Endometriosis (endometriosis) affects millions of women worldwide, and it is estimated that 5-10% of women of reproductive age suffer from this disease. According to the latest statistics, the number of people with the disease exceeds 1.76 billion worldwide. Although endometriosis is a benign disease, it has similar behavior to malignant tumor such as adhesion, infiltration, recurrence and distant metastasis, which is called “benign cancer” and “enigmatic” disease, and has become an increasingly difficult disease in gynecology, seriously affecting women’s physical and mental health and quality of life. It has become an increasingly difficult to treat gynecological disease, seriously affecting the physical and mental health and quality of life of women. Endometriosis (endometriosis) is not a newly discovered disease. The disease has been documented in ancient Egypt and China. Unfortunately, in modern society, we still know very little about this disease. Many people feel that it is not even easy to pronounce the words “endometriosis”. There are still a lot of unanswered questions about the causes of the disease, diagnosis, treatment, prevention of recurrence, etc. It has been called a “mysterious disease”. In fact, many women who suffer from endometriosis must endure long periods of pain. They suffer from severe dysmenorrhea or chronic pelvic pain, or they are physically and emotionally exhausted by the marital and family troubles associated with infertility. Also, their sexual life is affected. However, the lack of awareness of this disease and even many misconceptions have led many patients, including some doctors, to be insufficiently alert to this disease. Statistics show that many patients spend years and see several doctors before they are diagnosed as suffering from endogamy. Young girls, even, have been taught by their mothers incorrectly that abdominal pain during menstruation is a normal condition that must be endured, thus delaying the diagnosis for eight or ten years. Endometriosis is one of the most common conditions in women of childbearing age Endometriosis is one of the most common benign conditions. Many women suffer from endometriosis during the most fertile and creative years of their lives. How high is the incidence of endometriosis? According to statistics, the incidence is about 5%-15% among women of childbearing age, and it is even higher among women with infertility, about 30%, and nearly 50% among women with pelvic pain! In recent years, the incidence has been increasing. Globally, the incidence is higher in Asians than in Europe, with Asian women accounting for about 51% of the total number of patients. This disease seriously affects the health and quality of life of young and middle-aged women and should be given wide attention for early diagnosis and management. So, what are the typical symptoms that patients with endometriosis usually have? 1. Secondary progressive dysmenorrhea This is one of the main symptoms of ectopic disorder. Those with dysmenorrhea account for about 70%. Secondary progressive dysmenorrhea means that if there was no dysmenorrhea originally, it appears later and gets progressively worse. About 1/3 of patients complain of pain after sexual intercourse, and some even fear intercourse. The typical symptoms of ectopic disorder include anal cramping, stabbing or throbbing pain, which in mild cases is only present during menstruation and in severe cases is always present during the week. In a few cases, the pain also radiates to the thighs or vulva. Ovarian endometriosis cysts, or “chocolate cysts”, may also rupture and cause sudden lower abdominal pain, which may be misdiagnosed as appendicitis and be operated on in surgery. Another strange phenomenon in ectopic disease is that there is no clear relationship between the degree of stomach pain and the severity of the disease. We have encountered “chocolate cysts” larger than a child’s head in which the patient has no abdominal pain. In some cases, the pain is unbearable when there are only ectopic nodules growing in the back of the uterus. 2. Infertility This is another major symptom of ectopic disease. About 1/3 to 1/2 of the patients are infertile. Among women with unexplained infertility, about half of the patients can be found to have endometriosis. 3. Menstrual abnormalities There may be increased menstrual flow, prolonged periods and premenstrual dripping bleeding, which are related to ovarian dysfunction or concurrent diseases. Ectopic disease of the cervix or vagina may cause abnormal bleeding or even heavy bleeding. Treatment of endometriosis Clinical treatment follows a 28-word approach: reduce and eliminate lesions, relieve and relieve pain, improve and promote fertility, and reduce and avoid recurrence. Treatment takes into account the patient’s age, fertility requirements, severity of symptoms, extent of lesions, previous treatment history, and the patient’s wishes. Patients are treated on an individualized basis. Pelvic pain, infertility and pelvic masses are treated separately. Treatment options include surgical, pharmacological, and assisted reproductive treatment. Laparoscopy is the gold standard for the diagnosis of endometriosis and is the preferred treatment modality. Laparoscopy has been widely used for diagnostic examinations and surgical treatment because of its minimally invasive, aesthetic and quick postoperative recovery advantages. Drug therapy is considered one of the main means of endometriosis treatment. It can inhibit ovarian function, stop the progression of endometriosis, reduce the activity of endometriosis lesions as well as reduce the formation of adhesions. It can also be used postoperatively to reduce recurrence. Malignant transformation of endometriosis is a problem that cannot be ignored Large-scale clinical studies at home and abroad have found that endometriosis has the possibility of malignant transformation into cancer. The average duration of the disease is more than 8 years, and the chance of malignant transformation is about 1% to 2.5%. Ovary is the most malignant part and can become ovarian cancer, which is the deadliest malignant tumor in the reproductive system, and the five-year survival rate has been hovering around 30%. Therefore, it is important to be alert to the problem of malignant transformation of endometriosis. Patients with long-term conservative treatment, drug treatment, and patients after conservative surgery should have regular checkups, pay attention to diagnostic imaging, and changes in tumor markers to strictly prevent the occurrence of malignant changes. BOX: Why endometriosis occurs The normal endometrium should cover the inner surface of the uterine cavity, but any place other than the endometrium growth is “ectopic”. The most common site is the pelvic cavity, which is most likely to be involved in the peritoneum of the pelvic floor and the ovaries. Endotopic disease can also involve organs outside the pelvic cavity, such as ureters and intestinal tubes, and even the pleura and nasal mucosa, resulting in periodic hemoptysis and nosebleeds. Some people compare this “ectopic” to “illegal immigration”. So, why does “illegal migration” occur? First of all, there is the doctrine of retrograde flow of menstrual blood. That is, menstrual blood flows backwards through the fallopian tubes into the abdominal cavity. But this theory cannot explain all the clinical manifestations of endometriosis, such as how the “ectopic” lesions in the nasal mucosa or the lungs are created. It is not easy to explain. Therefore, another theory has been proposed, the somatic epithelial metaplasia theory, which states that epithelial cells, especially the peritoneal epithelium, have a tendency to differentiate into other epithelium. But when does it happen? Under what circumstances? It is not known.