Endometriosis (endometriosis) is a common gynecological condition in which endometrial glands and mesenchymal cells with growth functions appear outside the normal uterine cavity lining. The incidence is about 10-15%, mainly in women of childbearing age. The cause is still a mystery and is associated with endometrial implantation, epithelial metaplasia, and immunity. Is endometriosis hereditary? It is now well established that there is a genetic component to endometriosis. Studies have concluded that endometriosis, like diabetes, hypertension, and asthma, is the result of polygenic and multifactorial effects and has complex hereditary features. It has been found that the risk of developing the disease is seven times higher in people whose mothers or sisters have endoheterosexism than in the general population of women. Although many genes and chromosomal alterations have been identified that may be associated with the development of endoheterozygosis, the specific genes and genetic mechanisms of pathogenesis are still under further investigation. What is chocolate cyst? Can it cause infertility? Ovarian chocolate cysts are endometriosis that occurs in the ovaries. Due to the periodic shedding and bleeding of the ectopic endometrium, cysts can be formed and the fluid can be coffee-colored and sticky like chocolate after bleeding for a long time, hence the name. It is not related to eating chocolate. It is generally believed that 40% of patients with endometriosis can be accompanied by infertility, and 80% of infertile patients have endometriosis, and active treatment of endometriosis will increase the chance of conception. In addition, endometriosis also has the possibility of malignancy, and statistics suggest that there is a 1% chance of malignancy. Therefore, ovarian chocolate cysts should be treated surgically. The procedure is usually performed laparoscopically to remove the ovarian chocolate cyst, repair the ovary, and clarify the nature of the cyst. For patients with fertility requirements or a history of infertility, bilateral tubal lavage can be performed, and if there are adhesions, adhesiolysis and plastic surgery can be done to provide more chances for future pregnancies. Laparoscopic surgery is the most appropriate treatment for chocolate cysts because of its low trauma and quick recovery. Patients with concomitant infertility should also be medicated and followed up after surgery under the guidance of their physicians for early conception. Can endometriosis also grow on cesarean scars? With the recent increase in cesarean delivery rates, the incidence of scar endometriosis has increased significantly. The commonly accepted cause of endometriosis is that the endometrium enters the extra-uterine area due to surgical trauma and is implanted, grows and spreads under the action of estrogen and in suitable soil conditions. Endometriosis of the perineal incision scar, which occurs during normal labor and delivery, is also due to the same etiology. Patients may find small nodules in the scar that grow in size and become more pronounced at the time of menstruation, and are painful and swollen. The main treatment for endo-heterotaxy is surgical excision of the lesion, which can quickly improve the signs and symptoms. Since there will be infiltration around the endometriosis lesion, the surgery should be thorough to avoid recurrence and the results are excellent. What is uterine adenosis? What treatment is available? Adenomyosis is another type of endometriosis, in which the endometrium invades the myometrium. When menstruation occurs, the lesion in the myometrium may be accompanied by cyclic bleeding, which is painful because menstrual blood accumulates in the cystic cavity of the lesion in the myometrium and cannot flow out, and may be accompanied by excessive menstruation. Patients often go to the hospital because the painful menstruation is getting worse and worse, and even taking painkillers gradually fails to control it. For large diffuse lesions, hysterectomy is still the main treatment method to cure dysmenorrhea and excessive menstruation, especially for those who are older and do not need to have children. For localized lesions such as myometrioma, local hysterectomy can also be performed, followed by drug therapy. In younger patients, if the lesions are small, pharmacological treatment can be used first. For example, gonadotropin-releasing hormone agonist (GnRHa) can significantly shrink lesions and relieve pain, and is usually treated for 3 to 6 months. Since endometriosis is an estrogen-dependent disease, GnRHa can cause a significant decrease in ovarian hormone secretion, resulting in a low estrogen state in the body and temporary menopause. Its efficacy is remarkable, but menopause-like symptoms will occur; symptoms will worsen beyond 3 months of treatment and other medications will be needed to supplement treatment to relieve symptoms. A period of consolidation of treatment is often required after the course of treatment, such as with herbs and oral contraceptives, to reduce recurrence of the disease. Medication may avoid hysterectomy surgery or delay the surgery. Other medications include endometrium, pregnenolone and danazol, which should be used with attention to liver function and side effects associated with high androgens. Is there anything I can do to prevent the increasing incidence of endometriosis? The cause of ectopic disorder is not well understood, so it is difficult to prevent it completely. However, the following factors may be helpful in preventing endometriosis ①Patients with vaginal atresia of genital tract abnormality, which causes menstrual blood reflux with each menstrual flow, should be treated early, such as hymenotomy and vaginoplasty, to avoid endometrial reflux implantation. (ii) The risk of ectopic disease is reduced in those who take oral contraceptives, so oral contraceptives can be taken for those with a high family history of ectopic disease. (③Induced abortion may cause an increase in the occurrence of endometriosis, so women of childbearing age should take good contraceptive measures and avoid induced abortion. In addition, sexual intercourse should be avoided during menstruation. Multiple uterine surgical operations should also be avoided to minimize medically induced endometrial implantation, etc.