressing. This is why, even if the pain is relieved, to prevent the disease from progressing in silence, it is essential to benefit from the therapeutic support mentioned above.

In addition to the pill, other hormone treatments are sometimes prescribed according to medical records, such as:

Mirena IUD (hormonal)

or artificial menopause.

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

We have collected women's testimonies on hormonal treatments for endometriosis on our Media website (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 operated on.

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 that have worsened. This may be due to a poorly assessed benefit/risk balance, or from a doctor who is not competent in endometriosis surgery (officially on the medical program since 2020).

We have collected women's testimonies about endometriosis surgeries on our Media site (media.lelabdelendo.com, testimonial 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 generally 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.

C8D administration significantly reduced lesion diameter, volume and surface area.

In particular, C8D was able to modify lesion morphology, reducing epithelial glands and stroma. C8D showed antioxidant effects, reducing lipid peroxidation, Nox-1 and Nox-4 enzyme expression, and 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 evidenced by Masson's trichrome staining and reduced expression of MMP-9, iNOS and TGF-β. C8D reduced inflammation both in the harvested lesions, as shown by increased Ikb-α and reduced cytosolic expressions of COX2 as well as reduced 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 evidenced by reduced mast cell recruitment in the spinal cord and reduced release of neuro-sensitizing and pro-inflammatory mediators. 

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

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

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 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 with the saline group. Compared with the saline group, increased concentrations of TAS 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 regard to inflammatory and oxidative stress parameters in 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 epithelial cells for IL-6 (P = 0.0108), compared with the leuprolide acetate group.

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