1.Characteristics of endometriosis Endometriosis refers to the abnormal growth of endometrial tissue outside the endometrial layer of the uterus, which should grow in the innermost layer of the uterus, and is one of the most complicated gynecological diseases. It is one of the most complex gynecological diseases and is often difficult for obstetricians and gynecologists to treat because it is the least treatable and is prone to recurrence. The true etiology of endometriosis is still inconclusive, and there are various theories such as retrograde implantation of menstrual blood and histogenesis, but it is generally believed to be a specific type of in situ endometrial cells with invasive implantation of malignant cells. The incidence of this disease is about 10% in women of childbearing age, and there is a significant upward trend. Nearly 90 million women worldwide suffer from endometriosis with pelvic pain or infertility, which seriously affects the health and quality of life of young and middle-aged women. So who is prone to endometriosis? Although most studies have shown that 75% of patients with endometriosis are between the ages of 25 and 45, recent medical reports have found many patients younger than 20 years old as a result of advances in diagnostic methods and the use of laparoscopy, which has increased the diagnosis rate. Generally speaking, endometriosis occurs more often in women with higher social status or better economic situation, and less often in poor patients, so Dr. Meagher called this disease a disease of the rich. Studies have also found that patients tend to marry later, have children later and have fewer children. It is no wonder that endometriosis is increasing in recent times as society is moving in this direction. There is a phenomenon: although endometriosis is a benign disease, not a cancer, and not life-threatening, it can actually “grow legs” and migrate like a malignant tumor and “take root”, forming local distant metastases and adhesions to surrounding tissues, causing invasion and damage to other tissues or organs. It especially likes to invade pelvic organs and peritoneum, and other parts such as uterine rectal fossa, abdominal wall incision, umbilicus, bladder, kidney, ureter, lung, pleura, breast, lymph node, and even joint cavity of arm and thigh. Therefore, it is also called “cancer that is not cancer” by the medical profession. 2. Clinical manifestations of endometriosis The most common symptom of endometriosis is dysmenorrhea, with about 1/3 of patients having varying degrees of dysmenorrhea. The most characteristic feature is that the onset coincides with the menstrual cycle, often striking at the beginning of menstruation and continuing throughout the menstrual period, but the degree of pain is not necessarily proportional to the size of the lesion. A few patients have prolonged lower abdominal pain that worsens until menstruation. Some patients may experience localized pelvic pain due to bowel, bladder, or nerve compression, or unpleasant intercourse, especially in patients with cervical or vaginal invasion, and may have painful intercourse, constipation, and painful bowel movements. Sometimes minor lesions can cause more pain, while severe lesions can sometimes be present without any symptoms. The incidence of infertility has increased significantly in recent years, but it is difficult to realize that endometriosis is to blame. Professor Yang Jing points out that fifty percent of infertility patients have been found to be caused by this disease. The causes of infertility may be related to the adhesion of the endometrium to organs in the pelvic cavity, which weakens the peristalsis of the fallopian tubes and thus affects the discharge and uptake of eggs and the operation of fertilized eggs, changes in the pelvic environment, autoimmune reactions and many other factors. Treatment of endometriosis The treatment of endometriosis should be based on the patient’s age, fertility requirements, symptoms, location and extent of lesions and the presence of comorbidities, etc. A comprehensive analysis should be made to determine a personalized treatment plan. Treatment includes medication, surgery and radiotherapy. For young women with fertility requirements, medication or conservative surgery is used as much as possible; for older women without fertility requirements, total hysterectomy and double adnexal resection is feasible. (1) Drug therapy; mainly hormone therapy. Most of them use pseudo-pregnancy or pseudo-menopause therapy, such as androgens, progestins, estrogens, danazol, etc., which artificially cause menstruation to stop to form a pseudo-pregnancy state, and there is no dysmenorrhea without menstruation. After sex hormone therapy about 85% of patients’ symptoms can be relieved, and some patients also become pregnant after treatment. However, sex hormone drugs often have different degrees of side effects, such as loss of appetite, nausea, abnormal liver function, etc., which can disappear after stopping the drug, but menstruation will still come and go after stopping the drug, and the condition will generally continue to develop. Therefore, sex hormone therapy should be applied under the guidance of a doctor. (2) Surgery: Surgery should be considered for those whose ovaries have formed large cysts (endometriosis), serious pelvic lesions or severe symptoms after drug treatment has failed. Surgical procedures include the following: (1) minimally invasive surgery for patients with mild endometriosis with infertility, with few operable lesions; (2) conservative surgery to remove lesions visible to the naked eye; (3) semi-conservative surgery to remove the uterus and preserve the ovaries; (4) radical surgery to remove the whole uterus and bilateral adnexa. Conservative surgery can usually be done laparoscopically. Patients who need to have their uterus removed usually have obvious symptoms and heavy pelvic adhesions, so open surgery is safer. 4, prevention of endometriosis Endometriosis brings a lot of pain to women, and treatment is also more difficult, so many people are very concerned about how to prevent endometriosis. Theoretically, there is no fundamental solution for the prevention of endometriosis because the cause of endometriosis has not yet been fully understood, but it is not completely impossible to prevent it. This is because the cause of endometriosis is not completely understood, but it does not mean that it is not preventable. According to the analysis of the formation mechanism of the disease, in order to prevent the occurrence of the disease, we should pay attention to the following issues: first of all, we need to pay attention to adjust their emotions, maintain an optimistic and cheerful state of mind, so that the function of the body’s immune system is normal, and pay attention to the health care of the menstrual period, such as the menstrual period can not be overworked, the menstrual period can not have sex, etc.; as far as possible, do not give birth too late, because too late childbirth, for people who already have endometriosis potential It is also necessary to avoid unwanted pregnancies because once an unwanted pregnancy occurs, an artificial abortion will be required and the forced termination of pregnancy will cause endocrine disruption and become a cause of endometriosis. Contraceptive pills are useful in preventing endometriosis, so oral contraceptives can be used more often.