Professor Philippe Descamps on improving diagnosis and treatment of endometriosis

Philippe Descamps

El professor Philippe Descamps, FIGO’s former Vice-Chair, was Vice-Chair of the FIGO Congress 2023 Organising Committee. He discusses the impact of endometriosis and shares key insights on how to improve diagnosis and treatment of this disease.  

What are they key facts and figures on endometriosis? 

Endometriosis is a condition that affects between 5% and 10% of women of reproductive age, causing pain that is often very debilitating – including pain during menstruation, intercourse and defecation – and in some cases even infertility.  

It is characterised by the presence of fragments of endometrium - uterine mucus in an ectopic position, i.e. outside the uterus - which may be located in the ovaries, vagina, rectum, bladder, colon or peritoneum (tissue covering the organs inside the abdomen). It can even be found in the lungs. 

There are typically three types of endometrioses: peritoneal, ovarian and deep endometriosis, which may or may not be linked. 

Endometriosis is a multifaceted disease, which means that diagnosis is often an obstacle course for women suffering from it. 

What are the challenges for an early diagnosis and what progress has been made? 

There is clearly a problem with early diagnosis. The delay in diagnosis is often a result of preconceived ideas, since pain associated with menstruation is traditionally trivialised. 

There has been a great deal of research into endometriosis, but neither tests nor paraclinical examinations have sufficient sensitivity and specificity to establish diagnosis with certainty in all patients, be they blood tests, ultrasound, MRI or even coelioscopy with biopsies. Diagnosis often requires surgery, which is not recommended for very young women presenting symptoms. 

However, there are some recent breakthroughs. Professor Sofiane Bendifallah’s session during Congress presented the results obtained in the evaluation of a saliva test, based on the identification of biomarkers through the high-speed sequencing of micro-RNAs using artificial intelligence. 

This is a very promising test, which enables a rapid diagnosis to be made non-invasively. I mentioned earlier the hesitation we often have about performing a coelioscopy on a young girl to confirm the diagnosis of endometriosis, so this type of test should facilitate making a rapid diagnosis. It could also identify the different phenotypes of the disease, which is important for guiding treatment. 

What progress has been made in terms of treating the disease? 

With regard to the treatment of endometriosis, several experts have reported on advances in surgery including:  

  • Excision of deep endometriosis nodules by automated surgery appears to give better results 
  • Recommendation to take into account patients' quality of life and life choices, in particular by preserving their fertility, for better outcomes 

We must also highlight the importance of anticipation. Anticipation will also be at the heart of the clinical monitoring of endometriosis. The ability to better understand endometriosis and anticipate its development will undoubtedly lead to the most decisive advances in the treatment of this disease. 

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