Endometriosis is a common female gynecological condition in which endometrial cells are planted in abnormal locations. The endometrial cells are supposed to grow in the uterine cavity, but because the uterine cavity is connected to the pelvic cavity through the fallopian tubes, this allows the endometrial cells to grow ectopically via the fallopian tubes into the pelvic cavity. There are various theories on the pathogenesis of this disease, among which the commonly accepted one is the endometrial implantation theory. In addition, the occurrence of endometriosis is also related to the immune function of the body, genetic factors, and environmental factors.
Can endometriosis be cured?
Ovarian chocolate-like cysts are endometriosis of the ovary. Patients are most concerned about the treatment and recurrence of endometriosis.
1. Implantation theory
Menstrual blood reversal and endometrial implantation. During menstruation, menstrual blood exiting the body from the uterus and vagina is downstream, but a small portion of menstrual blood or for other reasons interspersed with shed endometrial fragments flows from the fallopian tube into the abdominal cavity and is planted in the superficial layer of the pelvic organs to form endometriosis lesions.
2.Chemical endometrium
Plasma membrane epithelium, chemogenic endometrium. In human body, during embryonic development, ovarian surface epithelium, peritoneum, vaginal rectal diaphragm, umbilicus are all derived from somatic epithelium, and these tissues are able to transform under the stimulation of gonadal hormones, inflammation, and mechanical factors to form another tissue, which can likewise be metastasized into endometrium.
3.Benign metastasis
Hemolymphatic, benign metastasis. This is a relatively rare cause of morbidity. Appearing in the lungs, meninges, pericardium, extremities and other distal endometriosis, it develops by transferring endometrial debris to rest on an organ or tissue through the blood circulation or lymphatic system.
4.Medical endometrial transplantation
This is a kind of artificially caused transplantation of endometrium to certain parts of the uterus, mostly seen during cesarean section, early and mid-term pregnancy scraping, perineal lateralization during delivery, abortion, etc.
5. Defective immune defense function
The endometrium that flows backwards to the abdominal cavity with menstrual blood is like a foreign body that activates the immune system in the body and mobilizes a large number of immune cells and body fluids to eliminate it, and if the immune function in the body is defective, it will develop into endometriosis.
6.Endocrine dysfunction
Ectopic endometrium, regardless of the source, its growth changes are related to ovarian endocrine, estrogen can promote the growth, progesterone can make it inhibit, clinical findings of most patients, progesterone deficiency, and therefore contribute to the development of the disease.
7. Genetic and physical factors
Clinical observation shows that people with family history of the disease are mostly affected by the disease. Physical factors such as obesity, overweight and excessive length also have a certain relationship.
Clinical manifestations
1. Dysmenorrhea
Dysmenorrhea is the most typical symptom of endometriosis. It can occur before, during and after menstruation. In the severe stage, the pain is unbearable and painkillers are even ineffective. The pain is caused by the inflammatory response of the local tissues stimulated by bleeding within the endometriosis. Dysmenorrhea is inevitably more pronounced due to increased secretion of prostaglandins from the endometriosis lesion, leading to contracture of the uterine muscles. After menstruation, the bleeding stops and the pain is relieved.
2. Abnormal menstruation
It can manifest as excessive menstruation or cycle disorders. Most menstrual abnormalities are related to endometriosis affecting ovarian function. Patients with endometriosis may experience ovarian dysfunction, such as abnormal ovulation.
3. Infertility
Patients with endometriosis are often associated with infertility. Reason: Endometriosis can often cause adhesions around the fallopian tubes that affect oocyte pick-up; or ovarian lesions that affect ovulation.
4. Painful intercourse
Endometriosis in the rectal fossa and vaginal rectal compartment can cause painful intercourse (deep tenderness), increased bowel movements during menstruation, and pain (ligamentous).
5.Other
Bladder irritation signs: Those with endometriosis to the bladder appear to have periodic urinary frequency, painful urination, and hematuria. Endometriosis in the abdominal wall scar and umbilicus presents with periodic localized masses and pain.
Examination
1.Laboratory tests
(1) CA125 (ovarian cancer-associated antigen) value is measured as a tumor-associated antigen and has some diagnostic value for ovarian epithelial cancer. However, in patients with endometriosis, CA125 value can be increased, and the positivity rate increases with the stage of endometriosis, and its sensitivity and specificity are high, so it is helpful for the diagnosis of endometriosis, and the efficacy of endometriosis can be monitored at the same time.
(2) Anti-endometrial antibody (EMAb) Anti-endometrial antibody is an autoantibody that uses endometrium as a target antigen and causes a series of immunopathological reactions, and is a marker antibody for endometriosis. The detection of serum EMAb is an effective test for the diagnosis and observation of the efficacy of patients with endometriosis.
2.Imaging examination
(1) B-mode ultrasound examination B-mode ultrasound examination is one of the commonly used examination methods in obstetrics and gynecology, and has an important role in the diagnosis of obstetrical and gynecological diseases. It determines the location, size and shape of the cyst and finds the masses that are not touched during gynecological examination.
(2) Laparoscopy is performed with the aid of laparoscopy to directly visualize the pelvic cavity, see ectopic lesions or biopsy visible lesions to determine the diagnosis, and to determine the clinical stage of pelvic endometriosis and determine the treatment plan based on the microscopic examination. Under laparoscopy, attention should be paid to the uterus, fallopian tubes, ovaries, uterosacral ligament, and pelvic peritoneum for endometriosis lesions. Staging and scoring of endometriosis will be performed according to what is seen on laparoscopy or surgery.
(3) X-ray examination is feasible with separate pelvic insufflation angiography and uterine tubal iodine oil angiography to assist in the diagnosis of pelvic endometriosis.
(4) Magnetic resonance imaging (MRI) MRI allows direct imaging in multiple planes to visualize the extent, origin and invaded structures of the lesion, allowing correct localization of the lesion and enhanced display of soft tissues. Therefore, MRI is of great value in diagnosing endometriosis and in understanding pelvic lesions and adhesions.
Diagnosis
According to the characteristics of this disease, a preliminary diagnosis of pelvic endometriosis is usually made in women of childbearing age who have a history of progressively increasing dysmenorrhea or infertility, and who have an inactive mass or painful nodule in the pelvis on gynecologic examination. Those with slightly more complicated conditions can be further diagnosed with the help of the above laboratory tests and special tests.
Treatment
Treatment options for endometriosis vary depending on the severity of the condition, the patient’s age and fertility status. If the condition is severe or manifests as heavy dysmenorrhea, or if pelvic examination reveals definite endometriosis nodules, pharmacological or surgical treatment is necessary.
1.Medication
Medications are used to counteract or suppress the cyclic endocrine stimulation of the ovaries. Initially, testosterone-based androgens were used, but the side effects were greater and their effectiveness was not strong enough, so they were gradually abandoned. Later, pseudopregnancy therapy and pseudomenopause therapy were developed.
(1) Pseudopregnancy therapy is the use of powerful progestogenic contraceptive drugs, which are taken for a long time without interruption in larger doses, so that menstruation stops and the endometrium and ectopic endometrium react like pregnancy under the action of the drugs, so it is also called pseudopregnancy therapy. There are many drugs used for this therapy and they are still being developed, the main ones are progesterone, provera and endometrium for oral use and progesterone caproate for intramuscular injection. This therapy should be continued for at least six months before the ectopic endometrium stops moving and finally atrophy occurs, thus producing a healing effect.
(2) Pseudo-menopause therapy In the 1970s to 1980s, foreign countries mainly used a drug called danazol, which is a derivative of androgen and is more effective, and is currently being used in China, but it has relatively large side effects. Since the 1980s, a drug called goserelin has been widely used abroad, which mainly inhibits the function of the ovaries very strongly and makes them almost completely useless for therapeutic purposes, and because this drug is a long-acting slow-release preparation, it only needs to be injected subcutaneously once a month, which is very convenient. These drugs can produce atrophy of the endometrium similar to that of menopausal women, hence the name pseudo-menopausal therapy.
2.Surgical therapy
It is generally believed that chocolate cysts occurring on the ovaries are often larger in size, or endometriotic nodules occurring in other parts of the uterus with a volume of more than 2 cm in diameter, that is, they are not easily controlled by drugs and require surgery; or if the condition does not improve after six months or even a year of drug treatment, surgical removal should also be considered. If the patient is young and has no children, surgery is usually performed to remove only the endometriotic lesion, while preserving the uterus and normal ovarian tissue.
This is called conservative surgery. This type of surgery preserves the possibility of fertility, but has a higher chance of recurrence. If the patient has children and is older (35), the uterus can be removed along with the endometriotic lesion, but the normal ovarian tissue is preserved. This method is better than conservative surgery in the long run, but it does not absolutely prevent recurrence. If the patient is nearing menopause, or if the endometriosis is too extensive to be completely eradicated, the uterus and ovaries should be removed together during surgery.
In recent years, the widespread use of laparoscopy has led to a new treatment option for endometriosis, especially in foreign countries, where the combination of laparoscopic surgery and goserelin drugs has become an increasingly widespread treatment option.