Endometriosis (English name: endometriosis) is a common disorder in young women, the name of which may not be clear to many, but when it comes to menstrual pain, it is expected that many will have it. Endometriosis is often described as a “pelvic dust storm” because it involves a wide range of lesions, usually involving the peritoneum (a layer of membrane covering the surface of organs in the stomach), ovaries, vaginal diaphragm, etc. A simple understanding of endometriosis can be said to be a monthly exfoliation and bleeding of the endometrium inside the uterus. The endometrium has grown out of the uterus in another location, and it bleeds during the monthly menstruation, thus creating various foci of disease. Endometriosis is a relatively stubborn disease, and once it develops, it often accompanies women during their reproductive years for decades. To date, its treatment is still a worldwide challenge. What are the symptoms? Dysmenorrhea is the most common symptom of endometriosis. Of course, dysmenorrhea may not always be caused by endometriosis, as malformations and inflammation may also be the cause of dysmenorrhea, but it can be said that more than 80% of dysmenorrhea is caused by endometriosis. Endometriosis often occurs on the ovaries in the early stage with some lesions on the surface of the ovaries. As the disease progresses, it tends to bleed repeatedly, forming an encapsulated accumulation of blood in the ovaries, bleeding once a month, and the blood inside becomes more and more viscous, like chocolate, which is also called chocolate cyst, commonly known as “coarctation”. This is also called a chocolate cyst, commonly known as a “coeliac”. Once the cyst breaks one day during menstruation, it will cause acute abdominal pain, so severe abdominal pain during menstruation should suspect the possibility of endometriosis rupture and bleeding. Painful intercourse is also a common symptom of endometriosis, usually because endometriosis invades the ligaments that hold the uterus in place or the diaphragm between the vagina and rectum, resulting in painful intercourse. Some patients are afraid of the doctor’s finger examination because once the doctor’s finger touches these nodules, it often leads to pain. Patients with endometriosis often have difficulty getting pregnant, and about half of them have infertility. Many infertile patients also have findings of intrapelvic lesions when they undergo laparoscopy. What is the etiology? Like many diseases, endometriosis is a result of genetic + environmental influences. Patients with endometriosis often have a genetic susceptibility, combined with external factors such as miscarriage, cold during menstruation, and surgery, followed by the development of endometriosis, but how it is initiated and how it occurs remains a mystery. How is it diagnosed? The gold standard for the diagnosis of endometriosis is laparoscopy, which means that endometriosis can be diagnosed by seeing blue, brown or white nodules on the peritoneum under laparoscopy. However, most patients do not require a surgical approach, as surgery is, after all, an invasive operation. Clinically, the diagnosis of endometriosis is usually made empirically based on the patient’s history of dysmenorrhea, the presence of painful nodules to the finger, the presence of characteristic ovarian masses on ultrasound, and the presence of elevated CA125 on laboratory tests. The presence of coarctation also tends to be characteristic. Does elevated CA125 indicate malignancy? CA125 is a test often prescribed by doctors in gynecological diseases. CA is the abbreviation of cancer antigen, which translates to cancer antigen. Patients with endometriosis often have elevated CA125, and the degree of elevation is often related to the disease, so CA125 can be used to monitor the condition of endometriosis. How is it treated? Endometriosis is a difficult disease to treat. As mentioned earlier, it has been described as a “benign cancer” because it is difficult to control. Therefore, if you have endometriosis and do not have large coeliacs, my usual advice is to try to get pregnant first. Many patients with dysmenorrhea often have relief from dysmenorrhea after pregnancy for this very reason. If the coeliacs are present and are relatively small, they can be observed or treated with medication, but if they are large, more than 4 cm, the doctor will usually recommend laparoscopic surgery to deal with the cyst first. The purpose of the surgery is, first, to clarify the diagnosis and, second, to remove the lesion as much as possible during the surgery to reduce the risk of menstrual rupture and further development. After surgery it is often possible to obtain remission of the disease and the success rate of pregnancy tends to increase. Six months after surgery is often the prime time to get pregnant, so in case of combined infertility, it is often recommended to try to get pregnant after surgery. If you are still infertile after about six months of trying, the next step is to consider an assisted reproductive method, artificial insemination or IVF is helpful to increase the pregnancy rate. There are many types of medications available, and oral contraceptives can also treat endometriosis. Many women with dysmenorrhea often have less dysmenorrhea after taking oral contraceptives, which is one reason for the treatment. Oral contraceptives contain relatively more progestin, which is helpful in relieving the condition. Pseudo-menopause or pseudo-pregnancy therapy is the use of drugs that simulate the environment of pregnancy or menopause. Progesterone is often used in the treatment of endometriosis, and after surgery, it is often necessary to use these drugs for treatment as well. Usually the cycle of taking the drugs takes 3 to 6 months because of the possibility of side effects such as masculinization, obesity, and hair, and is usually not used in the treatment of undiagnosed endometriosis. GnRH-a is a class of drugs, including Norelide, Daphylline, Suppressant, etc., which need to be injected, they inhibit the secretion of estrogen from the ovaries, simulating the environment of menopause in the body, which is also helpful for the treatment of endometriosis, the drug needs to be injected on the first day of menstruation, after the drug will not come to menstruation, temporarily will inhibit the endometriosis condition, after surgery if there is fertility The GnRH-a drug is relatively expensive, about 2,000 yuan per injection, and is generally administered for 3-6 months.