Cases
Ms. Zhao: "Doctor, I'm 40 years old, why are menstrual cramps getting worse and worse?"
Doctor: "Did you have menstrual cramps when you first had your period?"
Ms. Zhao: "No, the little girl didn't have much pain when she was a child, and it started to hurt after giving birth, and now it's getting worse and worse, and I have to take analgesics every time I have my menstruation!"
Doctor: "Don't worry, do some tests to see what is causing your menstrual cramps." ”
After some questioning and examination, the doctor suspected that Ms. Zhao's dysmenorrhea might be caused by endometriosis. Now let's take a look at this disease!
What is endometriosis
When endometrial tissue appears outside the endometrium, it is called endometriosis. Ectopic endometrium can invade any part of the body, such as the umbilicus, bladder, kidneys, ureters, lungs, pleura, breasts, and even arms, thighs, etc., but most of them are located in pelvic organs and peritoneal walls, and the common ectopic sites are ovary, uterine ligament, uterus, adjacent peritoneum, rectovaginal septum, etc.
Because endometriosis is a hormone-dependent disease, the lesions can gradually shrink and resorb after menopause, and the progression of the disease can be temporarily halted during pregnancy or the use of sex hormones.
What are the clinical manifestations of endometriosis
Endometriosis mostly occurs in young and middle-aged women, with asymptomatic patients accounting for 20%~30% and primary or secondary infertility patients accounting for 17%~30%.
Dysmenorrhea is the main symptom, which is mostly secondary, cyclical, and progressively worsening, and dyspareunia, and chronic pelvic pain. It can also manifest as menstrual disorders, such as shortened menstrual cycles, prolonged menstrual periods, and heavy menstrual bleeding.
When endometriosis involves the intestine, patients may have symptoms such as constipation or diarrhea, tenesmus, and blood in the stool, and when the urinary tract is involved, patients may have symptoms such as urinary frequency, urgency, dysuria, and hematuria.
How endometriosis is diagnosed
Imaging tests are an important way to diagnose ovarian, bladder, and rectal endometriosis. The diagnostic sensitivity and specificity of B-ultrasound are both above 96%. Computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis have diagnostic value in pelvic endometriosis, but they are more expensive than ultrasonography.
Carbohydrate antigen 125 (CA125) measurement CA125 values may be elevated in patients with endometriosis, and more significantly in patients with severe disease, and CA125 values in peritoneal fluid are more meaningful than intravenous serum values. CA125 value has a certain reference value for the diagnosis of endometriosis, but it cannot be diagnosed based on CA125 value alone, and dynamic monitoring of CA125 value is helpful to evaluate efficacy and predict recurrence.
Laparoscopy is currently the best way to diagnose endometriosis.
How endometriosis is treated
Expectant management is observation, which is only suitable for patients with mild endometriosis, and it is necessary to regularly review gynecological color Doppler ultrasound and CA125 values every 3~6 months, and general drug analgesia can also be given, such as indomethacin, ibuprofen, etc.
Drug treatment is mainly used for patients with chronic pelvic pain, obvious dysmenorrhea symptoms, fertility requirements and no ovarian cyst formation, including oral contraceptives (such as drospirenone ethinylestradiol tablets, ethinylestradiol cyproterone tablets, etc.), progestogens, danazol, gonadotropin-releasing hormone agonists, etc.
Surgical treatment includes fertility-sparing surgery, ovarian function-sparing surgery, and radical surgery (removal of the uterus, bilateral adnexa, and intrapelvic lesions).
How endometriosis can be prevented
At present, the etiology of endometriosis is not well understood, and multiple factors play a role. From a preventive point of view, paying attention to the following points can reduce the occurrence of endometriosis.
Prevent menstrual blood reflux It is necessary to detect and treat diseases that cause menstrual blood retention in time, such as congenital genital malformations, atresia, stenosis, and secondary cervical adhesions and vaginal strictures.
Contraception Combined oral contraceptives suppress ovulation, promote endometrial atrophy, and reduce the risk of endometriosis.
Prevent iatrogenic ectopic endometrial implantation Try to avoid multiple uterine cavity surgical operations, such as artificial abortion, dilation and curettage.
Reasonable diet Eating too hungry, too full, partial diet, unclean, etc., may cause endometriosis, so it is recommended to eat a regular, clean and reasonable diet.
Content Sources:
People's Medical Publishing House published "Family Doctor by Your Side - Women's Health Care"
Editor-in-Chief of the book:
Ren Jingjing, chief physician of the First Affiliated Hospital of Zhejiang University School of Medicine
Author of this article:
Gao Shanshan, Zheng Yuanyuan
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