Currently these two diseases are common among women of reproductive age, and many people are diagnosed with these two diseases by doctors due to various symptoms or during physical examinations. Now I will give you an overview of the clinical manifestations, diagnosis and common treatments for these two diseases.
What is endometriosis?
The uterus is a cavernous organ shaped like an inverted pear. The main structure is a thick layer of muscle that forms the palace where the fetus resides. When not inhabited by a fetus, like an uninflated balloon, the cavity is just a gap where two layers of muscle are affixed together. The inner layer of the muscle is covered with an inner membrane and the outer layer is the plasma membrane. The lining, which is literally understood to be supposed to be inside the uterus, thickens and sheds with the menstrual cycle to form menstruation. If once, for various reasons, it leaves that place where it was originally, the woman becomes sick.
If it enters the muscular layer, it is called adenomyosis. If it enters the pelvic cavity and is planted on the ovaries and the pelvic peritoneum, it is endometriosis. It may even be implanted in the bladder, rectum, liver, lungs, etc. These are relatively rare. In endometriosis on the ovaries, cysts often form, similar to tumors of the ovaries, but not tumors. Because the ectopic lining, like the endometrium, bleeds with the menstrual cycle, a chocolate colored cyst forms inside the ovarian endometriosis cyst, hence the common name “chocolate cyst”.
In other areas of the uterus, endometriosis also tends to bleed periodically as does the lining in place, with localized lesions such as purple-blue nodules and fibrous connective tissue hyperplasia.
Endometriosis and adenomyosis are similar in that they are both estrogen-related, which we call estrogen-dependent diseases, but they also have different characteristics. They often occur together, but they are not the same disease.
Estrogen-dependent disease means that it is more prevalent in the reproductive years when estrogen production is high. It does not develop before puberty or after menopause.
What kinds of symptoms would suggest that there is also endometriosis and adenomyosis?
1. Dysmenorrhea, chronic lower abdominal pain, painful intercourse, painful bowel movements: Often there is no dysmenorrhea in the first few years of menstruation, and then it appears, with increasing severity.
2.Increased menstrual flow: Adenomyosis often has increased menstrual flow.
3. Infertility: Endometriosis often causes infertility.
How to diagnose endometriosis?
Chocolate cysts and adenomyosis can usually be clearly diagnosed under ultrasound. For other pelvic endometriosis, the doctor can make a preliminary diagnosis by combining clinical symptoms and physical examination of the doctor, but a definitive diagnosis requires laparoscopic confirmation.
Objectives of treatment: removal of lesions, pain relief, promotion of fertility, prevention of recurrence.
Best treatment: pregnancy, promotion of fertility, laparoscopy.
The disease can be relieved during pregnancy and delays recurrence. Therefore, for women with fertility requirements, pregnancy is the best treatment. But often patients with endometriosis are not able to get pregnant naturally, so promoting fertility is the best treatment.
Many patients, often ask if I can have this disease without surgery. It is better to be treated conservatively with medication, preferably herbal medicine. Unfortunately, traditional Chinese medicine is ineffective, and western hormonal drugs are effective, but they are ineffective, have high side effects, and cannot be applied for a long time, and the disease will rebound after stopping the medication. Therefore, surgery is still the preferred method. Now, thanks to minimally invasive techniques, laparoscopic surgery can be taken. Laparoscopy allows both clear diagnosis and removal of the lesion, separation of adhesions and even removal of the ovaries and uterus.
Types of surgery
1. Conservative surgery that preserves the reproductive function. The procedure is performed by simply removing the chocolate cyst, removing the endometriosis lesion, and removing up to one ovary. Patients can have children after surgery.
2. Semi-conservative surgery that preserves ovarian function. The uterus and one side of the adnexa are removed, and the healthy or relatively healthy side of the adnexa is preserved. There is still some hormone production in the body.
3.Radical surgery. Removal of all internal genital organs: uterus and both adnexa. After surgery, the disease does not recur because the hormones are reduced to postmenopausal levels.
Except for radical surgery, medication should be applied after surgery to further destroy the lesions invisible to the naked eye during surgery and to prevent or delay recurrence.
Commonly used drugs: Danazol, Pregnant Triptan, also known as Nemeton, GnRH analogues (Inhibitors, Daphylline, Norelide, etc.) all play a role in suppressing the gonads, the effect is similar, but the side effects differ greatly. The choice of drugs is not based on how the results work, but on how to circumvent the side effects of the drugs according to the physical state of different patients.