The “wrong” endometrium has been documented in foreign countries since 1860. However, it was only in the 1920s that this disease received widespread attention from gynecologists. Statistics show that the incidence of endometriosis among women of childbearing age in China is 10%-15%, with a high prevalence among women aged 25-45.
The endometrium is affected by fluctuations in hormone levels every month, and there is a cycle of proliferation, thickening and eventual shedding, which is accompanied by bleeding when the endometrium is shed, forming menstruation. As can be seen, the disease depends on estrogen secreted by the ovaries for its development, and a higher or lower level of estrogen can affect the course of the disease. Therefore, the disease gradually resolves after the patient becomes menopausal.
In layman’s terms, endometriosis is a condition in which the endometrium “settles in the wrong place”. If the endometrium grows outside the endometrial layer, it is called endometriosis; if it grows in the myometrium, it is called adenomyosis.
Why does the endometrium grow and develop outside the uterus? The reason for this is unclear and there are many theories. One explanation is that the cells of the body shake out into a different kind of cell when they are stimulated in some way. When menstruation occurs, if menstrual blood enters the abdominal cavity, it stimulates the cells on the surface of the ovaries, turning them into the endometrium and causing ectopic disease. There is also an “implantation hypothesis” which states that if menstrual blood containing endometrium flows through the fallopian tubes on both sides of the uterus to the pelvic cavity, if the conditions are right, it will make its home there and reproduce, inducing disease.
These “ectopic” endometrium can interfere with the normal functions of the reproductive organs and are often accompanied by various symptoms of menstrual disorders, such as prolonged periods, excessive menstrual bleeding, premenstrual spotting and secondary dysmenorrhea. If a woman finds that her menstrual flow is gradually increasing and her dysmenorrhea is getting worse day by day; if she can obviously feel severe discomfort or even unnamable pain when making out with her lover; if she finds that she is in her prime but her efforts to get pregnant are repeatedly unsuccessful – all of them should be alerted to the possibility that she is suffering from endometriosis.
Endometriosis itself is a benign condition, but has some characteristics similar to malignant tumors. For example, it can infiltrate and grow into the surrounding tissues and organs and interfere with their normal functions, and can even metastasize to areas far from the uterus, such as the lungs and belly button, just like cancer. Moreover, symptoms such as dysmenorrhea and painful intercourse can worsen as the local lesion worsens. Moreover, patients have a very high chance of infertility or miscarriage. More than 40% of the infertility patients have endometriosis.
It has also been shown that endometriosis lesions are at risk for malignancy and may develop into certain malignant tumors.
Because of its lingering course and easy recurrence, it causes great pain and financial burden to women of childbearing age, both physically and mentally. Therefore, timely and correct treatment is crucial.
Treatment: Surgery + medication Endometriosis treatment requires different approaches that take into account the patient’s condition and the requirements for fertility. Laparoscopic confirmation and surgery combined with medication is currently considered the gold standard treatment for endometriosis.
Surgery can be performed laparoscopically. Young women who still have fertility needs can be treated with ovarian endometrioid cyst debulking, which can preserve fertility, but has the highest recurrence rate of 50% after surgery. In slightly more severe cases or with adenomyosis, surgery with preservation of ovarian function can be performed, but recurrence still occurs in 1/4 of patients after surgery. radical surgery with removal of both ovaries can be performed in patients over 45 years of age, or in patients with severe dysmenorrhea.
There are also many medications available for this group of patients, including gonadotropin-releasing hormone analogs, androgen derivatives, short-acting oral contraceptives, and highly effective progestins. Although the ingredients of these drugs are different, their effects are more or less the same, the major difference being the different side effects.
The most clinically used is the gonadotropin-releasing hormone analogs. Its effects are the strongest, but the side effects are also the most pronounced. Once patients start using the drug, menopausal symptoms, such as hot flashes, insomnia and irritability, will soon appear. After long-term use, bone loss, loss of libido and depression will also appear one after another. In response to this situation, the medical community has gotten along with two ways to deal with it: First, after 3 cycles with GnRH-a, appropriate estrogen or progestin supplementation. Second, after the first 3 cycles of adequate dosage, start to reduce the dosage by half.
Early androgen derivatives were mostly Danazol, whose side effects included hirsutism, acne, thickening of the voice, and headache. An upgraded version, progesterone, is now available but should be used with regular follow-up of liver function. Danazol vaginal pessary can relieve the symptoms of dysmenorrhea in patients with mild endometriosis and does not interfere with menstruation, and is also a treatment option.
The short-acting oral contraceptive pill is indicated for patients with mild dysmenorrhea, or for consolidation therapy after surgery. It also has the effect of reducing the risk of ovarian cancer and endometrial cancer. However, it is contraindicated in people who are obese, smoke, have breast cancer or venous thrombosis, and suffer from liver disease.
Highly effective progestins are also added as oral medications to intrauterine devices, which are placed in the uterine cavity to provide significant relief from dysmenorrhea, transplant endometrial growth and treat the disease while preventing pregnancy. In foreign countries, many patients choose this type of birth control device, which is effective in patients with moderate to severe dysmenorrhea. In China, many women have some concerns due to the side effects of amenorrhea and reduced menstrual flow that can occur after use.
It should be reminded that endometriosis has a greater impact on fertility. Six months after surgery is the prime time to get pregnant. If there is no pregnancy 2 years after surgery, the chances of a natural pregnancy are low and another plan is needed.
There are numerous high-risk factors that induce endometriosis with the seven prescriptions for prevention. Based on several studies, medical experts have summarized seven “prescriptions” for early prevention.
Exercise prescription: Yoga is the first. A study of 69 female college students found that after 18 months of exercise, their dysmenorrhea symptoms were significantly relieved. Dysmenorrhea is a concomitant symptom of endometriosis and a cause of the disease. Among them, those who practiced yoga had the most significant symptom relief at 78%; fitness walking was the second most effective at 65%; and aerobics was 57% effective. Studies have concluded that exercise can improve microcirculation, indirectly giving massage and stimulation to certain glands and adjusting static blood distribution. In particular, the exercise of the lumbar and abdominal muscles can effectively reduce the degree of uterine congestion during menstruation and shorten the contraction time of the uterus. In general, women of childbearing age should perform 3 physical exercises and 1 moderate intensity full body activity per week.
Hygiene prescription: not to have sex during menstruation. Intercourse during menstruation increases the chances of menstrual blood reflux. During this special period, women should also avoid heavy physical labor and overexertion. If the menarche is early and the cycle is shorter than 27 days, but each period is long (more than 7 days), it should be taken seriously. Such women are more likely to have menstrual reflux.
Family prescription: protect against family history. Studies have shown that women with endometriosis, such as mothers or sisters, have a 7-fold increased risk of the disease in their immediate female family and should be taken seriously. Such women should seek early medical attention if they have significant dysmenorrhea when they have their periods at puberty. It is important to know that dysmenorrhea is never a normal phenomenon. It may be the result of high levels of prostaglandin action, causing strong contractions of the smooth muscles of the uterus; or it may be a sign of congenital reproductive tract abnormalities, both of which can increase the risk of endometriosis.
Dietary prescription: Stop smoking. A balanced diet with plenty of fresh vegetables and fruits is good for general health. It is also crucial to quit smoking, limit alcohol, and restrict the intake of cream, lard, and animal oils. This is because eating more of these foods can cause prostaglandin levels in the body to rise and induce menstrual cramps. When you have your period, you also have to stop “cold food”, do not drink iced drinks, do not eat cold food and ice cream, too acidic and too spicy food also less touch.
Emotional prescription: optimism first. Negative brain activity will weaken the body’s immune system, giving a variety of diseases can take advantage of the opportunity. The high level of mental stress, work tension, too much mental work, will make people in a state of chronic stress, will also change the internal environment of the body. Women should be open-minded, not to take the bull by the horns, to maintain an open-minded, positive mental state.
Beauty prescription: use less things that are too fragrant. When buying toiletries and various skin care products, be sure to pay attention to the logo and ingredients list. Too fragrant skin care products, home air fresheners, etc., will use a large number of additives, may also be harmful to health.
Fertility prescription: the birth of a child, less abortion. This is especially important to remind the workplace “white” people, do not just busy with work, and delayed life events. Studies have shown that 21-29 years old is the prime period for childbirth. A full-term birth can improve the lining of the uterus, strengthen the immune system and alleviate problems such as cervical stenosis. Late marriage, late childbearing, infertility or multiple abortions can elevate the risk of endometriosis.