What is endometriosis?
Endometriosis (English name: endometriosis) is a common disorder in young women, the name of which may not be clear to many, but when it comes to menstrual cramps, it is expected that many will have it.
Endometriosis is often described as a “pelvic dust storm” because it involves a wide range of lesions, usually involving the peritoneum (a layer of membrane covering the surface of organs in the stomach), ovaries, vaginal diaphragm, etc. A simple understanding of endometriosis can be said to be a monthly exfoliation and bleeding of the endometrium inside the uterus. The endometrium has grown out of the uterus in another location, and it bleeds during the monthly menstruation, thus creating various foci of disease.
Endometriosis is a relatively stubborn disease, and once it develops, it often accompanies women during their reproductive years for decades. To date, its treatment is still a worldwide challenge.
What are the symptoms
Dysmenorrhea is the most common symptom of endometriosis. Of course, dysmenorrhea may not necessarily be caused by endometriosis, deformity and inflammation may also be the cause of dysmenorrhea, but it can be said that more than 80% of dysmenorrhea is caused by endometriosis.
2, endometriosis often occurs on the ovaries in the early stage is some lesions on the surface of the ovaries, with the progress of the disease, often repeated bleeding, the formation of an encapsulated accumulation of blood in the ovaries, bleeding once a month, the blood inside will become more and more viscous, like chocolate, this time also called chocolate cysts, commonly known as “coarse cysts This is also called a chocolate cyst, commonly known as a “coeliac”. Once the cyst breaks one day during menstruation, it will lead to acute abdominal pain, so severe abdominal pain during menstruation should suspect the possibility of endometriosis rupture and bleeding.
Painful intercourse is also a common symptom of endometriosis, usually because endometriosis invades the ligaments that hold the uterus in place or the diaphragm between the vagina and rectum, resulting in painful intercourse. Some patients are afraid of the doctor’s finger examination because once the doctor’s finger touches these nodules, it often leads to pain.
4. Patients with endometriosis often have difficulty getting pregnant, and about half of them have infertility. Many infertile patients are also found to have intrapelvic lesions when they undergo laparoscopy.
What are the causes
Like many diseases, endometriosis is a result of genetic + environmental influences. Patients with endometriosis often have a genetic predisposition, combined with external factors such as miscarriage, cold during menstruation, and surgery, followed by the onset of endometriosis, but how it is initiated and how it occurs remains a mystery.
How to diagnose
The gold standard for the diagnosis of endometriosis is laparoscopy, which means that endometriosis can be diagnosed by seeing blue, brown or white nodules on the peritoneum under laparoscopy. However, most patients do not require a surgical approach, as surgery is, after all, an invasive operation. Clinically, the diagnosis of endometriosis is often made empirically based on the patient’s history of dysmenorrhea, the presence of painful nodules to the finger, the presence of characteristic ovarian masses on ultrasound, and the presence of elevated CA125 on laboratory tests. The presence of coarctation also tends to be characteristic.
Does elevated CA125 indicate malignancy?
CA125 is a test often prescribed by doctors in gynecological diseases, CA is an abbreviation of cancer antigen, which translates to cancer antigen. Patients with endometriosis often have elevated CA125, and the degree of elevation is often related to the disease, so CA125 can be used to monitor endometriosis.
How to treat
Endometriosis is a difficult disease to treat. As mentioned earlier, it has been described as a “benign cancer” because it is difficult to control.
Pregnancy is the best form of treatment for endometriosis, as the level of progesterone in the body increases dramatically during 10 months of pregnancy, so it is equivalent to taking 10 months of medication. Many patients with dysmenorrhea often have relief from dysmenorrhea after pregnancy for this very reason.
If the coeliacs are present and are relatively small, they can be observed or treated with medication, but if they are large, more than 4 cm, the doctor will usually recommend laparoscopic surgery to deal with the cyst first. The purpose of the surgery is, first, to clarify the diagnosis and, second, to remove the lesion as much as possible during the surgery to reduce the risk of menstrual rupture and further development. After surgery it is often possible to obtain remission of the disease and the success rate of pregnancy tends to increase. Six months after surgery is often the prime time to get pregnant, so in case of combined infertility, it is often recommended to try to get pregnant after surgery. If you are still infertile after about six months of trying, the next step is to consider an assisted reproductive method, artificial insemination or IVF is helpful to increase the pregnancy rate.
There are many types of medications available, and oral contraceptives can also treat endometriosis. Many women with dysmenorrhea often have less dysmenorrhea after taking oral contraceptives, which is one reason for the treatment. Oral contraceptives contain relatively more progestin, which is helpful in relieving the condition.
Pseudo-menopause or pseudo-pregnancy therapy is the use of drugs that simulate the environment of pregnancy or menopause. Progesterone is often used in the treatment of endometriosis, and after surgery, it is often necessary to use these drugs for treatment as well. Usually the cycle of taking the drugs takes 3 to 6 months because of the possibility of side effects such as masculinization, obesity, and hair, and is usually not used in the treatment of undiagnosed endometriosis. GnRH-a is a class of drugs, including Norelide, Daphylline, Suppressant, etc., which need to be injected, they inhibit the secretion of estrogen from the ovaries, simulating the environment of menopause in the body, which is also helpful for the treatment of endometriosis, the drug needs to be injected on the first day of menstruation, after the drug will not come to menstruation, temporarily will inhibit the endometriosis condition, after surgery if there is fertility The GnRH-a drug is expensive, about 2,000 yuan per injection, and is usually administered for 3-6 months.
It is also a better treatment to avoid the trouble of taking the pill every day, and the continuous release of the drug every day helps to suppress the recurrence of the lesions, and is suitable for patients without fertility requirements.
What to do in case of recurrence
Endometriosis is a disease that is very prone to recurrence. According to statistics, the chance of recurrence after surgery is around 70%. Repeated surgery is not a wise move for endometriosis treatment because some hemostatic operations that need to be used during surgery are more or less disruptive to ovarian function, especially for patients with fertility requirements, therefore, in general After recurrence, if the symptoms are not severe, the above mentioned medication can be chosen. If there is a cyst recurrence, ultrasound-guided cyst puncture + sclerotherapy can also be considered, and if malignancy cannot be excluded, surgery should be considered. Of course, if one is approaching menopause without fertility requirements, more radical surgical management such as oophorectomy or hysterectomy + oophorectomy can be performed for recurrent endometriosis to reduce the risk of recurrence.
If it is clear that the problem is not a recurrence but a pseudocyst, surgery is not necessary in the absence of symptoms and regular observation is sufficient.
Is there a risk of malignant change?
Unlike other cysts, endometriosis cysts have a 0.5% chance of malignancy, and the occurrence of ovarian clear cell carcinoma is related to endometriosis cysts. Therefore, for long-standing coarctation cysts, it is not advisable to delay surgery, and surgery should also be considered to obtain a clear diagnosis of pathology.
Endometriosis in special areas
Endometriosis of the abdominal wall is usually associated with cesarean surgery, because during cesarean surgery, blood from the uterine cavity remains partially in the surgical incision of the cesarean section and bleeds monthly following the menstrual cycle, and some patients experience periodic pain and palpable painful nodules in the wound. Endometriosis in such a cesarean wound should be surgically removed, and recently we have tried to treat it with focused ultrasound.
Lateral perineal wounds can also be seen with incisional endometriosis, which is also associated with the implantation of ectopic endometrium in the wound site and is also treated with surgical excision.
Other rare sites of endometriosis have been reported to occur in the bladder, lungs, nose, etc., also presenting with periodic bleeding.
Are myometriosis and endometriosis related?
When ectopic endometriosis occurs in the muscular layer of the uterus, the periodic bleeding also causes localized lesions, which usually lead to severe menstrual pain, sometimes wrapped like a fibroid, and sometimes scattered. Infertility can also be caused by the presence of lesions in the uterus.
Treatment of myometriosis is also often tricky, and any treatment that preserves the uterus, locally removes the lesion or destroys it will often be incomplete and prone to recurrence. If there is no requirement for fertility and severe menstrual pain due to myometriosis, the most complete approach is to opt for hysterectomy. If preservation of the uterus is required, removal of the local lesion under laparoscopic surgery or destruction of the lesion with focused ultrasound is one option. The placement of a Manned IUD, which releases progesterone locally, will also be helpful for the relief of dysmenorrhea in myometriosis.
Combined infertility in myometriosis is often difficult and requires the combined efforts of gynecologists and reproductive surgeons for comprehensive treatment.