ZhiMei has a friend who will be tortured to death every month by painful menstruation, but for various reasons, she has been dragging herself to the hospital.
Until recently, after being dragged hard by a friend to do a test, I found that I was not an ordinary dysmenorrhea, but suffered from chocolate cysts...
At first glance, when you hear the name "chocolate cyst," you might think for a moment that it's caused by eating too much chocolate.
But in fact, chocolate cysts (referred to as "smart cysts") are a type of endometriosis.
First of all, endometriosis, as the name suggests, is that some endometrial tissue that should have grown normally on the lining of the uterus ran to a part outside the uterine cavity [1].
In general, in women of childbearing age (women aged 15-50 years), the probability of endometriosis is about 10% [2], which means that 1 in 10 women of childbearing age may have the disease.
If some endometrium "gets lost" to the ovaries and forms cysts, the endometrial cells in the cyst will also be affected by female hormones like the endometrial cells of the uterine cavity, and periodic hyperplasia and bleeding will occur.
However, this bleeding is not excreted from the body as it is during menstruation, but instead accumulates in the ovaries and forms a cyst [3].
Repeated bleeding, taking on a viscous, tan appearance, very similar to chocolate sauce.
That's how the name chocolate cyst came about.
If a close relative has a history of chocolate cysts, or if she suffers from congenital vaginal atresia, cervical stenosis, etc., the probability of cysts will increase [4].
People with chocolate cysts may have the following symptoms, and if you have one, it is best to go to the gynecological department of the hospital to check it out.
Lower abdominal pain and dysmenorrhea
The most common clinical manifestation of qiao sac is pain, and 70% to 80% of patients will have different degrees of lower abdominal pain and pelvic pain. And over time, the pain gradually worsens.
If the cyst leaks or ruptures, it can also cause sudden sharp pain, and you should go to the emergency department immediately.
Symptoms of dysmenorrhea are characterized by chronic dull pain, throbbing pain [5,6], usually beginning 1 to 2 days before menstruation and lasting throughout menstruation.
infertile
Severe sacs can erode the normal ovarian epithelium, hinder egg excretion, affect the reserve function of the ovaries, and cause infertility.
Women of childbearing age who have endometriosis may cause infertility in 40 to 50 percent of patients [5].
Pelvic masses
If the capsule is large, the mass may be touched in the adnexal area during the gynecological physical examination.
This is a characteristic manifestation that distinguishes the cyst from other types of endometriosis, but not all patients have this feature.
Of course, if there are relevant symptoms, don't scare yourself, let alone sit in the right seat. Many girls' dysmenorrhea is normal physiological pain and will not affect normal life.
If you really go to the doctor because of dysmenorrhea, the doctor will also diagnose the diagnosis through physical examination, imaging examination and even laparoscopy.
In general, the symptoms of the relatively mild sac, less likely to affect normal life, can not take special treatment, or use medication treatment.
If symptoms are severe, surgery can be used. However, there is still a possibility of recurrence after surgery.
Therefore, it is necessary to take different treatment methods according to each person's different situation.
drug therapy
For sacs with imaging tests smaller than 4 cm and no clinical symptoms, doctors may recommend medication first and then regular re-examination [7] (recommended every 6 to 12 months).
Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to relieve pain symptoms, or oral contraceptives, progesterones, and other drugs may be used to act on the endometrium and cause the lesion to atrophy [8,9].
Surgical therapy
If the effect of drug treatment is not ideal, or the size of the capsule is relatively large, when there are indications for surgery, it is time to let the surgical treatment appear.
At present, the first in China is laparoscopic cyst removal, which is a procedure with little trauma, not only fast recovery, but also relatively small abdominal scars [10].
Postoperative injections of gonadotropin-releasing hormone agonists (GnRH-a) may be required for a complete cure.
In practice, doctors still design individualized surgical treatment plans based on the patient's age, fertility requirements, severity, etc. [11].
Speaking of which, there may be many friends who are worried that they have suffered from "smart bags". And can't help but worry about the problems that affect fertility.
Ectopic endometrium can induce inflammation or cause pelvic adhesions, so more severe cysts can indeed lead to infertility.
However, it is not without treatment, such as surgery, ovulation induction, or artificial assisted reproduction to improve infertility [12].
In addition, the capsule is a benign lesion that is less likely to increase the risk of cancer overall,[13] but patients with the capsule have a slightly increased risk of certain subtypes of ovarian cancer (ovarian clear cell carcinoma and ovarian endometrioid carcinoma) [14].
Finally, the sentence that was emphasized ten thousand times:
When dysmenorrhea affects your life, don't brace yourself.
Be sure to go to the hospital in time for a check-up.
Of course, it is best to have no problem, but if there is a real problem, early detection can be treated early.
Contributing Author
Hu Yi | Eight-year doctorate in gynecology, Xiangya Hospital, Central South University
bibliography
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