Endometriosis in Marrakech: symptoms, diagnosis and care

Endometriosis is a common gynaecological condition. Every month, the lining of the uterus (the endometrium) prepares to receive a pregnancy and is then shed with the period. In endometriosis, tissue similar to this lining is found outside the uterine cavity, for example on the ovaries, tubes, peritoneum or, more rarely, the bowel and bladder. This tissue responds to the hormones of the cycle and causes inflammation, pain and sometimes adhesions.

The exact cause is not fully known. It is not cancer, it is not contagious and it is not the result of lifestyle.

Symptoms vary a great deal from one woman to another. The most common are:

• very painful periods that stop you working or studying and resist the usual painkillers;
• pain during or after intercourse;
• chronic pelvic pain outside periods;
• digestive or urinary problems that come back at the time of periods (pain on opening the bowels, bloating, pain passing urine);
• marked tiredness;
• difficulty conceiving.

The severity of symptoms does not always reflect the extent of the disease: endometriosis can be extensive with little pain, or limited with severe pain.

Many women hear from adolescence that "pain during periods is normal". Diagnosis is therefore often made after several years of pain. Pain that disrupts daily life nevertheless deserves a consultation, at any age.

The earlier endometriosis is recognised, the more possible it is to relieve pain, prevent progression and protect fertility.

Diagnosis rests on several elements:

• a detailed history of pain, cycles and the effect on daily life;
• a clinical examination, done with your agreement and explained before it is carried out;
• a pelvic ultrasound, most often by the vaginal route, which looks for ovarian cysts (endometriomas) and signs of deep disease;
• a pelvic MRI when ultrasound is not enough or to map deep disease.

Laparoscopy is no longer systematically needed to make the diagnosis: it is reserved for situations where it also allows treatment.

In outline we distinguish:

• superficial (peritoneal) endometriosis, made of small implants on the surface of the peritoneum;
• ovarian endometriosis, with a cyst called an endometrioma;
• deep endometriosis, which infiltrates certain organs (ligaments of the uterus, rectal wall, bladder).

The same patient may have several forms. The form determines the choice of treatment.

There is no single treatment, and the choice is made together, according to your symptoms, age and plans for pregnancy:

• painkillers and anti-inflammatories, to relieve flare-ups;
• hormone treatments, which rest the endometrium and reduce periods and pain (pill taken continuously, progestogens, hormonal IUD, others);
• surgery, most often by laparoscopy, when indicated (endometrioma, deep disease, failure of treatment, blocked plans for pregnancy);
• supporting measures: physical activity, pelvic floor rehabilitation, chronic pain management, psychological support.

No surgery is offered without a clear indication, and a second opinion is always welcome.

Many women with endometriosis conceive, naturally or with help. However, the disease can reduce the chances of pregnancy, notably through adhesions or involvement of the tubes or ovaries.

If you want a pregnancy, talk about it early: the doctor assesses your fertility, discusses the most favourable timing and the options, from simple monitoring to assisted reproduction, avoiding unnecessary surgery that could reduce ovarian reserve.

Chronic pain weighs on tiredness, mood, working life, relationships and sexuality. You do not have to endure it in silence: talking about it is part of the consultation. Regular follow-up lets treatment be adjusted, cysts monitored and adaptation to the different stages of life (plans for pregnancy, postpartum, perimenopause).

The clinic offers a consultation with time, targeted examination and imaging, a clear explanation of your situation and a personalised care plan. When the form is complex, a joint discussion or specialist opinion may be offered.

The doctor does not promise a cure: endometriosis is controlled and relieved, but it can recur. He does not offer "miracle" diets or supplements. This page is informational.