If the time can be returned to 2017, Xiang Jing (pseudonym) will resolutely put aside all concerns and accept the treatment plan of the doctor to place the progesterone intrauterine ring. In this way, now that she has just entered the age of confusion, she probably does not have to face such a cruel choice as whether to remove the uterus.
Can't make up the determination, can't afford to drag the disease
In October 2017, Xiang Jing found a 5 cm ovarian cyst during a physical examination and subsequently underwent cyst removal surgery.
The surgeon found that his fallopian tubes were fluidated and the adhesions were severe, and after urgent consultation with the family, the operation simultaneously removed the right fallopian tube. Postoperative pathological reports show that Xiang Jing also has a fibroid close to the depths of the uterus, combined with adenomyosis. Considering that she had a son and no second child plan, doctors recommended that she insert a progestin intrauterine ring to slow the course of the disease.
In order to consider the side effects such as obesity that may be brought about by hormonal changes, Xiang Jing did not accept this treatment recommendation and wanted to pay attention to the course of the disease by insisting on regular follow-up.
△ The picture is from Visual China
However, the panic at the beginning of the illness was quickly diluted by the busy work and life.
After several months of TCM conditioning, The problems such as Xiang Jing's self-conscious dysmenorrhea have eased, and it is natural to gradually neglect health management and regular follow-up. Even though the 2019 physical examination indicated that a cyst had appeared in her right ovary, combined with mild adenomyosis and endometriosis, she still could not make up her mind to insert the progesterone intrauterine ring.
Until 2021, B ultrasound doctors seriously warned The problem of The Quiet Uterus was serious, and after further imaging examinations, the doctor found that his condition had progressed to deep endometriosis, and there was a high degree of adhesion between the posterior wall of the uterus and the anterior wall of the rectum.
This time, the doctor's advice is no longer to administer the drug intrauterinely, but to remove the uterus.
Four years of hesitation brought extremely heavy consequences, and also made Xiang Jing more and more remorseful about his earlier choices in addition to being stunned.
"Even if you are a little fat, your health is always good." Looking back on the past course of her illness, Xiang Jing has a deeper understanding of reproductive health.
Long-term care, regular examinations, early diagnosis and early treatment, those opportunities she once missed, are now repeatedly taught by her female friends. Behind Xiang Jing's unrepentant regrets, it also reflects the incomprehension, disregard and uneasiness of hundreds of millions of women in China for reproductive health.
More than one stage, more than one concern
The elements that shape women's reproductive health go far beyond the reproductive system itself.
In fact, the public awareness and education of reproductive health is still quite limited, and the adolescent, childbearing age, and menopause experienced by women in their lifetime are highly related to reproductive health, not just equivalent to perinatal and childbearing health. Ma Caihong, deputy director of the Reproductive Medicine Center of the Third Hospital of Peking University, pointed out that the concept of reproductive health is gradually being extended and is no longer limited to women of childbearing age, "child health care, adolescent sexual knowledge education, maternal mental health, menopausal health, disease prevention, assisted reproduction and other links should actually receive more attention." ”
As a "net red doctor" of Douyin, Chen Rong has a good understanding of this. As the chief physician of the Department of Obstetrics and Gynecology of Peking Union Medical College Hospital, Dr. Chen Rong has passed on reproductive health knowledge to the public through new media channels in recent years, and has gained more than 1.6 million fans. However, in reality, cases of missed treatment due to lack of attention, or birth risk due to insufficient reproductive health knowledge reserves, which makes Dr. Chen Rong deeply regretful.
On the other hand, reproductive-related problems are often hidden in secret corners, hidden under the cover, becoming difficult for patients to explain, and even causing irreparable consequences.
Dr. Ma Rainbow's patients have many such cases. "Taking the common problem of dysmenorrhea in women as an example, many parents will think that after experiencing the gestation process, painful menstruation will be cured." However, behind dysmenorrhea, there are often some lesions of the reproductive system, "there may be abnormal development of the reproductive tract, causing endometriosis, in the long years of pain, may promote endometriosis cysts, resulting in impaired ovarian tissue function." ”
In Dr. Chen Rong's view, fertility protection is a long process, running through the entire life cycle, requiring women to pay full attention to their own health and long-term care.
Children and adolescent girls need to pay more attention to healthy development. "Precocious puberty or delayed puberty are abnormal, and severe dysmenorrhea in adolescent girls also requires special attention."
For women of childbearing age between the ages of 20 and 40, menstruation should be of primary concern. As a "barometer" of women's physical health, whether the menstrual cycle is regular and between 24-38 days, whether the menstrual flow is normal, and the menstrual period is not obviously accompanied by symptoms. "Polycystic ovary syndrome may manifest as irregular cycles, endometriosis or adenomyosis may be manifested as dysmenorrhea is particularly serious, so menstrual problems, be sure to seek medical attention in time." At the same time, regular physical examinations are also of indispensable significance for women of childbearing age. "Women in this age group must do a good job of screening for breast cancer and cervical cancer, and pay more attention to reproductive health."
With the increasing number of tragedies caused by postpartum depression in the news, the mental health management of pregnant women during pregnancy and childbirth has also become a social issue of considerable concern. "The more you learn, the less panic you have." Dr. Chen Rong suggested that pregnant mothers can increase the knowledge reserves related to pregnancy and childbirth by reading books and participating in relevant course training, so as to make themselves "more confident" in their hearts, and maternal families also need to build a harmonious family atmosphere and increase positive encouragement.
After childbearing age, women begin to prepare for menopause. On the one hand, pay attention to the menstrual situation, on the other hand, we must develop a sense of regular physical examination and prevent organic diseases. "To reserve some knowledge about menopause in time, such as menstruation is no longer regular, starting hot flashes, sweating, insomnia, etc., may mean that we have entered a new stage of life." If necessary, you can also go to the gynecological endocrinology department or menopausal clinic to relieve discomfort and avoid anxiety being amplified. ”
Be a little more open, be a little more proactive
As one of the basic elements of human health, reproductive health is an important part of the realization of the "Healthy China" strategy. But more often than not, reproductive health is a veil of mystery for the general public.
From the official introduction of the concept of reproductive health by the Chinese government in 1994, to the gradual implementation of family planning and health work in China. The Outline of the Thirteenth Five-Year Plan for National Economic and Social Development clearly proposes to improve the level of public services such as reproductive health and maternal and child health care, establish a national basic public service system for reproductive health that is provided free of charge, and provide adolescent reproductive health services.
However, although the reproductive health cause has established a complete working mechanism that combines administrative management, mass work and technical services in long-term practice, the concept of reproductive health is still a long way from being truly "deeply rooted in the hearts of the people and outspoken".
As with any kind of disease management, this should be an open topic that is generously placed in front of the stage, but more often, reproductive-related questions and pain are often blinded by a huge sense of shame, difficult to talk about, ashamed to ask a doctor. Coupled with the fact that the disease itself is highly insidious, the onset is slow and the process is slow, making it possible for many diseases that could have been well controlled at an early stage to wreak havoc.
A young patient in his 30s once made Dr. Chen Rong sigh. "There will also be bleeding outside the physiological period, but because the amount of bleeding is not large, it has been endured and dragged, and when I came to the clinic more than a year later, the cervix was flame-like, and it was already advanced cervical cancer." This made Dr. Chen Rong particularly distressed, "Cervical cancer is relatively special, whether it is regular screening for two cancers, or timely medical treatment after symptoms, we actually have a lot of lines of defense that can strangle it in the cradle." But every year we will still find a lot of women, because they do not pay attention, do not do the census, and then evolve into advanced cervical cancer, breast cancer, which is particularly undesirable. ”
Dr. Ma Caihong, who has been engaged in assisted reproduction for many years, is also deeply touched by this. "If you have a cold, you have no scruples about talking to others, but if you have infertility, patients will have a lot of psychological pressure, and we do meet many patients, who need to resign to see a doctor and do IVF." And such a psychological state itself will also delay the patient's medical treatment, and even affect the final treatment effect.
In addition, reasonable fertility planning is also of great significance to women's reproductive health. "For women, the timing of childbirth is very important, and we recommend that women have children before the age of 35 to significantly reduce the maternal and fetal risk." At the same time, Dr. Chen Rong has also repeatedly reminded women that in addition to fertility planning, they must do a good job of effective contraception.
"Induced abortion can damage the endometrium and can also affect a woman's normal pregnancy and childbirth." Dr. Chen Rong pointed out that the use of condoms is a good contraceptive method, and compared with this male-led contraceptive method, the compound short-acting oral contraceptives that can be taken by themselves are more conducive to women's ownership of contraception. "That's why I often encourage women to use combined short-acting oral contraceptives, which are arguably one of the most efficient forms of contraception, and can also provide benefits such as regular menstruation and avoiding the risk of abnormal uterine bleeding in the long run."
Nutrition management also greatly affects women's reproductive health. "Overnutrition and undernutrition can have a negative effect." Dr. Ma Rainbow pointed out that contemporary women often have too many carbohydrates, proteins and lipids, and the intake of trace elements such as vitamins and minerals is very limited. For example, insufficient folic acid can increase the incidence of neural tube malformations in newborns; insufficient nutrition can reduce the quality of female oocytes, which may lead to abnormal embryonic development; vitamin B deficiency may lead to increased hyperhomocysteine, which also has an impact on reproductive health. "It is very important to improve the reproductive environment of women." Because of this, Dr. Ma Caihong also advocates, "Use some polynutrients containing folic acid to improve women's reproductive health." ”
"Our science education on reproductive health is far from enough." Dr. Ma Caihong pointed out that the long-term health management education behind the treatment of the disease is not perfect enough; family and school education for adolescent sex education is often still "half covered", and bad information channels have breeding soil; women of childbearing age are hindered by the pressure of life, work and other aspects, have no time to take care of their own reproductive health, and lack of awareness and cognition of scientific pregnancy preparation and health management during pregnancy, and it is more difficult to have reasonable planning and implementation of the next generation. "Our reproductive health focus is shifting from treatment to prevention to life-cycle health management, which is more dependent on the strong investment of the government and society." Dr. Ma Rainbow appealed.