What is endometriosis?
Endometriosis is a common gynecological condition known as endometriosis, which is the growth of the endometrium in a location other than the uterine cavity, commonly in the ovaries and pelvic peritoneum, causing pain and other discomfort. When the ectopic endometrium grows on the ovaries, it forms old, hemorrhagic cysts with vesicles that resemble chocolate, hence the name chocolate cysts. The endometrium can also grow in the myometrium, which is called “myometriosis”.
Endometriosis is histologically benign, but its clinical manifestations are the same as those of malignant tumors, with proliferation, infiltration, spread, and even vascular dissemination and distant metastasis, resulting in a range of clinical manifestations. It has a prevalence of about 10% among women of childbearing age, and there is an obvious increasing trend, becoming a “modern disease”. 80% of patients have significant dysmenorrhea, and 50% of them have infertility, which seriously affects the health and quality of life of young and middle-aged women. It can be said that it is a “genie that makes you suffer, torments you, but does not let you die”.
What are the manifestations of endometriosis?
Dysmenorrhea is the main manifestation of endometriosis, with a history of dysmenorrhea accounting for about 70% of cases.
Young women have dysmenorrhea, which is usually the worst on the first day of menstruation and improves quickly thereafter, but the pain level gradually increases with age, and some women do not get better even after having children.
Another characteristic of dysmenorrhea in ectopic disorders is that the dysmenorrhea increases progressively, and many people go to the doctor for this reason. In addition, there is a change in the timing of the dysmenorrhea. For example, if the dysmenorrhea was on the first two days of menstruation, but now it is painful throughout the entire menstrual period, or in some cases it starts a few days earlier and is still painful after the menstruation clears, think of endometriosis.
In addition, about 1/3 of patients have pain in the abdomen during intercourse, and some of them are very severe and thus afraid to have intercourse. Another 1/3 of patients often feel pain on one or both sides of the lower abdomen. Typical symptoms of ectopic disorder include anal cramping, stabbing or throbbing pain, pain during menstruation in mild cases, or pain during normal times in severe cases. In a few patients, the pain also radiates to the thighs or pubic area. Another strange phenomenon in endometriosis is that there is no significant relationship between the degree of stomach pain and the severity of the disease.
How do I know I have endometriosis?
The main manifestation of endometriosis is dysmenorrhea. 87.7% of patients with endometriosis have dysmenorrhea; 71.3% have lower abdominal pain; 57.4% have total abdominal pain; 56.2 have painful intercourse; 42.6% have anal pain; and 39.5% have painful bowel movements. Moreover, infertility caused by endometriosis can reach 50%. When a patient has the above pain or discomfort, he or she should go to the hospital for examination. The doctor will get a preliminary diagnosis by taking a medical history and doing a gynecological examination. Ancillary tests will also be used to confirm endometriosis, such as: diagnostic ultrasound, diagnostic laparoscopy, and serum CA125 measurement can all help to confirm the diagnosis of the disease.
How can endometriosis be prevented?
The cause of endometriosis is not fully understood and prevention is difficult, but it can be prevented by paying attention to the following points.
1. Reduce the chance of medically induced endometrial implantation: ectopic disease in abdominal and lateral perineal wounds is caused by endometrial implantation during surgery. In order to reduce the endometrium brought to the pelvis or other parts of the body, pelvic examinations should generally not be done during menstruation, abortions are best not done or done less often, and negative pressure should be used correctly when done. Menstrual period as far as possible not to do sterilization, excessive menstruation without ordinary intrauterine device, etc.;
2, active treatment of high-risk factors: no strenuous exercise during menstruation, avoid sexual intercourse during menstruation, active treatment of severe primary dysmenorrhea. Regular gynecological examination for those with a family history of ectopic disease, so that early detection and timely treatment;
3. Regular exercise is likely to reduce the occurrence of endometriosis, and long-term use of contraceptive pills also has a certain preventive effect.
Why does endometriosis cause infertility?
About 15-20% of infertile women suffer from endometriosis. The ectopic endometrium can also have periodic bleeding and blood cannot flow out, stimulating the pelvic peritoneum, resulting in adhesions and scars, which can cause obstruction of the fallopian tubes by pressure; causing the plasma membrane of the fallopian tubes to adhere to bundles and twist, thus affecting the transport function of the fallopian tubes to take in eggs and fertilized eggs; adhesions can fix the uterus posteriorly, making it difficult for sperm to enter the mouth of the uterus; adhesions can encircle the ovaries and the eggs cannot be discharged; chocolate cysts, ectopic in The endometrial lesions within the ovary destroy the ovarian parenchyma and affect ovulation and the secretory function of the ovary.
There is also a condition in which ectopic endometriosis is scattered in the pelvic peritoneum in the form of dots or small dots, without discomfort and not detected by gynecological examination, and can only be detected by laparoscopy. The reasons are as follows.
1, the ectopic endometrium produces prostaglandins that are significantly higher than the normal endometrium. Excessive prostaglandins can prevent follicle growth and affect the peristalsis of the fallopian tubes and affect conception; they can also contribute to the degeneration of the corpus luteum, which can easily lead to miscarriage;
2, ectopic endometrium periodic bleeding, can not flow out of the body, the body macrophages macrophage absorption, thus inducing autoimmune reflection, such as serum anti-ovarian antibodies, anti-endometrial antibodies rise, affecting ovulation and corpus luteum function, affecting the implantation of pregnant eggs;
3. Some patients with endometriosis can cause an increase in serum prolactin, which inhibits FSH secretion and causes follicular dysplasia, leading to non-ovulation or luteal insufficiency and infertility.
How to treat endometriosis?
Treatment of endometriosis should achieve four objectives.
1.Reducing and controlling pain
2.To treat and promote fertility
3.Reducing and removing lesions
4. Prevention and reduction of recurrence
The international medical community considers there are five “best treatment” options.
1.Laparoscopic treatment
2.Ovarian suppression therapy
3.”Three stage” treatment method
4.Pregnancy treatment
5. Pregnancy assistance techniques
These five methods are not good or bad, but mainly based on the patient’s age, symptom level, lesion level, marriage and pregnancy hope and past treatment status, so as to individualize the treatment and help the patient to the greatest extent.
The methods of treatment are divided into two categories: surgery and medication. Surgery is the main treatment method today. The modality and scope of surgery can be divided into three types: conservative surgery (preserving fertility); semi-radical surgery (preserving ovarian function); and radical surgery. Although surgery is more effective, there is a considerable chance of recurrence, especially with conservative and semi-radical surgery. Therefore, postoperative pharmacological treatment is essential.
Medications are used to achieve ovarian suppression or “pseudo-pregnancy”, “pseudo-menopause”, often with drugs such as progestins, danazol, endometrium (progesterone) and gonadotropin-releasing agonists. Although medication is effective and safe, the biggest problem is that low estrogen in the body causes menopausal symptoms.
Pregnancy is the main goal of treatment for young patients, and pregnancy itself is the best treatment for endometriosis. Therefore, assisted conception techniques are the main treatment option for endometriosis. Treatment begins with ovulation promotion and intrauterine insemination, and if this is unsuccessful, or if the condition is severe, IVF may be considered.
In a sense, like diabetes, asthma and other diseases, it requires a long period of cooperation, follow-up, counseling and guidance to ensure good results.