Endometriosis: the surgery supposed to cure it could actually make the pain worse

Home → Article → Endometriosis: the surgery supposed to cure it could actually make the pain worse

One in 1,000 women suffers from endometriosis. This chronic gynecological disease is characterized by the presence of endometrium, the mucous membrane that lines the uterus, outside this area. A phenomenon that causes severe pain during menstruation, but also during sexual intercourse, as well as fertility disorders.

If there is no treatment to cure endometriosis, some can relieve patients. This is the case with non-steroidal anti-inflammatories, which relieve pain, hormonal treatments, which prevent menstruation from occurring and treatments with GN-Rh agonists, which stop the production of estrogen by the ovaries and which place patients in artificial menopause.

Another treatment offered to patients with endometriosis: surgery. The goal? Remove endometrial lesions by laparoscopy, also called laparoscopy. But this operation would not always be effective: in some patients, it could even make the pain worse, as revealed by researchers from the University of Oxford and the University of Edinburgh in an article in the Guardian.

Endometriosis: "The condition of patients does not always improve with surgery"

"We find that patients don't always get better with surgery, and those who do often feel better for a very short time," Andrew Horne, professor of gynecology and life sciences, told the British newspaper. reproduction at the University of Edinburgh.

Endométriose : la chirurgie censée la soigner pourrait en fait aggraver les douleurs

According to this specialist, the effectiveness of this operation would depend on the type of endometriosis. He distinguishes three: cystic ovarian endometriosis, deep endometriosis and superficial peritoneal endometriosis. This last form of the disease concerns 80% of patients and reacts less well to surgical treatment. In question ? The pain would not be caused by the endometrial lesions themselves but by their interaction with the nerves of the pelvis.

Neuropathic pain involved

These patients would thus suffer from neuropathic pain, in other words from damaged nerve endings. This phenomenon could be caused by hypersensitivity of the nerves surrounding the endometriosis lesions, the compression of the nerves by said lesions or the damage caused to the nerves during surgery for endometriosis. Yes, because nerves can develop in endometrial lesions, as explained by Dr. Christian Becker, associate professor at the University of Oxford.

When a patient with superficial peritoneal endometriosis and suffering from neuropathic pain undergoes surgery, nerves can therefore be severed when the lesions are removed. Thus, "patients whose symptoms are mainly caused by neuropathic pain are less likely to benefit from surgery, and may even experience more pain after the operation", explains Katy Vincent, pain specialist and associate professor. at Oxford University. She says nerve pain treatments are said to be more effective than surgery, but have not been approved for the management of endometriosis.

Endometriosis: the need for personalized care

If this specialist underlines that surgery remains "a very important tool in the treatment of endometriosis", it seems to him essential to "better understand when and how it should be used as part of a more personalized treatment plan".

A necessity that notably requires a better understanding of this pathology. And for good reason: "Endometriosis continues to be in the shadows, in part because it is a female disease and funding and research are not yet there", explains Katy vincent.

Improving the management of the disease also involves screening. According to specialists from the universities of Oxford and Edinburgh, an improvement in imaging tools is necessary in order to no longer have to go through laparoscopy, which remains for the time being the only examination allowing a clear diagnosis to be made. of endometriosis.