Pelvic endometriosis: A worrying disease of young women

For almost two decades, endometriosis has become a worrying female pathology for the medical profession as a whole, and more particularly for gynaecologists and obstetricians. Its peak incidence in young women, its impact on fertility and pregnancy, sexuality, marital, family or professional life goes far beyond the health field and concerns all of society in all its aspects. As an estrogen-dependent disease, it draws, in the current state of our knowledge and means, the main part of the medical treatment from the association of level I or II analgesics (sometimes III with specific monitoring) and anti-estrogen hormonal drugs that are perfectly identified for their efficiency but are not adapted to a desired procreation. Chronic pain treatment strategies focused on improving quality of life, in particular those combining specific patient care in pain centers, behavioral and physical treatments, are preferred. Resort to surgery, reserved for complex cases that are not solved by medical treatments or coming from relapses or a desired pregnancy, is implemented according to a multidisciplinary protocol (gynaecological, digestive, urological, etc.) in which the goal is to eradicate all lesions without altering fertility in these patients, who are often nulliparous, and therefore by preferring minimally invasive and conservative techniques to restrict complications and sequelae. The current issues, besides the specific problem of fertility, particularly consist of the access to care and its quality. They go hand in hand with the creation of an approved healthcare circuit and of specialized centers, able to offer all the adequate therapeutical solutions, approved or innovative, a qualified followup and a determined strategy in terms of training, fundamental and clinical research. The necessity to assess the precise incidence of this illness among the whole population, to provide all the conditions for an early diagnosis (far too much delayed nowadays) and for a thorough follow-up on a long-term basis can only find an adequate response in a wake-up call at all the levels of responsibility, be it local, regional or national. These are all the questions raised by this report, and these are all the answers given by the French National Academy of Medicine in its recommendations. (C) 2021 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved.