“There are always those few days in a month ……”, a household name for a sanitary napkin commercial, speaks to a woman’s physiological cycle – the menstrual period (or great aunt as it is popularly known) requires careful care. Menstruation (aunt) is the regular vaginal bleeding that occurs once a month. A normal woman’s menstrual blood volume is 30 to 50 ml. The menstrual period usually lasts 3 to 7 days, and there can be mild pain or swelling in the lower abdomen and lumbosacral area, which usually does not affect normal work and life. If the symptoms seriously affect life, work and study, it is called dysmenorrhea. Primary dysmenorrhea refers to dysmenorrhea without organic lesions in the reproductive organs, accounting for more than 90% of dysmenorrhea; secondary dysmenorrhea refers to dysmenorrhea caused by organic pelvic diseases, most commonly endometriosis. The occurrence of primary dysmenorrhea is mainly related to the increased prostaglandin content of the endometrium during menstruation, the tightness of the endocervix, and excessive mental stress factors. Primary dysmenorrhea is common in adolescence. This is why it is called dysmenorrhea in girls. Generally the primary dysmenorrhea of young girls grow up, especially after marriage and childbirth, dysmenorrhea will naturally ease or disappear. The pain is most intense on the first day of each menstruation, with spasmodic pain in the lower abdomen, radiating to the lumbosacral region and inner thighs. It is accompanied by nausea, and in severe cases, pallor and cold sweat. My child would come to me in the clinic before each menstrual period: “Auntie, prescribe me painkillers, my period is coming soon, and every time it is a gradual pain, and I can only feel better after the first 12 hours, when exactly will I feel better?” I always reassured her, “Relax and unwind, apply hot compresses to your abdomen, don’t eat cold food, pain relief is symptomatic, and it will automatically ease when you get married and have children.” Time flies, in the blink of an eye, Azi is already an adult. Marriage, are very smooth. Soon after the marriage, a son was born in a normal birth. When Zi took her baby back to her mother’s house, she would always come to my house to visit. I often pinch her son’s red apple-like cheeks and say: “You are mommy’s little lucky star, you’re here, mommy no longer have to suffer the pain of the “aunt”! Zi nodded with emotion and kissed her son on the cheek with great affection. Two years later, Zi gave birth to another daughter by C-section. Her relatives and neighbors were happy for her, happy with her son and daughter! But in March last year, one year after the birth of her second child, that is, after her menstrual cycle resumed, Zi became a regular visitor to our clinic again due to dysmenorrhea. At the beginning, she was given symptomatic treatment and the pain was still tolerable. In recent months, the pain became more severe, and the lower abdominal cramps started to appear a few days before the menstrual period. Zi cried, “Gradual pain, gradual collapse, gradual tears, gradual madness, gradual life is worse than death, auntie how can this painful menstruation that has obviously healed itself relapse again?” In fact, from the first day when Azi’s dysmenorrhea appeared again one year after her cesarean delivery, I suspected that she might be suffering from endometriosis causing secondary dysmenorrhea, only that the initial diagnosis of this disease was not based on enough evidence, and clinical examination (such as ultrasound, CT or MRI) could not find the ectopic foci. In other words, when the evidence is conclusive, the disease should have a duration of more than one year. Now the diagnosis is clear: 1. secondary, progressive dysmenorrhea 2. Periodic painful nodules of approximately 2 cm in size and hardness in the upper right 2 cm of the lower abdominal cesarean incision. The ultrasound suggests spherical enlargement of the uterus, uneven echogenicity of the myometrium, thickened granules, and multiple hypoechoic nodules (myometriosis is also a type of endometriosis). 3. Endometriosis is a common gynecological condition in women. The endometriosis cells are supposed to grow inside the uterine cavity, but for various reasons they settle outside the uterine cavity (including the cervix and the uterine pulpy muscle layer), where they proliferate and bleed during the cycle, causing menstrual pain. It can be ectopic to almost all parts of the body, with benign diseases and malignant behaviors, sometimes called “undead cancer”, but of course the most common sites are the pelvis and lower abdomen. In addition to causing intractable dysmenorrhea, endometriosis can lead to infertility and miscarriage. There are various theories about the pathogenesis of this disease. One of them, endometrial transplantation of medical origin, is to be of concern to all. This is an artificially caused transplantation of the endometrium into certain areas, mostly seen during cesarean section, scraping in early to mid-term pregnancy, lateral perineal incision during delivery, abortion, etc. (it can also occur during regular operations). Thus, the only thing we can do clinically about this undead “cancer” is to minimize endometrial transplantation of medical origin. Reducing the rate of cesarean delivery, especially for a large proportion of women due to fear of pain and social factors such as choice of birth date, is an urgent matter. In the specific case of Zi (35 years old), we gave her a personalized treatment plan: 1. 2, Surgical removal of ectopic nodules in the lower abdominal wall. 3.Oral mifepristone to antagonize ectopic endometrium and temporary amenorrhea. 4.Chinese herbal medicine to activate blood circulation and remove blood stasis and symptomatic treatment. After active treatment, Zi’s symptoms improved significantly and she was able to work and live happily. Since amenorrhea for more than half a year will lead to uterine atrophy and vaginal dryness, Mifeprex cannot be taken continuously for a long time, so the drug was discontinued once every six months. However, it is easy to relapse after stopping the drug, so the saying of “undead cancer” is true, so it is necessary to continue taking the drug after stopping for a period of time. The key to prevention: 1. Marriage and childbirth at the right age For women with late childbirth, especially those with dysmenorrhea, they should have children as early as possible. 2.Drug contraception For those who have dysmenorrhea, you can choose oral contraceptives, which can prevent pregnancy and reduce the occurrence of endometriosis. 3.Prevent menstrual reflux During menstruation, prohibit all intense sports and heavy physical labor; avoid sexual intercourse during menstruation. 4.Prevent the occurrence of medically induced endometriosis Minimize the rate of cesarean section, operate correctly during surgery, pay attention to protect the wound and avoid bringing the endometrium to the incision for implantation. Adopt suitable contraceptive measures, minimize abortion, and require uterine operations to be performed 3 to 7 days after menstrual cleansing.