Today, I'd like to introduce you to Blandine Hougas, a petite gynecologist at 1.55m tall who, on this special day, is here to talk to us about endometriosis! Passionate about her profession, she works every day for the well-being of women.
"It's essential not to suffer pain. We mustn't stay with a body that bruises us. Women already take too much on themselves, we mustn't accept pain. "
Can you introduce yourself and tell us about your background?
My name is Blandine Hougas, I'm 44 years old, and I'm an obstetrician-gynecologist. I began my medical studies at Paris XII (Créteil), then moved to Toulouse for my internship. There, I discovered a real passion for my work, and quickly turned to antenatal diagnosis, mainly performing fetal ultrasounds. Then I became interested in gynecological ultrasound, with a particular focus on endometriosis, a little-known pathology at the time.
Has medicine always been a vocation for you?
Yes, medicine has always been a vocation for me. However, I swore I'd never become a gynecologist and never live in Toulouse. Well, anything can change! Initially, I wanted to work in neonatal intensive care, a field I admire enormously, but I knew that the job demanded a great deal of moral stamina. Losing babies is extremely difficult, and I wasn't prepared for it. In the end, I fell into gynecology.
For those unfamiliar with the disease, can you explain what endometriosis is?
Endometriosis is a pathology that affects women from puberty onwards. It results from the abnormal implantation of cells of the uterine mucosa. Normally, these cells are shed during menstruation if pregnancy does not occur. However, in many women, cells migrate upwards into the genital tract, and in some, these cells cling to the peritoneum, the membrane covering the organs of the pelvis. This leads to an inflammatory reaction, forming nodules that can become very painful with each menstrual cycle.
What are the most common symptoms?
The most frequent symptom is pain, particularly during menstruation. Other associated symptoms include pain during bowel movements, urination and sexual intercourse. More and more women are also describing general signs of inflammation, such as a swollen belly and increased fatigue, especially during menstruation.
Can endometriosis cause pain outside the menstrual period?
Of course, endometriosis is not just a pain associated with menstruation. It's a chronic condition that affects the entire menstrual cycle, with pain exacerbated during periods. Deep endometriosis, in particular, creates a kind of "cement" between organs that are supposed to be mobile. The intestines no longer slide, the bladder becomes blocked and nerve endings are irritated, causing continuous pain.
How does endometriosis affect patients' lives?
For example, I had a patient who fainted every time she went to the toilet! For others, it impacts on their ability to work, care for their children, or even maintain intimate relationships. These pains can affect all aspects of daily life, both professional and personal. It's important to remember that there are as many forms of endometriosis as there are women, and that it's very difficult to predict the evolution of inflammation.
Is it easy to diagnose endometriosis today?
It was complicated for a long time. It was thought that suffering during menstruation was normal, which led to a delay in awareness of the disease. Today, even though progress has been made thanks to awareness campaigns, some women are told that endometriosis is just a fashion phenomenon and that there's no need for diagnosis.
The most difficult thing is access to care: my patients sometimes take 4 to 5 months to get an appointment with a specialist. What's more, diagnosis is tricky. Sometimes, despite obvious pain, an ultrasound scan reveals nothing. These may be flat lesions that will not give clear ultrasound signs. MRI may be necessary, but even this may not be sufficient.
What treatments are available and what are their limitations?
The recommended treatment is mainly hormonal, aimed at suppressing menstruation for at least 18 months. In more severe cases, where there are repercussions on the digestive or urinary organs, or in the interests of short-term pregnancy, surgery may be considered. However, surgery carries risks and is not a miracle solution. In particular, it can cause post-operative pain. I believe that you should always choose what is least damaging to the body, and I maintain that hormone treatment should be tried, despite women's growing reluctance to take hormones. And if the treatment doesn't work, there are a number of other possibilities at our disposal, giving us a wide choice of options.
In parallel, supportive treatments are used, working closely with dieticians to establish anti-inflammatory diets, for example. Or with osteopaths or physiotherapists to relieve muscular tension in the pelvis and reduce patients' pain. Finally, pain physicians and psychologists play a key role in the care of women in pain.
What prejudices would you like to deconstruct about endometriosis?
Although the word is out, many women are told that their pain is "imaginary" or that they should "stop looking at social networks". This type of response is not only offensive, but also very discouraging. It's important to remember that the diagnosis of endometriosis is not always obvious. Even without a formal diagnosis, the pain must be taken seriously and there are solutions to help these women.
What advice would you give to a woman who suspects endometriosis but doesn't know where to turn?
I advise them to get in touch with associations like EndoFrance, which can put them in touch with specialized professionals. These professionals have undergone specific training and have the necessary skills to question and examine patients. and examine patients. This can save them time and effort in searching for answers in the wrong place.
How has endometriosis research evolved?
There has been real progress in the management of endometriosis, notably with new treatments and more hindsight on their effectiveness. For example, Toulouse and other pilot regions are beginning to implement a saliva test to determine whether a patient has endometriosis. Given that the younger the patient, the more difficult it is to diagnose endometriosis, we are anxious to see this test extended to all women, even those under 18.
However, much remains to be done, especially for women with treatment resistance or recurrence. Research into fertility preservation is also a crucial area, as many women have difficulty conceiving because of endometriosis.
How does endometriosis affect fertility?
Inflammation can disrupt the egg/sperm encounter. Adhesions or lesions on the fallopian tubes can prevent the egg from reaching the uterus. There may also be lesions of adenomyosis (damage to the uterus), which prevents the embryo from implanting. Sometimes it's the ovaries that are affected, either by endometriosis cysts or by surgery. And with the pain, sexual relations are not necessarily as frequent.
Do you advise women with endometriosis to conceive earlier?
Age is an aggravating factor, which is why the question of fertility must be raised quickly when endometriosis is suspected. Once again, solutions do exist: for example, we offer women with ovarian damage who so wish, oocyte preservation to enable them to realize their parental project at a later date. However, there are statistics on the one hand and life's pleasant surprises on the other, so don't be discouraged from having children naturally, whatever your age!
What role do you play in supporting these patients?
My main role is to make a precise diagnosis. I carry out ultrasound scans to confirm endometriosis, and am then involved in monitoring the evolution of the lesions. Patients are often referred to me by gynecologists or midwives.
I also play a role in providing psychological support, as many women feel lost when they receive this diagnosis. My role is to provide information to women who think that endometriosis means infertility or chronic pain for life. It's essential to give them clear information and keep their hopes alive, because there are treatments that work. I think it's important to learn to tame your body, control your stress, exercise, eat better, stop smoking, etc., because by taking care of your overall health, you can already do a lot.
What's the most rewarding part of your job?
The most gratifying thing is when I finally make a diagnosis and the patient understands what's going on in her body. Most of the time, they cry with joy, realizing that it wasn't all "in their heads". It's a huge relief and they thank me. So, yes, it's possible to be moved as a gynaecologist!
Conversely, what's the hardest part of your job?
The hardest thing is when I can't find a solution. It can be frustrating for me, because I question myself, but also for the patient, who feels abandoned. I try never to leave my patients without an answer. We explore all the other possible avenues (of which there are many) and I explain each step to them, so they don't feel abandoned with pain that goes on and on.
Is being a doctor difficult to reconcile with your personal life?
It's a very demanding and passionate job, but I'm lucky to have a very supportive husband. I train regularly and take part in congresses, sometimes internationally, to continue learning about endometriosis, which is all the more demanding! But I try to find a balance, set limits and make time for my family. I believe that you can only be a good doctor if you take care of yourself.
What advice would you give to women about their bodies and gynecological health?
Now that's a good question! I often advise them to keep a diary to track their symptoms, sleep quality, stress levels, and to note what they eat. This can help them spot pain triggers, such as certain foods or habits. There are also apps, like Endo Ziwig, that can help them better understand endometriosis and track their gynecological health. I'd love to have the time to develop a site where I can easily find all the advice I give in consultation!
A message for women with endometriosis?
Never give up! My message is that of one woman to another: "We have a body for our whole life, and it's essential to feel good in it". It's essential not to suffer pain. We mustn't be left with a body that bruises us. Women already take too much on themselves, so we mustn't accept the pain. Keep helping her, keep looking for answers, even if the diagnosis can take a long time.
Finally, a few questions to get to know you better:
And outside of medicine, what are your passions?
I'm an avid reader and love running in the mountains. I also love to cook, although my children often tell me that my dishes are a little too "light" for their tastes! But I'm thinking of their health, so I don't let that discourage me.
If you had to name one object that never leaves your bag?
My anti-inflammatory! I'm a migraine sufferer and I'm never without it.
Do you have an anecdote to share about your experience in medicine, especially as a woman in a sometimes masculine environment?
An anecdote that marked me as a woman and as a petite ! It goes back to my internship years. I was in a surgical internship with a very tall surgeon, at least 1m90 tall. In the middle of the operation, he got angry because I wasn't assisting him properly and asked them to get me a footboard because I was too low... even though I was already on a footboard! I ended up perched on two running boards, more than 60 cm off the ground. It was a real challenge, but you always manage, even in the most improbable situations!