A difficult diagnosis and unsatisfactory treatment...

“When a woman comes to us with an infertility problem, we have a 30 to 40% chance of discovering endometriosis; for those who come about a pain issue, this figure increases to approximately 70%”, confirms Michelle Nisolle, who emphasises that, paradoxically, this condition is very often under-diagnosed, leading many women on a never-ending medical shopping trip. It is estimated that five to ten years often go by between the beginning of the symptoms and the diagnosis...

To be fair, this condition is very difficult to diagnose, and only laparoscopy can reveal these lesions – and, again, only if you have a very practised eye! “These lesions are sometimes very discreet but with practice, when we ‘palpate’ the tissue with our instruments, we can feel a localised thickening.  Not to mention the fact that some lesions are hidden behind a seemingly healthy peritoneum”, Michelle Nisolle continues. And she knows what she is talking about: her PhD thesis in 1996, included a classification for three types of endometriosis – peritoneal, ovarian and rectovaginal – a classification currently used worldwide.  “Initially”, she explains, “peritoneal endometriosis presents itself in the form of red lesions, because the endometrial cells are deposited on the peritoneum, which is full of blood vessels.  Then they gradually become covered, merging into the peritoneum and the lesion takes on a blackish aspect. Finally, as fibrosis develops, it becomes whitish. Some of these lesions will disappear spontaneously but not the majority of them.”

“My clinical plan essentially consists of developing therapeutic strategies to help these women”, Michelle Nisolle continues. "This is no small matter because many couples break up, either because of the pain during sexual intercourse, or because of the tension caused by waiting for a pregnancy that never happens. And yet, although there are a whole range of drugs to treat endometriosis, very few are actually efficient.”

With the knowledge we currently have, we make do with calming the symptoms above all: either by prescribing painkillers or anti-inflammatories to reduce the pain, or by blocking the menstrual cycle with contraceptives or other medication. If there are no periods, there is no pain... But with either strategy, the endometriosis remains. It doesn’t progress but it doesn't regress either. And when a pregnancy is desired, the problem will still be there... Therefore, doctors are essentially required to operate for infertility problems. “This type of surgery is difficult, more difficult than operating on cancer, because of the many adhesions caused by the disease itself. We are therefore dealing with a high level of inflammation, where it is sometimes difficult to distinguish some organs from others”, emphasises Michelle Nisolle, whose reputation as a surgeon stretches beyond the Atlantic (read "Robot or plasma energy?”).

An analogy with cancer?

Wandering cells that leave their original mucous membrane to settle elsewhere in the body is somewhat out of the ordinary... We can’t help thinking of similarities with metastases escaping from a malignant tumour to go and proliferate in other tissues. This analogy didn’t escape Michelle Nisolle’s attention, or that of Professor Jean-Michel Foidart when he asked the researcher, in 2002, to come and continue at the GIGA-Cancer’s Laboratory of Tumour & Development Biology the work she had previously begun .