Michel Canis, M.D., Ph.D., Nicolas Bourdel, M.D., Céline Houlle, M.D., Anne Sophie Gremeau, M.D., Revaz Botchorishvili, M.D., Sachiko Matsuzaki, M.D.
Volume 105, Issue 1, Pages 32-34
For more than a century, endometriosis has been described as unexplained, poorly understood, or enigmatic. As a result treatments are not based on the pathophysiology of the disease, which consequently cannot be cured effectively, meaning
that the symptoms, which have major consequences on women's quality of life, will almost inevitably recur. Such pessimistic perspectives have devastating consequences, particularly on the results of treatments for chronic pelvic
pain. All the mechanisms proposed, whether retrograde menstruation, metaplasia, lymphatic and vascular metastasis, embryology, stem cells, and mullerianosis, may occur in all € women. However, we still do not know why and when the disease
begins, and why some patients have minimal disease, whereas others have extensive peritoneal implants and adhesions or large, deep infiltrating nodules or ovarian cysts. We also are almost at a loss to describe a usual and somewhat
‘‘logical’’ spontaneous evolution of this disease, except for ovarian endometriomas, which may increase in diameter and rupture. The ‘‘activity’’ and/or the ‘‘aggressiveness’’ of the disease proposed for many years to explain these differences
in phenotypes still has to be elucidated. Most of the fears of physicians and patients are based on a few ideas. First the risk of recurrence is supposed to be very high, whereas many recurrent clinical symptoms may be explained by inadequate
response to medical treatments and/or incomplete surgical excision of the disease.
Read the full text at: http://www.fertstert.org/article/S0015-0282(15)01926-3/fulltext