The Another

    Still no cure, but research is trying to catch up



    Nearly 20 years of struggle. This is what Claire Cathrine recalled when she talked about the pain she endured during her periods. “It started when I was 11 years old. I was in so much pain I would vomit. But the doctors would say, ‘Menstruation hurts, that’s how it is.’ Or that it was all in my head and I was a sissy.” One day, Cathrine, a nurse who is now 38, passed out from pain at work. “An intern in general medical said to me, ‘I think you have endometriosis.’ He referred me to St. Joseph Hospital [in Paris]where I finally met doctors who listened to me and took care of me.”

    Like one in 10 women of childbearing age – some 2 million in France and about 200 million worldwide, according to the World Health Organization – Cathrine suffers from endometriosis, a chronic inflammatory hormone-dependent disease. It begins with the first menstrual period and subsides at menopause. It’s estimated that half of all cases of female infertility are due to this condition. However, there is still no cure.

    While its symptoms were described as far back as ancient Egypt, the illness has long been dismissed. In the Middle Ages and the Renaissance, disorders related to menstruation were associated with hysteria, with the Greek etymology (hysterikos, “uterus”) of the term playing a significant role. In 1860, Austrian anatomical pathologist Karel Rokitansky discovered the histology of the disease: cells of the endometrium (the mucous membrane that lines the uterus) are located outside of it. And in 1927, American gynecologist John A. Sampson gave his name to the condition and provided a theory on its origin: a reflux of menstrual blood through the tubes in the pouch of Douglas (the fold in the peritoneum located between the rectum and uterus) that does not drain. This is an extremely common mechanism in women, but it does not necessarily lead to the disease.

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    In concrete terms, endometriosis is characterized by the presence of endometrial cells that migrate abnormally during the menstrual cycle, multiply and colonize the genital organs (ovaries or vagina) and sometimes the rectum, colon and bladder. The problem is that these endometrial cells behave in exactly the same way as if they were located in the uterus. During each cycle, they proliferate and trigger an inflammatory reaction responsible for intense pelvic pain and even bleeding, but they are not destroyed when menstruation occurs. “It was as if I was being stabbed,” recalled Cathrine. Other women mentioned pain that was like “a broken bone,” “renal colic” or “childbirth without an epidural.” Endometriosis can also cause pain during sexual intercourse, defecation or urination. This pain is sometimes even neuropathic.

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