Regular menstruation is one of the signs of the maturity of female reproductive function. Usually, there are no special symptoms during menstruation, and some women may experience discomfort or distension in the lower abdomen and lumbosacral region, sometimes accompanied by mild diarrhea and other gastrointestinal disorders, which do not affect normal life and work. If there is pain and swelling in the lower abdomen around the time of menstruation or during menstruation, accompanied by lumbago or other discomfort, and the symptoms seriously affect the life of workers, then it is dysmenorrhea. Dysmenorrhea is divided into primary dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea refers to those who are not found to have obvious abnormalities in the pelvic organs after detailed examination, mostly functional dysmenorrhea, often appearing from puberty; secondary dysmenorrhea is caused by reproductive organ lesions, such as endometriosis, pelvic inflammatory disease, pelvic stasis syndrome, tumors, etc. Endometriosis is the most common cause of secondary dysmenorrhea, and more than half of secondary dysmenorrhea is caused by endometriosis. Therefore, this article mainly introduces the manifestation, diagnosis and prevention of endometriosis.
What is endometriosis?
As we know, normal endometrium should stay on the inner surface of the uterine cavity, and with the cyclic changes of female hormones secreted by the ovaries, the endometrium undergoes cyclic changes of proliferative phase, secretory phase and menstrual phase (endometrial exfoliation and bleeding) accordingly. If the endometrium does not stay honestly in the uterine cavity and runs to plant outside the uterine cavity, it also undergoes cyclic bleeding with the hormonal changes secreted by the ovaries as well, which leads to proliferation of surrounding fibrous tissues and the formation of cysts and adhesions, resulting in purplish-brown spots or vesicles in the lesion area, which eventually develop into purplish-brown nodules or masses of varying sizes. Ectopic in the myometrium is called “adenomyosis”, ectopic in the ovary is called “ovarian endometriosis cyst”, also known as “ovarian chocolate cyst”, and can also be ectopic in the posterior wall of the uterus, the rectal recess, and the rectum. It can also be ectopic in the posterior wall of the uterus, the rectal recess, the cervix, the rectum, the peritoneum, the urethra, the bladder, the perineum, the fallopian tubes, the abdominal wall, the chest, the arms, the legs, and the central nervous system. In fact endometriosis can be found in all parts of the body except the spleen. The most common sites are the ovaries and pelvis, while other sites are rare. Endometriosis (referred to as endometriosis) often occurs in the reproductive age of 25-45 years, and its incidence has shown a significant increase in recent years, positively correlated with socioeconomic status, and is increasingly becoming a modern disease that endangers women’s health.
What are the manifestations of endometriosis?
The clinical manifestations of endometriosis are varied depending on the person and the site of the lesion, and the symptom profile is often related to the menstrual cycle, with about 25% of patients having no symptoms.
1. Lower abdominal pain and dysmenorrhea: Pain is the main symptom of endometriosis, and the typical symptom is secondary dysmenorrhea with progressive aggravation. However, 30% of patients have no dysmenorrhea.
Infertility: The infertility rate of endometriosis patients is as high as 40%. The causes of infertility caused by endometriosis are complex and can be due to: (1) mechanical factors: endometriosis patients often have pelvic adhesions, and the causes of infertility in severe cases may be related to extensive adhesions of organs and tissues in the pelvic cavity that affect the discharge of eggs, resulting in weakened peristalsis or even adhesions of the fallopian tubes, resulting in the inability of the fallopian tubes to pick up eggs and the inability of fertilized eggs to run normally to the uterus. (2) Abnormal ovarian function (2) Abnormal ovarian function: Endometriosis can be associated with various abnormal ovarian functions, such as abnormal LH peak, abnormal follicular development, anovulation, hyperprolactinemia, luteal insufficiency, and luteinization syndrome of unruptured follicles (LUFS), which can affect conception to varying degrees. (3) Autoimmune reaction: lymphocytes in patients with endometriosis produce an anti-endometrial antibody, which can interfere with early fertilization egg transport and implantation, while the presence of endometriotic lesions in the abdominal cavity causes the accumulation of a large number of macrophages, which can phagocytose sperm and interfere with the division of fertilized egg cells, thus leading to infertility. (4) Impairment of bed and miscarriage: Endometriosis can affect early embryonic development with abnormal luteal function and abnormal intrauterine environment, interfering with the development and implantation of early embryos, leading to impairment of bed and miscarriage. (5) Other causes: Patients with endometriosis may experience deep intercourse pain during sexual intercourse, which may more or less affect the patient’s mood and even inhibit ovulation. The cause of infertility due to endometriosis may be the result of multiple factors.
3. Discomfort during sexual intercourse: It is mostly seen in those with ectopic lesions in the rectal fossa of the uterus or those with a posteriorly inclined fixed uterus due to local adhesions. The pain is caused by collision or uterine contraction and lifting during sexual intercourse, and is generally manifested as deep painful intercourse, which is more obvious before the onset of menstruation.
4. Menstrual abnormalities: 15%-30% of patients have increased menstrual flow, prolonged menstrual period or incomplete menstrual dripping or premenstrual spotting. This may be related to ovarian lesions, anovulation, luteal insufficiency or the combination of adenomyosis and fibroids.
5. Other special symptoms: When there is ectopic endometrial implantation growth in any part outside the pelvis, periodic pain, bleeding and masses may appear locally and respond to symptoms. For example, patients with post-cesarean abdominal wall endometriosis or perineal lateral incision site endometriosis often have periodic pain at the scar months to years after cesarean delivery or perineal lateral incision, and painful masses are found deep in the scar, which gradually increase in size and pain with time; pulmonary endometriosis may manifest as hemoptysis; periodic bleeding from the rectal bladder and painful defecation during menstruation, endometriosis of the rectal bladder should be considered first. When the ectopic lesion invades and/or compresses the ureter, it causes ureteral stricture and obstruction, lumbar pain and hematuria, and even develops into hydronephrosis and renal atrophy; etc.
In addition to the above symptoms, when an ovarian endometriotic cyst ruptures, the contents of the cyst flow into the pelvic and abdominal cavity causing sudden and severe abdominal pain with nausea and vomiting and anal swelling, similar to the rupture of ectopic pregnancy, which is an acute abdominal condition.
How is endometriosis treated?
Treatment should be individualized according to the patient’s age, symptoms, location and extent of lesions and fertility requirements, etc.
1. Mild lesions with mild or no symptoms and no intention to have children can be treated with expectant treatment, i.e. regular follow-up and symptomatic treatment of milder menstrual abdominal pain.
2.Pharmacological treatment: It is suitable for patients with chronic pelvic pain, obvious menstrual dysmenorrhea symptoms, no fertility requirements and no ovarian cyst formation. Commonly used drugs include compounded oral contraceptives, progestin, progesterone, Danazol and gonadotropin-releasing hormone agonists.
3.Surgical treatment: It is suitable for patients whose symptoms are not relieved after drug treatment, whose local lesions are aggravated or accompanied by infertility and whose reproductive function has not been restored, patients with larger ovarian endometriosis cysts and patients with special areas of endometriosis. Laparoscopic surgery is the surgical method of choice, and laparoscopic diagnosis, surgery + medication is currently considered the gold standard of treatment for endometriosis. Depending on the circumstances, surgery to preserve fertility, surgery to preserve ovarian function, and radical surgery can be performed. The surgical resection of endometriosis at specific sites is performed depending on the site.
Although endometriosis is a benign disease, it has malignant behaviors, such as easy recurrence and even distant morbidity, etc. It is said that cancer is not cancer, and it is said that it is not cancer but looks like cancer.
How to prevent endometriosis?
Women are suggested to pay attention to the following points.
1.Menstrual period must be eliminated from sexual life.
2. Pay attention to keep themselves warm and avoid catching cold.
3, during menstruation, prohibit all intense sports and heavy physical labor.
4, girls should avoid fright during puberty, so as not to cause amenorrhea or the formation of menstrual reflux.
5. learn to control emotions during menstruation and not to sulk, as this may lead to endocrine disorders.
6. to adjust their emotions at any time and maintain an optimistic and cheerful state of mind so that the immune system of the organism functions normally
7. if endometriosis has been detected, ovarian chocolate cysts larger than 5 cm should be operated in time, and attention must be paid to maintaining emotional stability and avoiding overwork during menstruation or midmenstruation.
8. timely treatment of menstrual reflux diseases such as genital tract malformation, atresia and cervical canal adhesions.
9.Drug contraception can prevent endometriosis to some extent.
10, timely marriage and childbirth can reduce the probability of endometriosis
11.Reducing cases of cesarean section, abortion and uterine operation.