Source: French to English Tester Published on: 2026-04-07
Source: The Conversation – France in French (3)– By Nadjib Mohamed Mokraoui, Epidemiologist, PhD candidate at the Center for Research in Epidemiology and Population Health (CESP), Gynecological Epidemiology team (EpiGyn), Inserm. Research work concerning endometriosis, Inserm
Severe pelvic pain, very painful periods, infertility… these symptoms related to endometriosis were already mentioned in medical texts dating back to Antiquity. Yet this disease, which affects 10% of women of childbearing age, was long ignored. The reason: the long history of medical and social representations of female pain.
Having very painful periods. Being constantly exhausted. Suffering during sexual intercourse or experiencing unexplained digestive disorders. For millions of women, these symptoms are part of daily life. Yet, they are still often downplayed, or even considered “normal.” Behind this pain, there sometimes lies a common but long-ignored disease:endometriosis.
It is currently estimated that endometriosis affectsabout one in ten women of childbearing age in the world, that isnearly 190 million women. In France, this would representabout two million people. The average delay between the appearance of the first symptoms and the diagnosis remains estimatedbetween seven and ten yearsin themany countries.
To understand this delay, it is necessary to look back at the long history of medical and social representations of thepainfemale.
A suffering known since Antiquity
Contrary to a common belief, endometriosis is not a recent disease. While its identification as a distinct medical entity is relatively modern, descriptions of compatible symptoms – intense pelvic pain, very painful periods, infertility – already appear in themedical textsofAntiquity.
The first references appear inEgyptian medical papyri dating from around 1855 BCE. In ancient Greece, thewritings ofHippocratic Corpus, attributed to Hippocrates (5th–4th century B.C.), describe gynecological disorders marked by severe menstrual pain, abnormal bleeding, and difficulty conceiving.
These symptoms were then interpreted through the theory of the “wandering uterus,” according to which a supposed mobile uterus was the cause of physical and psychic disorders. Although this explanation was incorrect, it nevertheless reflects an old observation: women’s suffering was observed but understood through philosophical and cultural frameworks, in the absence of biological knowledge.
The National Library of Medicine
The “hysteria”, or the confusion between bodily symptoms and representations of the feminine
Over the centuries, this interpretation has continued. Gynecological pains have been widely perceived as a feminine fatality, and often interpreted as an expression of a moral or psychological imbalance.
The term “hysteria”, derived from Greekhystera(“uterus”), is part of this long history, marked by a persistent confusion between bodily symptoms and social representations of femininity. This approach has had a lasting influence on how women’s complaints have been taken into account andexplored on the medical level.
From suspicion to medical recognition
A turning point occurs at the end of the 19th centurye19th century. In the 1860s, the pathologistKarl von Rokitansky describes, during anatomo-pathological examinations, lesions containing glandular tissue resembling the uterine mucosa, located outside the uterine cavity. These observations constitute the first morphological description of what would later be identified as endometriosis.
At the beginning of the 20th centuryeTo century, theAmerican gynecologist John A. Sampson takes an additional step. Between 1921 and 1927, he introduced the term “endometriosis” and proposed a first conceptualization of the disease as a distinct clinical entity.
He puts forward the hypothesis of retrograde menstruation, suggesting a backflow of endometrial cells into the abdominal cavity. Although this hypothesis remains one of the major explanatory frameworks today, it alone does not account for all the forms and locations of the disease.
These works raise thefoundations of the modern understanding of endometriosis. Yet, they are not immediately accompanied by an improvement in care. For much of the 20th centuryeIn the century, the disease remains perceived as not very severe, while menstrual pain continues to bewidely trivialized.
A chronic disease long made invisible
Long considered primarily from an anatomopathological perspective, endometriosis has gradually been recognized, over the past decades, as a chronic disease associated with inflammatory phenomena. This evolution in knowledge has allowed for a better understandingthe extentofits clinical manifestationsA: severe pain, persistent fatigue, digestive and urinary disorders, significant deterioration in quality of life, and sometimes infertility.
Despite these advances, diagnostic wandering remains significant. This is explained both by the great heterogeneity of symptoms and by the persistence of social representations around menstruation and female pain.
Numerous studies show that patients report having long heard that their pains were “normal” or attributed to stress or anxiety, thus contributing todelay access to diagnosisandTo appropriate care.
A story that is still ongoing
Over the past two decades, the management of endometriosis has undergone a significant evolution. Advances inmedical imaging, notably from theMRIand ofultrasoundspecialized, have made it possible to improve the diagnosis of complex forms, while therapeutic strategies have diversified, with increasing attention paid to quality of life.
In France, this development has been accompanied by increased institutional recognition, particularly with the establishment, in 2022, of theNational strategy to fight endometriosiswhich aims to improve early diagnosis, structure care pathways, strengthen the training of health professionals, and support research.
While these advances have profoundly transformed the understanding and management of the disease, many challenges remain. Current research focuses in particular on better understanding early painful trajectories and intervening earlier, with the goal of moving beyond a strictly curative approach to ultimately consider prevention strategies.
A research project on painful rules from adolescence
From this perspective, thePRECURSOR research project, which will soon be launched in France, deals with very painful rules from adolescence.
Its objective is to assess whether early management combining several approaches could help prevent the onset of chronic pelvic pain and, in the longer term, reduce the risk of developing endometriosis. Adolescent girls suffering from severe menstrual pain will soon be invited to participate in this study.
Also read:
Endometriosis in teenagers: early management is necessary
The story of endometriosis thus sheds light on the persistent challenges for health systems in identifying and managing women’s pain, which remains a central public health issue.
Nadjib Mohamed Mokraoui received funding from the Fondation pour la Recherche Médicale; Fondation Apicil; Fondation pour la Recherche sur l’Endométriose; Association Endofrance
–ref. Endometriosis: a disease long ignored despite symptoms described since Antiquity –https://theconversation.com/endometriosis-a-disease-long-ignored-despite-symptoms-described-since-antiquity-279804