Endometriosis is a common and frequent disease in gynecology and has become the second most common disease in gynecology after fibroids, mostly in women of childbearing age between 30 and 40 years old.
The clinical incidence has increased significantly, with a 10% incidence in women of childbearing age, and endometriosis is found in 8% 30% of gynecological procedures. 50% of patients have combined infertility and 80% have significant dysmenorrhea.
It is a benign infiltrative disease common among women in their reproductive years, characterized by proliferation, infiltration, metastasis and recurrence, and is one of the difficult gynecological diseases that seriously affect the health and quality of life of young and middle-aged women.
What is “endometriosis”?
Endometriosis is a disorder caused by the presence of the growing endometrium outside the inner wall of the uterine cavity.
Most of the endometriosis grows in the pelvic tissues and organs, such as the myometrium, ovaries, fallopian tubes, uterine ligaments, rectovaginal diaphragm, peritoneum of the pelvis, vagina, cervix, appendix and bladder.
Endometrial tissue has been documented in the navel, chest cavity, lungs, limbs, brain, and even on the scars of abdominal surgery.
Ectopic endometrium in the human body can be said to be ubiquitous, pervasive and indefensible.
How does endometriosis develop?
The etiology is not well understood, but there are mainly theories of menstrual reflux and epithelial metaplasia.
During menstruation some endometrial fragments flow backwards with the menstrual blood through the fallopian tubes to other tissues. These fragments are still alive and therefore take root and grow on other tissues. It is also under endocrine control, and as it grows, sheds and bleeds periodically, it collects locally little by little, forming an endometriotic nodule or cyst.
The ectopic lesions located in the ovaries cycle from month to month, and the trapped “menstrual blood” accumulates and forms cysts. As the old blood accumulated in the cyst becomes concentrated into a mucus-like consistency, it resembles chocolate, and is therefore called “ovarian chocolate cyst”.
What are the signs of endometriosis? How is it diagnosed?
About 20% of the patients have no conscious symptoms, and those who have symptoms mostly have periodic episodes of dysmenorrhea: secondary and progressive dysmenorrhea, with pain mostly in the lower abdomen and lumbosacral area, radiating to the vagina, perineum, anus and thighs. The pain starts 1 to 2 days before menstruation and is most severe on the first day of menstruation. The pain is relieved and gradually disappears after the menstruation clears.
Irregular menstruation: Sometimes the cycle is shortened, the volume of menstruation is increased or the period is prolonged, and there are cases of premenstrual spotting.
Infertility: The infertility rate of endometriosis patients is 40% to 50%, which is more than 2 times higher than that of normal women.
Other: 10% of patients have pain or discomfort during sexual intercourse. If the lesion invades the rectum, vagina or sacral area, constipation or pain during defecation may occur before or during menstruation.
Endometriosis in the scar of the abdominal wall and umbilicus presents with periodic localized masses and pain.
Patients with intrinsic endometriosis tend to have a distended uterus, but rarely beyond 3 months gestation. In the case of a posterior uterus, adhesions are often fixed.
It is important to note that one to two or more small hard nodules, such as the size of a mung bean or soybean, are often palpable in the rectal fossa, uterosacral ligament, or posterior cervical wall, and mostly have significant tenderness, which is more obvious on anal examination.
Ultrasound: It is currently an effective method to assist in the diagnosis of endometriosis and is mainly used to observe ovarian endometriotic cysts.
Laparoscopy: It is the gold standard for the diagnosis of endometriosis and allows direct visualization of the pelvic cavity and a clear diagnosis when ectopic lesions are seen.
Needs attention.
Many people do not know much about the etiology and pathology of this disease.
It is similar to many other diseases.
In general, patients and non-specialists are not very alert to this disease.
To find out if you have endometriosis, you should seek diagnosis and treatment from a specialist and a doctor with some specialist credentials and experience.
Endometriosis affects fertility due to mechanical factors: ectopic endometrium on the surface of the fallopian tube causes adhesions caused by the proliferation of connective tissue around it, which affects the peristalsis of the fallopian tube and the role of the umbilical end in collecting eggs, and even causes atresia of the fallopian tube.
Endocrine factors: Ectopic endometrium can produce more prostaglandins with relatively high local concentrations, which can dysregulate the egg collection function and peristalsis of the fallopian tube, affecting its egg collection and transport of sperm and eggs; it can also hinder follicle development and inhibit ovulation, or cause the development of fertilized eggs to be out of sync with the metaphase changes of the endometrium, preventing the fertilized eggs from being laid.
Immune factors: i.e. autoimmune reaction, ectopic endometrial bleeding induces tissue fibrosis with increased lymphocytes and phagocytes, and anti-endometrial antibodies produced by lymphocytes. This autoimmunity causes damage to the biochemical metabolism and physiological function of the endometrium, interfering with the early fertilization of spermatozoa, or causing infertility because sperm and eggs are engulfed and interfere with the division of oocytes during the rendezvous process.
How is endometriosis treated?
Medication § Surgical treatment (laparoscopic surgery, open surgery) § Surgical treatment + medication § Medications used to treat endometriosis are mostly hormonal drugs. Hormone therapy mainly inhibits ovulation or causes amenorrhea, causing degenerative changes in the ectopic endometrium, followed by necrosis and resorption.
After sex hormone treatment about 85% of patients’ symptoms can be relieved, and some patients also have pregnancy after treatment.
Patients taking sex hormone drugs often have different degrees of side effects, such as loss of appetite, nausea and abnormal liver function, which can disappear after stopping the drug.
In some patients, the efficacy is not stable enough after long-term use, and relapse is easy after stopping the drug.
Because of its adverse effects on liver function, liver function should be paid attention to during drug use. Therefore drug therapy should be applied under medical supervision.
Minimally invasive laparoscopic surgery has opened up new avenues for the effective treatment of endometriosis.
Laparoscopy can not only detect early disease, but also treat it under the laparoscope, i.e., diagnosis and treatment can be carried out simultaneously, and the disadvantages of open surgery can be avoided, and blind medication can also be avoided to delay the disease.
The whole procedure is performed under visualization, and the ectopic endometrium is accurately identified, the ectopic lesion is removed, and then the treatment is consolidated with medication.
The treatment does not damage the female uterus and reproductive function, is safe and painless, requires no stitches, has little intraoperative bleeding, has few postoperative complications, has a rapid recovery and high cure rate, the abdomen is as smooth as before after surgery, humane treatment keeps the woman in style, and is the best method for endometriosis eradication.
For young patients who desire to have children, the goal of treatment is not only to eliminate the lesion, but also to restore the reproductive function as much as possible. Both hormone-based medications and surgical approaches to endometriosis can improve the patient’s ability to conceive.
It has been reported that after pseudopregnancy therapy, conception occurs in approximately 30% of cases; pseudomenopausal therapy can achieve a 50% pregnancy rate at 1 year. If conservative surgery is performed to remove as many endometriotic lesions as possible, while loosening the adhesions around the uterus, fallopian tubes and ovaries one by one and carefully repairing the wounds to reduce re-adhesions, the pregnancy rate after surgery can be about 50%.
It is generally believed that the pregnancy rate of surgical treatment is higher than that of pharmacological treatment. Therefore, in young cases, such as those with obvious cysts or nodules in the pelvis, timely conservative surgery is mostly preferred to provide patients with a higher chance of conception§ Although the recurrence rate as well as the reoperation rate after surgery are relatively high, it is worth trying for a woman who urgently needs to have children. Combined postoperative treatment with GnRH-a medication for 3 to 6 months is now advocated and is beneficial in both reducing recurrence rates and increasing pregnancy rates.
Surgery to preserve ovarian function: semi-radical surgery for severe patients under 35 years of age but without fertility requirements. Total hysterectomy or subhysterectomy and adnexal resection on the diseased side are performed. However, one or part of the ovary is preserved to maintain the patient’s endocrine function.
Radical surgery: the uterus is removed along with the bilateral adnexa and the lesions left in the pelvis. It is indicated for severe patients over 45 years of age who are near menopause.
In conclusion, endometriosis is a disease that requires a combination of surgical and pharmacological treatment. The treatment of this disease must emphasize the three principles of accurate diagnosis, individualized treatment, and scientific treatment.
To prevent endometriosis, we should pay attention to gynecological hygiene, check the life of both sexes, eliminate unmarried pregnancy, avoid menstrual intercourse, and reduce the chance of menstrual blood reflux.
Regulate your emotions, keep warm, and pay attention to personal hygiene during menstruation.
Pay attention to adjust your emotions and keep an optimistic and cheerful state of mind, so that the function of the body’s immune system is normal.
During menstruation, prohibit all intense sports and heavy physical labor.
Try to avoid abortion and scraping, and do a good job of family planning.
During menstruation, you must do your own health care, pay attention to control your emotions, do not sulk, otherwise it will lead to endocrine changes.
Girls should avoid being frightened during puberty, which may lead to amenorrhea or the formation of reflux.
Women who may have a genetic predisposition, whose mothers or sisters have severe menstrual pain or suspected endometriosis, should take the initiative to go to a regular hospital for examination.
The dietary principle for endometriosis patients is to avoid cold foods. Before and after menstruation, special attention must be paid to eating hot soups and dishes, and cold foods are forbidden.
Eat more food to nourish deficiency and benefit qi. It can help the qi to move the blood and can have the effect of relieving pain.
Fatty and greasy food is better to eat less. Light foods are more appropriate.
Avoid eating sour and astringent foods. You can eat warm and slightly spicy food, but not too much, because too much spicy stimulation will also aggravate the pain.
Foods to avoid.
Cereals, beans and potatoes as staple foods can be eaten and need not be avoided.
Poultry and livestock, eggs and milk, fish and fresh can generally be eaten, and those who are deficient in qi and blood are better off with qi and blood. Conch, clams and mussels, crab and turtle are cold and should be eaten sparingly. Too fatty meat avoid eating.
Among the vegetables, rape, shepherd’s purse, amaranth, kelp, cucumber, loofah, winter melon, eggplant, leek, bamboo shoots, lotus root are cool, eat less before and after menstruation is good, especially not raw. The white onion is good for dispersing cold and draining the liver meridian. Wood ear has and blood function, can also eat more.
Fruits are mostly raw, and should be avoided before and after menstruation.
Dried fruits are not contraindicated and can be eaten at any time. Walnuts, jujube, cinnamon for blood, more suitable.
Liquor warming Yang and blood circulation, moving Qi and dispersing cold can be appropriate to drink. Mustard, fennel, pepper, pepper and so on, the nature is also warm pass. Rose to relieve worry, and blood to disperse blood stasis, used to flavor are good. Brown sugar boiled ginger, drink daily, quite beneficial.