{"id":630,"date":"2022-06-15T23:55:16","date_gmt":"2022-06-15T23:55:16","guid":{"rendered":"https:\/\/afiyafrica.com\/?p=630"},"modified":"2022-06-15T23:55:16","modified_gmt":"2022-06-15T23:55:16","slug":"lendometriose-maladie-ignoree","status":"publish","type":"post","link":"https:\/\/afiyafrica.com\/index.php\/dossier\/lendometriose-maladie-ignoree\/","title":{"rendered":"L\u2019endom\u00e9triose, maladie\u00a0 ignor\u00e9e?"},"content":{"rendered":"
\n
\n \t<\/i> Read Time:<\/span>4 Minute, 47 Second <\/div>\n\n <\/div>\n

L\u2019endom\u00e9triose est une maladie b\u00e9nigne au sens m\u00e9dical du terme, c\u2019est \u00e0 dire qu\u2019elle n\u2019impacte pas le pronostic vital, mais elle peut \u00eatre extr\u00eament douloureuse et certaines formes peuvent invalider le quotidien des personnes atteintes et constituer un handicap invisible.<\/p>\n\n\n\n

C’est la pr\u00e9sence en dehors de la cavit\u00e9 ut\u00e9rine de tissu semblable \u00e0 la muqueuse ut\u00e9rine qui subira, lors de chacun des cycles menstruels ult\u00e9rieurs, l\u2019influence des modifications hormonales.<\/p>\n\n\n\n

Les sympt\u00f4mes peuvent \u00eatre multiples et li\u00e9s \u00e0 la localisation de la maladie, chroniques ou p\u00e9riodiques, ou totalement absents dans les formes asymptomatiques, et leur intensit\u00e9 n\u2019est pas r\u00e9v\u00e9latrice de la gravit\u00e9 des l\u00e9sions.<\/p>\n\n\n\n

Les formes d\u2019endom\u00e9triose<\/h2>\n\n\n\n

Aujourd\u2019hui on ne classifie plus les endom\u00e9trioses en \u00ab stades \u00bb I \u2013 II \u2013 III \u2013 IV. On parle d\u00e9sormais de 3 formes d\u2019endom\u00e9triose. Voici les d\u00e9finitions issues des Recommandations pour la pratique clinique de l\u2019endom\u00e9triose (RPC endom\u00e9triose) publi\u00e9es par la Haute autorit\u00e9 de sant\u00e9 et le Coll\u00e8ge national  des gyn\u00e9cologues et obst\u00e9triciens de France (CNGOF) en 2018 :<\/p>\n\n\n\n

\u2013 l\u2019endom\u00e9triose superficielle (ou p\u00e9riton\u00e9ale) qui d\u00e9signe la pr\u00e9sence d\u2019implants
d\u2019endom\u00e8tre ectopiques localis\u00e9s \u00e0 la surface du p\u00e9ritoine,<\/strong><\/p>\n\n\n\n

\u2013 l\u2019endom\u00e9triose ovarienne : l\u2019endom\u00e9triome ovarien est un kyste de l\u2019ovaire caract\u00e9ris\u00e9 par son contenu liquidien couleur chocolat,<\/strong><\/p>\n\n\n\n

\u2013 l\u2019endom\u00e9triose pelvienne profonde (ou sous-p\u00e9riton\u00e9ale) correspond aux l\u00e9sions qui s\u2019infiltrent en profondeur \u00e0 plus de 5 mm sous la surface du p\u00e9ritoine.\u00a0L\u2019endom\u00e9triose profonde peut toucher typiquement les ligaments ut\u00e9rosacr\u00e9s (50 % des cas), le cul-de-sac vaginal post\u00e9rieur (15 %), l\u2019intestin (20-25 %), repr\u00e9sent\u00e9 majoritairement par la face ant\u00e9rieure du rectum et la jonction recto-sigmo\u00efdienne, la vessie (10 %), les uret\u00e8res (3 %) et audel\u00e0 de la cavit\u00e9 pelvienne, le sigmo\u00efde, le c\u00f4lon droit, l\u2019appendice et l\u2019il\u00e9on terminal pour les\u00a0localisations les plus fr\u00e9quentes.<\/strong><\/p>\n\n\n\n

Rappelons qu\u2019il n\u2019y a pas de corr\u00e9lation entre l\u2019intensit\u00e9 de la douleur ou le type d\u2019endom\u00e9triose et qu\u2019une endom\u00e9triose superficielle peut \u00eatre tr\u00e8s douloureuse en raison de la pr\u00e9sence de nombreux nerfs.<\/p>\n\n\n\n

Les sympt\u00f4mes<\/h2>\n\n\n\n

Les sympt\u00f4mes peuvent \u00eatre multiples et li\u00e9s \u00e0 la localisation de la maladie, chroniques ou p\u00e9riodiques, ou totalement absents dans les formes asymptomatiques, et leur intensit\u00e9 n\u2019est pas r\u00e9v\u00e9latrice de la gravit\u00e9 des l\u00e9sions.<\/p>\n\n\n\n

Le sympt\u00f4me le plus courant de l\u2019endom\u00e9triose (retrouv\u00e9 chez 50 \u00e0 91% des femmes selon les \u00e9tudes) est la douleur survenant de mani\u00e8re cyclique surtout au moment des r\u00e8gles,  r\u00e8gles douloureuses (dysm\u00e9norrh\u00e9e), douleurs pendant les rapports sexuels (dyspareunie), douleurs pelviennes fr\u00e9quentes, d\u00e9f\u00e9cation douloureuse, difficult\u00e9 pour uriner (dysurie), abdominales (ombilicales \u2026), douleurs pelviennes pouvant irradier jusque dans la jambe (cruralgie), \u2026<\/p>\n\n\n\n

Cette douleur n\u2019est g\u00e9n\u00e9ralement pas une dysm\u00e9norrh\u00e9e primaire qui passe avec du parac\u00e9tamol. Il s\u2019agit, dans la majorit\u00e9 des cas, d\u2019une douleur invalidante entra\u00eenant une incapacit\u00e9 totale ou partielle pendant quelques jours, voire, pour les cas les plus s\u00e9v\u00e8res, permanente, et n\u00e9cessitant le recours \u00e0 des antalgiques puissants et m\u00eame morphiniques.<\/p>\n\n\n\n

Toutes les femmes qui ont des douleurs de r\u00e8gles n\u2019ont pas d\u2019endom\u00e9triose, heureusement ! Si la douleur c\u00e8de avec un simple antalgique, alors il n\u2019y a pas lieu de s\u2019inqui\u00e9ter. La douleur qui doit alerter est celle qui revient chaque mois, de plus en plus forte, de plus en plus pr\u00e9sente et qu\u2019un anti spasmodique ou antalgique l\u00e9ger ne suffit pas \u00e0 calmer. Cette douleur n\u00e9cessite une consultation.<\/p>\n\n\n\n

Toutefois, chaque cas est unique et il existe des endom\u00e9trioses dites \u00ab asymptomatiques \u00bb qui se d\u00e9veloppent sans bruit, sans douleurs\u2026 et souvent, dans ce cas, on d\u00e9couvre l\u2019endom\u00e9triose par hasard, ou lors d\u2019un bilan de fertilit\u00e9.<\/p>\n\n\n\n

L’infertilit\u00e9 est aussi l’une des circonstances de d\u00e9couverte lorsque la maladie peut aussi \u00eatre totalement asymptomatique. Dans ce cas, elle est g\u00e9n\u00e9ralement d\u00e9couverte de fa\u00e7on fortuite alors que la patiente consulte en raison d\u2019une difficult\u00e9 \u00e0 concevoir un enfant. Une proportion importante des patientes endom\u00e9triosiques est effectivement infertile. L\u2019explication scientifique de ce lien n\u2019est pas enti\u00e8rement \u00e9lucid\u00e9e. La pr\u00e9sence d\u2019amas de tissus, et notamment celle de kystes ovariens, peut cr\u00e9er une barri\u00e8re m\u00e9canique \u00e0 la f\u00e9condation dans le cas de l\u00e9sions graves. Des \u00e9tudes r\u00e9centes montrent par ailleurs que l\u2019endom\u00e8tre des patientes endom\u00e9triosiques pr\u00e9sente des profils hormonaux et d\u2019expression des g\u00e8nes anormaux. Il se pourrait donc que l\u2019ut\u00e9rus des patientes pr\u00e9sente des caract\u00e9ristiques d\u00e9favorables \u00e0 l\u2019implantation d\u2019un embryon. <\/p>\n\n\n\n

Les localisations<\/h2>\n\n\n\n

Les organes le plus souvent touch\u00e9s en cas d\u2019endom\u00e9triose profonde sont : <\/p>\n\n\n\n

\u2022 les ovaires\u00a0<\/strong><\/p>\n\n\n\n

\u2022 les ligaments ut\u00e9rosacr\u00e9s\u00a0<\/strong><\/p>\n\n\n\n

\u2022 le rectum<\/strong><\/p>\n\n\n\n

\u2022 la vessie<\/strong><\/p>\n\n\n\n

\u2022 le vagin\u00a0<\/strong><\/p>\n\n\n\n

Plusieurs organes peuvent \u00eatre touch\u00e9s chez une m\u00eame patiente. Dans de rares cas, des l\u00e9sions d\u2019endom\u00e9triose peuvent m\u00eame appara\u00eetre au niveau d\u2019organes localis\u00e9s \u00e0 distance de l\u2019ut\u00e9rus, par exemple dans les poumons ou le cerveau. Concernant cette derni\u00e8re localisation, seuls deux cas ont \u00e9t\u00e9 rapport\u00e9s \u00e0 ce jour. Dans l\u2019un des deux (rapport\u00e9 en 1993), la patiente souffrait d\u2019attaques c\u00e9r\u00e9brales le premier jour de ses r\u00e8gles, jusqu\u2019\u00e0 ce qu\u2019on l\u2019op\u00e8re pour retirer la l\u00e9sion. <\/p>\n\n\n\n

Actuellement, le diagnostic d\u00e9finitif de l\u2019endom\u00e9triose repose sur l\u2019analyse d\u2019un fragment de nodule d\u2019endom\u00e9triose obtenu par biopsie. Or cette biopsie est r\u00e9alis\u00e9e lors d\u2019une intervention chirurgicale par c\u0153lioscopie. Ce geste ne peut \u00eatre programm\u00e9 \u00ab juste \u00bb pour un diagnostic : la biopsie n\u2019est donc r\u00e9alis\u00e9e que lorsqu\u2019un autre geste chirurgical y est associ\u00e9. <\/p>\n\n\n\n

Pour r\u00e9soudre cette \u00e9quation d\u00e9favorable au diagnostic de la maladie, une \u00e9quipe du CHU d\u2019Angers teste une nouvelle technique plus simple et moins invasive : l\u2019utilisation d\u2019un traceur du tissu endom\u00e9trial observable par une technique d\u2019imagerie TEP (tomographie par \u00e9mission de positrons).<\/p>\n

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L\u2019endom\u00e9triose est une maladie b\u00e9nigne au sens m\u00e9dical du terme, c\u2019est \u00e0 dire qu\u2019elle n\u2019impacte pas…<\/p>\n","protected":false},"author":1,"featured_media":631,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[13],"tags":[119,30,57,62],"class_list":["post-630","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-dossier","tag-endometriose","tag-sante","tag-sante-de-la-femme","tag-sante-en-afrique"],"yoast_head":"\nL\u2019endom\u00e9triose, maladie\u00a0 ignor\u00e9e? -<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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