Case:
2 years ago, I was 32 years old, had a decent job, and was also married to love. The fly in the ointment is that I have been pregnant for a year but have not moved.
I've been taking painkillers for dysmenorrhea since I was a kid, but I've recently discovered that menstrual cramps are getting heavier every time.
I originally thought it was just due to work pressure, but a severe menstrual cramp made me suddenly feel that it would be the body that needed conditioning? So, I went to the hospital...
After a series of tests, I was diagnosed with endometriosis. It was this illness that kept me from conceiving a baby.
If you have also been plagued by dysmenorrhea for a long time, or if you have not been successful in trying to conceive, you must read this article carefully.
The endometrium is a tissue located on the surface of the uterine cavity that varies with the monthly periodic fluctuations of sex hormones.
If there is no pregnancy at the end of a cycle, the endometrium will fall off the uterine cavity, forming a menstrual period and excreting it from the body.
The normal endometrium should stay in the uterine cavity, but the uterus is not a closed little box.
Therefore, some "rebellious" endometrium will "run away from home" through the holes at the corners of the uterus and go to the ovaries, abdominal cavity, rectum, bladder and other places to "camp".
Bleeding also occurs during each menstrual period, causing adhesions and local inflammatory reactions, or forming masses that involve nerves.
Reflected in the body, it can cause dysmenorrhea, dyspareunia, pelvic pain, and infertility – what we often call endometriosis [1,2].
What causes endometriosis?
The reason is not entirely clear at this time. It has been suggested that it is related to the counterflow of intimal tissues, immune abnormalities, disorders of endocrine signaling, and genetic factors [2].
Many people believe that menstrual blood reflux can trigger endometriosis.
In practice, however, only 10 to 15 percent of women develop the disease, because only when other abnormalities (such as immune abnormalities) occur at the same time, can the "exodus" lining take root and form endeopathy [3].
1. Abdominal pain and dysmenorrhea
Dysmenorrhea is the initial manifestation, and 80% of women with ectopia have pelvic pain of varying degrees [4].
It is most commonly manifested by dull pain or cramps in the lower abdomen that begins 1-2 days before menstruation and lasts for several days after the end of menstruation.
Others present with chronic dull pain in the lower abdomen, or throbbing, sharp, or burning pain [5,6].
2. Dyspareunia
Pelvic inflammation, fibrosis, and adhesions caused by endeopathy can cause deep dyspareunia in addition to pelvic pain [2,7]. This is slightly different from other causes of dyspareunia (such as congenital malformations, infections, etc.).
3. Infertility
Women under the age of 35 who do not conceive without taking any contraceptive measures and have been having sex regularly for more than one year (> 35 years old is half a year) is infertility [8].
If infertility is accompanied by more severe dysmenorrhea, it may be endopathy.
4. Localized periodic pain, bleeding and lumps
If the endometrium runs to another part of the body, that location will experience periodic pain as during menstruation.
Therefore, if you suddenly find that a certain part of the body will be accompanied by pain when you menstruate, you should pay more attention.
5. Other symptoms
For example, abnormal bladder function is manifested by urinary urgency, frequency, and pain of urination aggravated by menstruation, and intestinal abnormalities are manifested by diarrhea, constipation, and painful bowel movements that aggravate menstruation [2].
If the above manifestations appear, it is recommended to go to the hospital to hang up the gynecological department for examination.
drug therapy
These include nonsteroidal anti-inflammatory drugs (e.g., ibuprofen) that relieve pain, progesterone drugs that cause endometrial atrophy (e.g., denofgescin is the first choice for long-term use), oral short-acting contraceptives that inhibit the hypothalamic-pituitary-ovarian axis, and gonadotropin-releasing hormone agonists [11].
The above several drugs are used in combination, but also accompanied by corresponding side effects, we must not take their own medicine, must listen to the doctor.
Surgical treatment
Laparoscopic surgery is generally taken, and the timing of surgery is different for different ectopic sites and different symptoms, and the common situations that require surgical treatment are summarized as follows:
1. Symptoms do not resolve after drug therapy (eg, severe dysmenorrhea, pelvic pain), or cannot tolerate drugs due to their own factors [12].
2. Local lesions. For example, endometriosis leads to obstruction of the urethra and intestine, and suspicious malignancy of endopathic lesions [13,14].
3. Fertility function has not been restored. In patients with endopathy and infertility, surgery not only allows for a definitive assessment and diagnosis of endomegaly, but also removes lesions to relieve pain and relieves adhesions to treat infertility [15].
4. There is a large ovarian endometriosis cyst, or a mass suspected malignancy. Surgical removal is recommended >5 cm in diameter and is symptomatic (dysmenorrhea, infertility, etc.) or the possibility of a malignant mass [16].
Endeopathy is a disease that requires long-term management, and in general, doctors will consider medication in combination with surgery.
Although the symptoms of endopathy are diverse, the recurrence rate is high, and some will be tortured and exhausted, anxious and depressed due to pain and infertility, the existing treatment strategies are also relatively perfect, and we must have confidence!
Doctors will see the tricks according to the specific situation, and can always control the development of the disease and symptoms. The fight against endopathy is a protracted battle, and we want to:
1. Actively learn relevant knowledge, know thyself and know thyself;
2. Regular follow-up, with the doctor's treatment;
3. Adjust your mindset and increase your confidence.
In the end, we can work with doctors to defeat it!
Reviewer
Liu Haiphong | Deputy Chief Physician of the Department of Obstetrics and Gynecology, Huashan Hospital, Fudan University
bibliography
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