Endometriosis is one of the most common gynecological diseases in women of childbearing age, and it is often combined with infertility. The development of this disease is similar to malignant tumor in many aspects, especially the disease is very easy to recur, and it brings a lot of physical and mental pain to the patients. Many people are diagnosed with this disease by doctors due to infertility tests.
First of all, let’s talk about what is endometriosis. The uterus is a cavernous organ with an inverted pear shape. The main structure is a thick layer of muscle that forms the palace where the fetus lives. When not inhabited by a fetus, like an uninflated balloon, the cavity is just a gap where two layers of muscle stick together. The inner layer of the muscle is covered with an inner membrane and the outer layer is the plasma membrane. The lining, which is literally understood to be supposed to be inside the uterus, thickens and sheds with the menstrual cycle to form menstruation.
If once, for various reasons, it leaves its original place, for example, into the pelvic cavity, and is planted on the ovaries, on the pelvic peritoneum, and possibly even in the bladder, rectum, liver, lungs, etc., it is endometriosis. Endometriosis on the ovaries often forms cysts, similar to tumors of the ovaries, but not tumors. Because the ectopic lining, like the endometrium, bleeds with the menstrual cycle, a chocolate colored cyst forms inside the ovarian endometriosis cyst, hence the common name “chocolate cyst”. In other areas of the uterus, endometriosis also tends to bleed periodically as does the lining in place, with localized lesions such as purple-blue nodules and fibrous connective tissue hyperplasia. Endometriosis is related to estrogen and is called estrogen-dependent disease, which means that the fertile period when estrogen production is high is the time of prevalence. The disease basically does not develop before puberty. After menopause, the disease will gradually disappear.
Clinical manifestations
1. Dysmenorrhea, chronic lower abdominal pain, painful intercourse, and painful bowel movements. Often there is no dysmenorrhea in the first few years of menstruation, and then it appears later, with increasingly severe dysmenorrhea, starting with pain during menstruation and gradually progressing to continuous pain throughout the menstrual cycle.
2. Infertility: Endometriosis often causes infertility. The disease affects pregnancy in many ways.
(1) Ovulation disorders: abnormal egg development, non-rupture of follicles, insufficient luteal function;
(2) adhesions and obstruction of the fallopian tubes;
(3) Decreased endometrial tolerance (embryos do not easily implant).
(4) abnormal abdominal fluid (abdominal fluid contains many components that are not conducive to pregnancy).
(3) Ovarian chocolate cyst: the diagnosis of “chocolate cyst” can usually be clearly diagnosed under ultrasound. For other pelvic endometriosis, a preliminary diagnosis can be made by combining clinical symptoms and physical examination by a doctor, but a definitive diagnosis requires laparoscopic confirmation.
Treatment methods
Objectives of treatment: remove lesions, relieve pain, promote fertility, and prevent recurrence.
Best treatment: pregnancy, promotion of fertility, laparoscopy.
The disease can be relieved during pregnancy and delays recurrence. So for women with fertility requirements, pregnancy is the best treatment. However, often patients with endometriosis cannot get pregnant naturally, so doing everything possible to promote fertility as soon as possible is the best treatment.
1.If you have been married for a short time, have not been treated for infertility, do not have coeliac disease, have regular menstruation, have clear fallopian tubes and normal semen of the male partner, you can monitor ovulation and guide intercourse.
2.After 3 months of guided intercourse without pregnancy, you can promote ovulation treatment and if necessary, artificial insemination to improve the chances of pregnancy.
3.With cochlear implantation less than 4 cm, but no other infertility factors, it is recommended to promote ovulation and artificial insemination to get pregnant as soon as possible.
4.If the coelomic bursa is larger than 4 cm, especially combined with tubal adhesions, laparoscopic surgery is recommended, and post-operative fertility treatment is recommended as soon as possible.
5.If the fallopian tubes are incompetent or the tubal adhesions are still infertile after surgical treatment with artificial insemination, IVF should be done as early as possible.
Why is it better to have children as soon as possible after chocolate cyst surgery? The reasons are as follows.
1. The post-operative period is the easiest time to get pregnant.
2. The disease has a high chance of recurrence and the ability to conceive decreases over time.
3, the process of pregnancy is the best treatment for this disease, perhaps after the birth of a child, the disease is cured.
4.The older you are the more your fertility will decline year by year.
If you do not have children for many years, the inflammatory diseases of the reproductive organs will increase year by year, further affecting the ability to get pregnant. Many patients often ask if they can have this disease without surgery?
It is best to be treated conservatively with medication, preferably herbal medicine. Unfortunately, traditional Chinese medicine is ineffective, and western hormonal drugs are effective, but they are ineffective, have high side effects, and cannot be applied for a long time, and the disease will rebound after stopping the medication. Therefore surgery is still the preferred method. Laparoscopic surgery is the best method to treat this disease. Laparoscopy allows both clear diagnosis and removal of the lesion.