Endometriosis: from diagnosis to management

Endometriosis is a common and complex gynecological condition. It is caused by the presence of the endometrium outside the uterine cavity. This condition very often results in severe pelvic pain, particularly during menstruation, painful intercourse, and is also frequently associated with digestive or urinary problems and reduced fertility. It is estimated that 5 to 10% of women of reproductive age and nearly 40% of infertile women are affected.

The Caen Normandy University Hospital is a regional referral center for endometriosis. It has several missions, including:

• To train practitioners or future practitioners in the care of patients suffering from endometriosis;
• To coordinate and participate in research work on endometriosis;
• To engage in a regional coordination dynamic through the EndoReNo association with establishments that take care of endometriosis.

The cases of patients with complex endometriosis or those requiring multidisciplinary care are discussed at Multidisciplinary Tumor Boards (MTBs). These MTBs bring together gynecologists, radiologists, fertility specialists, digestive surgeons, urologists, thoracic surgeons, pain specialists, and other specialists. They are held monthly at the Caen Normandy University Hospital. There is also a MTB , bringing together practitioners from the public and private sectors of the former Lower and Upper Normandy regions, to discuss the most complex cases.

The Caen Normandy University Hospital treats 400 patients per year, including approximately 200 complex cases involving multidisciplinary collaboration.

The Caen Normandy University Hospital participated in the external validation of the Ziwig Endotest® test, the first saliva-based diagnostic test for endometriosis.

This in vitro diagnostic medical device is reserved exclusively for healthcare professionals for the diagnosis of endometriosis from a saliva sample. It is already available in several European countries, as well as in Saudi Arabia and the United Arab Emirates.

Ziwig hopes to make it available in France by the end of 2023: https://ziwig.com/endotest/

Several practitioners are trained within the department to support patients with this disease and offer them comprehensive care and a coordinated treatment pathway – from diagnosis to medical and surgical treatments and infertility management. Endometriosis consultations take place at the Women and Children's Center of the University Hospital

Cervical cancer is a malignant tumor that develops from the lining of the cervix. The main risk factor is the prolonged presence of the human papillomavirus (HPV) in the cervix. Each year in France, it affects nearly 3,000 women and causes approximately 1,100 deaths.

There are two ways to prevent cervical cancer:

• Screening tests should be carried out every 3 years for women between 25 and 29 years old, after 2 normal tests carried out one year apart, then every 5 years between 30 and 65 years old;
• Vaccination against human papillomavirus (HPV) is recommended for boys and girls between 11 and 14 years old. It can also be offered as a catch-up vaccination up to and including age 19.

Cervical cancer screening makes it possible to identify 32,000 cancerous or precancerous lesions each year, and to treat them before they develop into cancer.

The Pap smear, combined with the HPV test , remains the essential examination for screening for cervical lesions. In 2022, the gynecology-obstetrics medical team at Caen Normandy University Hospital performed nearly 1,800 Pap smears as part of the screening for cervical pathologies and the gynecological follow-up of women.