Both of them had normal periods before, but in the past six months, their menstrual flow was more than half of what it was before, with dark color and irregular bleeding between periods. Both of them are in their 30s and have no children yet, so they are very anxious. Both patients had scanty menstruation, what caused it? We performed hysteroscopy on both patients, in which Xiao Fang’s uterine wall showed multiple yellow nodule-like granulomas with pathological examination suggesting endometrial tuberculosis, while Xiao Yan’s uterine cavity was basically completely adherent, with normal form disappearing and only a little endometrial tissue visible. The diagnosis was: tuberculous adhesions of the uterus. Both patients presented with decreased menstrual flow, with very different hysteroscopic presentations, and both were finally diagnosed with endometrial tuberculosis. So what kind of disease is endometrial tuberculosis? Why does it cause changes in menstruation? How should the disease be treated formally? First, let’s understand what endometrial tuberculosis is. Endometrial tuberculosis is an inflammation of the endometrium caused by Mycobacterium tuberculosis (called acid-resistant mycobacterium because it stains acid-resistant), often secondary to pulmonary tuberculosis, renal tuberculosis, gastrointestinal, bone or joint tuberculosis, etc. It is often part of systemic tuberculosis. The main source of endometrial TB pathogens is pulmonary or peritoneal TB. Mycobacterium tuberculosis from these sites reaches the reproductive organs by circulation, direct spread or lymphatic transmission, mostly infecting the fallopian tubes first and then spreading to cause endometrial TB. Tuberculosis transmitted through the respiratory tract has an incubation period of several years; therefore, by the time endometrial tuberculosis is detected, the primary lesion may have disappeared. Endometrial tuberculosis accounts for 50-60% of female genital tuberculosis and occurs in women of childbearing age between 20-40 years, with 80%-90% of patients belonging to this age, and can also be seen in prepubertal girls and older women after menopause. Since the founding of the country, tuberculosis has been controlled due to the high priority given by our government to the prevention and treatment of tuberculosis, and the development of anti-TB drugs. However, after the mid-1980s, due to HIV infection and the increase of drug-resistant strains of Mycobacterium tuberculosis, the disease has resumed its epidemic, with about 10 million new cases of tuberculosis each year and about 3 million deaths from tuberculosis. The symptoms of the disease caused by Mycobacterium tuberculosis lack specificity, for example, patients with tuberculosis may not have the typical symptoms of coughing up blood, but rather a prolonged cough. In addition, people are less alert to the disease and it can develop, so it is not conducive to timely diagnosis and treatment. Endometrial tuberculosis often spreads from tubal tuberculosis. In the early stage of tuberculosis bacilli attacking the endometrium, the endometrium becomes congested and edematous, with only a small number of fleshy swollen nodules, and menstruation increases at this time. Although some of the tubercle bacilli are excreted with the periodic shedding of the endometrium, the proliferating functional layer of the endometrium can still be reinfected and the course of the disease can be prolonged. The formation of menstruation depends mainly on the endometrium, and the change of the endometrium from early to late stages leads to the change of menstrual flow from more to less. Therefore, early stage of endometrial tuberculosis hysteroscopy shows granulomas in the uterine cavity, while late stage of endometrial tuberculosis, due to the complete destruction of the endometrium, hysteroscopy shows scarring and even complete adhesions. What are the clinical symptoms that occur after Mycobacterium tuberculosis invades the endometrium? 1, increased vaginal discharge, in which endometrial tuberculosis, due to the transformation of all endometrium into caseous granulation tissue, can appear plasmacy foul-smelling vaginal discharge, if combined with infection of the cervix, there may be purulent or purulent blood discharge, and there may be contact bleeding; 2, changes in menstruation, the early stage of the disease , there may be a decrease in menstrual flow, to the late stage, due to the atrophy and destruction of the endometrium, there may be a decrease in menstrual flow; 3, abdominal pain, uterine In 25%-50% of patients with endometrial tuberculosis, there are different degrees of lower abdominal pain, which is manifested as long-term lower abdominal pain, aggravated before menstruation; 4. Severe patients often have systemic manifestations such as emaciation, low fever, night sweats, fatigue, and a history of infertility and abnormal menstruation; 5. Gynecological examination: it is often found that the patient’s uterus is poorly developed, small or deformed. If combined with pelvic tuberculosis, positive signs such as pelvic mass or pressure pain can be palpated. The following tests can be done to confirm the diagnosis of endometrial tuberculosis: X-rays can be taken to detect lesions such as those in the chest and abdomen; hysteroscopy can directly detect endometrial tuberculosis lesions and biopsies can be taken for pathological examination under direct vision; early lesions can be seen as uneven endometrium with small nodules attached to the surface; in advanced lesions, the uterine cavity is In advanced lesions, the uterine cavity is adherent, the shape is irregular, the scar tissue is hard, and even stone like calcified foci are formed; laparoscopy is also a method of diagnosis. Many patients in the clinic often ask whether the disease is serious or not. Actually, Mycobacterium tuberculosis infection is not serious, due to the development of anti-tuberculosis drugs. However, the endometrial tuberculosis caused by it has a great impact on the patient, often leading to adhesions in the uterine cavity and the formation of scar tissue, making the originally fertile “soil” infertile and causing obstacles to embryonic implantation; another characteristic of endometrial tuberculosis is that the glands around the tuberculous nodules are insensitive to ovarian hormones, showing persistent hyperplasia or insufficient secretion. Inadequate secretion. The abnormal ovarian function seriously affects fertility, and infertility is a complication in the majority of patients. The restoration of fertility in patients with endometrial tuberculosis depends on whether the treatment is timely or complete. Due to the irreversibility of the lesions, those with mild lesions may regain fertility after active treatment, but due to the destruction of the fallopian tubes and endometrium by tuberculosis bacilli, the chances of obtaining a normal pregnancy are low. The damage to the uterine cavity caused by tuberculosis is generally irreversible, and even if the tuberculosis is cured, the chance of natural conception is very small. Therefore, it is very important to prevent this disease, and BCG vaccination should be given as scheduled during childhood, pregnancy should be avoided during the active period of tuberculosis, and when there is a tuberculosis patient in the family, attention should be paid to isolation and treatment. Treatment of endometrial tuberculosis is complicated and requires regular and adequate courses of anti-TB drugs. Patients who have developed tuberculous uterine adhesions, often combined with tubal tuberculosis, are very difficult to treat and require hysteroscopic electrosurgery to separate the adhesions and modern assisted reproduction techniques to obtain a pregnancy. The specific treatment plan will be decided by the doctor according to the condition of the lesion and the patient’s fertility requirements.