Patient: Description of condition (onset, main symptoms, hospital visited, etc.): 47 years old, suffering from endometriosis for 7 years, ca125 was 120, uterus six weeks, with dysmenorrhea but without painkillers, ca125 was 18, uterus six weeks, no dysmenorrhea after taking endometrium for three months in the third year of suffering. In January this year, menstrual cramps worsened and became unbearable, the left abdomen was bulging and stabbing, ca125 was 220, the doctor checked the uterus for ten weeks, ultrasound left anterior wall adenomyoma 6*3.9, suggesting adenomyosis, in February, I was allergic to mafron, (I am allergic) In the third year, after taking endometrium for three months, ca125 was 18, the uterus was six weeks, no menstrual cramps. In January this year, the menstrual cramps became more unbearable, the left abdomen bulged and stabbed, the ca125 was 220, the doctor checked the uterus for ten weeks, the ultrasound left anterior wall adenomyoma 6*3.9, suggesting adenomyosis, in February, I was allergic to MaFuLong, (I am allergic) Is there a rule of thumb without removing the uterus? Wang Xiaoyuan, Department of Obstetrics and Gynecology, Shandong Province Qianfo Mountain Hospital
Wang Xiaoyuan, Department of Obstetrics and Gynecology, Jinan Central Hospital: If you don’t want to remove the uterus, you can consider laparoscopic excision of large parts of adenomyoma to improve menstrual pain, but there is a possibility of recurrence after surgery.
Patient: Thank you very much, Dr. Wang! You suggested laparoscopic major excision of adenomyoma, and since I have to wait for about six months for this operation, can I use endometrium to treat it first during these six months? Or is there any other way?
Wang Xiaoyuan, Department of Obstetrics and Gynecology, Jinan Central Hospital: Yes, it can reduce intraoperative bleeding.
Patient: Thank you again, Dr. Wang! May I ask again: Has the uterus shrunk or increased in size in six months after the surgery?
Patient: Thank you again, Dr. Wang! Please ask again: Will my uterus increase in size in six months after the surgery? Will the uterus shrink or increase in size when I take Nemonetone? If it is still enlarged? Do I need to use Daphylline now?
The Department of Obstetrics and Gynecology of Jinan Central Hospital, Wang Xiaoyuan: The mechanism of action of Nemeton and Dafylline is the same, which can shrink the lesion, but the latter has no effect on liver function. In Beijing, Dr. Zhang Zhenyu of Chaoyang Hospital is a master in laparoscopic adenomyoma resection, you can look for him.
Patient: Thanks to Dr. Wang! I am a patient in Beijing and immediately contacted Dr. Zhang. I have 3 questions for you: 1: I am allergic, I took one piece of Mafolone in February, that is, I had abdominal discharge, and then I continued to take it and reflected all the adverse reactions shown in the drug. The doctor did not recommend Daphylline for fear that the body would not work, so I was given Endometrium, which was painless three days after the first tablet, but only a light rise in the left lower abdomen, and today I am taking 6 tablets; my uterus is now 10 weeks old during surgery, so if there is no discomfort with Daphylline and my uterus is shrinking, can I be treated with an IUD? 3. Is there any sequelae if the uterus is removed to treat this lesion? (I am very reluctant to have my uterus removed)
Wang Xiaoyuan, Department of Obstetrics and Gynecology, Jinan Central Hospital: For adenomyoma and restrictive adenomyosis, the effect of Manuel is not good, but after laparoscopic surgery, dysmenorrhea can be improved significantly, but of course, it has a great relationship with the operator, after all, after a few years of amenorrhea. The only radical surgery is total hysterectomy, which generally has no significant complications except for possible early menopause.
Patient: 05 years felt dysmenorrhea 02 years ca125 for, 05 years felt dysmenorrhea 02 years ca125 for 80 Concordia diagnosed endometriosis 05 years —–10 5 years visit ca125 for 80-120 ultrasound suggest diffuse adenomyosis in 06 years Followed Concordia doctor’s advice to take 3 months endometrium ca125 for 18 ultrasound suggest diffuse adenomyosis 3 months later ca125 for 80-120 ultrasound suggest diffuse adenomyosis In 2007, after following the doctor’s instruction to take 3 months of Nemeton ca125 for 18 months, the ultrasound suggested diffuse adenomyosis, ca125 for 80-120 after 5 years of compliance with the doctor’s instruction: 1. every six months to check ca125 and ultrasound, 2. for 5 years, there is a day or two before the menstrual period, menstrual pain is uncomfortable, 5 years did not take painkillers, do not need to take medication. 5 years of menstruation 28 days are regular. The uterus is six weeks old. In September 2010, ca125 was 80-120 and ultrasound suggested diffuse adenomyosis. 11 years: in January, menstrual pain was significantly worse and I felt a bulge in my left lower abdomen. The doctor suggested IUD. In February, the doctor recommended IUD and switched to Mafron. In February, she had dysmenorrhea. After menstruation, I felt a rise in my abdomen and belly. In March, I stopped taking Mafolone. I had painful periods and did not take any painkillers. March 24: I visited the doctor 3 weeks after stopping the medication and was advised to have a hysterectomy because my uterus was 8 to 10 weeks old. March 25 The doctor suggested to take progesterone for 2 months to consider the removal of the left adenomyoma, but it will recur. On March 26, she took Nemetone, and on March 30, she had menstruation without any pain and fatigue. March 16 ca125 188.5 liver function is normal. Ultrasound of uterus suggests adenomyosis. Ultrasound of liver shows a single hemangioma. Uterine ultrasound suggestive of adenomyosis April 25 ca125 81.96 normal liver function. Ultrasound of uterus indicates adenomyosis Ultrasound of liver with multiple hemangiomas. May 16 After taking February progesterone, ca125 is 43 and liver function is normal. Ultrasound of uterus suggests adenomyosis Ultrasound of liver with multiple hemangiomas. May 20, the doctor’s opinion: gynecological examination confirmed the diagnosis of the left side is not adenomyoma is myoma, confirmed taking progesterone 1 capsule without menstrual pain, stop taking progesterone, no IUD, observe 1 to 2 months, can consider removing the left side of myoma. Dr. Wang, is the multiple hemangiomas on liver ultrasound related to taking progesterone? Should I continue to take the medication? What disease caused the high ca125?
Wang Xiaoyuan, Department of Obstetrics and Gynecology, Jinan Central Hospital: It should not be related to progesterone, and the elevated CA125 is related to adenomyosis.
Patient: Thank you, Dr. Wang! You and both Dr. Zhang Zhenyu are my respect and trust! I have made an appointment with Dr. Zhang for laparoscopic excision of adenomyosis (left side) and pelvic lesions and repair of the uterus next month, and since I have been taking progesterone for three months so far and my liver function is normal, I need to take another month of progesterone before the surgery next month as advised by Dr. Zhang. Dr. Wang, if the liver function is abnormal in the fourth month, is it possible to operate? Should I do it after my period or should I continue to take the fifth month of progesterone? Is the recent anal acidity and left abdominal acidity (gastroenterology examination is normal) related to this disease? How long does it take to recover from laparoscopy and are there any after-effects? Thanks again, Dr. Wang!
Wang Xiaoyuan, Department of Obstetrics and Gynecology, Jinan Central Hospital: It’s okay to take another month, no need to wait for menstruation. The digestive symptoms are related to the disease and may be combined with endometriosis. Recovery from laparoscopic surgery is fast, usually 2 weeks after surgery.
Patient: Dear Dr. Wang: Thank you very much for your recommendation Dr. Zhang Zhenyu, he gave me on July 1 laparoscopic surgery to remove adenomyosis nerve, now after surgery in February gynecological examination is normal, postoperative TCT results in another half month, after surgery in March to do ultrasound. July and August injections Norad, because of the injection of Norad body state strange uncomfortable September independent stop Norad, please ask you: 1. After the second injection of norethindrone, on August 17, the test of estradiol and progesterone are in menopause, on the 24th the doctor prescribed tibolone 7 tablets, once every other day, because of allergies did not eat; now the independent stop norethindrone, but also take tibolone? 2 If the TCT and ultrasound results are normal after half a month, will menstruation resume? (Pre-operative menstruation is regular) 3. what other tests and medications are needed? Thank you, Dr. Wang, for your trust!
Obstetrics and Gynecology Department of Jinan Central Hospital, Xiaoyuan Wang: I am waiting to resume menstruation after stopping the medication, I don’t know if I have any menopausal symptoms and what is the result of estradiol?
Patient: Thank you for rushing to reply in the middle of the night! My surgical diagnosis: endometriosis in the rectal recess of the uterus, excision of the resisted nerve, excision of 5*6 adenomyoma. Estradiol and progesterone were tested on August 17 after the second injection of Norelide in menopause, estradiol is less than 20, progesterone is 0.16; symptoms: 1. poor sleep: weakness, upper eyelids can not lift, poor memory, slow response 2. orthopedic clinic this month, both knees weakness 3 since the post-operative drinking water after meals sweating 4. the second injection after the meal volume significantly reduced, yesterday the lower abdomen stomach gas, gastroenterology clinic this month is normal 5. breast pain. This month’s breast ultrasound diagnosis of double mammary hyperplasia and six months ago the examination results consistent. The above intertwined and co-existing strange symptoms that were not present before the surgery I gave up the injection on my own! Dr. Wang:Is the gas in the lower left abdomen related to the cut nerve? Can I use progesterone if I control recurrence? Can I take the tibolone prescribed? I respect and trust your opinion, thank you!
Wang Xiaoyuan, Department of Obstetrics and Gynecology, Jinan Central Hospital.
At present, estradiol is too low, you need to take tibolone to improve menopausal symptoms; left lower abdominal distension may be related to lesion adhesions, as for progesterone for the time being, there is no need to use it again, observe the improvement of dysmenorrhea after resuming menstruation, it should be significantly improved.
Patient: Dr. Wang; last month’s medical advice to take one tablet of tibolone every other day for a total of 7 tablets, from now on, one tablet a day or every other day, and continue to take mom after 7 tablets?
The main reason for this is that it is a good idea to take one tablet every other day, and you can stop taking it when your menopausal symptoms improve significantly.
Patient: Dear Dr. Wang: I am very grateful for your timely, thoughtful and meticulous response for 19 times in half a year. Your medical ethics and skills deserve my respect and trust! Although I can’t have a face-to-face consultation with Dr. Wang in Beijing, I firmly believe that Dr. Wang Xiaoyuan is the best doctor to see for gynecological diseases!
Dr. Wang Xiaoyuan, Department of Obstetrics and Gynecology, Jinan Central Hospital.
You are very kind, you should.
Patient: Dear Dr. Wang: I’m troubling you again. After stopping 2 injections of Norelide, I took 5 tablets of tibolone every other day in accordance with your instructions and stopped taking it normally. The echogenicity of the myometrium is not uniform, and the posterior wall of the uterus is irregular in outline and slightly protruding locally. The echogenicity in the uterine cervix is homogeneous and the morphology is not significantly abnormal. The left ovary shows two echogenic areas, 4.0*3.4*2.4 in size, with clear borders and fair internal translucency, no obvious masses in the right adnexa, and a dark area of fluid in the pelvis, 1.5 deep. Dr. Wang: the left lower abdomen is obviously sour and up you and digestive judgment may be adhesions, taking a week of whole intestine and four mill soup is not effective, since I feel non-digestive disease, now the stomach abdomen than after surgery also bulging uncomfortable how to cure? After the operation has not yet menstruation left ovary is cysts? How can I treat it? How to treat pelvic effusion? Thank you, Dr. Wang, for your trust!
Wang Xiaoyuan, Department of Obstetrics and Gynecology, Jinan Central Hospital: How about trying morbutine? The left ovarian cyst and pelvic fluid do not need to be treated for now. Also, why is estradiol rising so fast? Is it a lab error?
Patient: Thank you very much! I will take morbutrin today. The doctor in charge also thinks that estradiol is rising quickly with 5 tablets of tibolone taken every other day, but the day before yesterday’s test said that she was about to have her period, so do I need to retest estradiol after November if I haven’t had my period? If I get my period, do I need to have my ca 125 checked and will my adenomyosis come back quickly if my estradiol rises quickly? How can I control it? Dear Dr. Wang, you have worked hard and I sincerely wish you and your family a happy holiday!
Dr. Wang Xiaoyuan, Department of Obstetrics and Gynecology, Jinan Central Hospital: Just wait patiently for the return of menstruation, and recheck blood CA125 after menstruation.