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Endometriosis
Endometriosis characteristics
The main characteristic of endometriosis is painful menstruation, and in severe cases, it can lead to heavy periods and prolonged menstrual cycles. If endometriosis leads to the formation of ovarian chocolate cysts, the rupture of these cysts can cause severe abdominal pain. Moreover, endometriosis can easily lead to pelvic adhesions, which are a common cause of infertility. If the condition is severe, abdominal pain may also occur after the menstrual period has ended. In the case of adenomyosis, the symptoms include an enlarged uterine body, heavy periods, and prolonged menstrual cycles. If the condition is severe, then surgical treatment may be necessary.
Is it easy to get pregnant with endometriosis?
Endometriosis, which has a relatively high incidence among women, refers to the condition where the endometrial tissue is located outside the uterine cavity. This condition can easily lead to infertility. Although endometriosis is a benign disease, it exhibits characteristics similar to those of malignant diseases, primarily manifesting as local infiltration that causes adhesions and can disrupt the function of the fallopian tubes and ovaries. First, it can lead to the presence of chocolate cysts on the ovaries, which can affect the ovulation function of the ovaries. Second, it can sometimes cause adhesions in the fallopian tubes or pelvic adhesions, affecting the egg-pickup function of the fallopian tubes. This prevents sperm and eggs from fertilizing within the fallopian tubes. Even if fertilization occurs, the impaired function of the fallopian tubes may also lead to an increased risk of ectopic pregnancy.
Endometriosis has several manifestations.
When women suffer from endometriosis, the clinical manifestations can vary depending on the specific location of the ectopic endometrial tissue, but there are some commonalities. A major symptom is pain related to menstruation, such as dysmenorrhea. For example, ovarian chocolate cysts can cause progressively worsening dysmenorrhea and affect the amount of menstrual flow; issues like increased menstrual volume and prolonged menstrual periods can also occur, and some women may experience pain during intercourse. Endometriosis often leads to the occurrence of pelvic adhesions, so some women may also experience chronic pelvic pain. When endometrial tissue is located on the ovaries, it can affect normal ovulation and hormone secretion, leading to irregular menstrual cycles and infertility.
How is endometriosis diagnosed?
Endometriosis is a condition where the uterine lining grows outside of the uterine cavity, commonly seen in the pelvic region, particularly above the ovaries. Therefore, ultrasound (B-ultrasound) examinations are primarily used for accuracy. The ultrasound may reveal a large mass on one side of the fallopian tubes or ovaries, with uneven content inside. During the ultrasound, it can also be observed that the capsule of the mass is intact. Additionally, during a gynecological examination, the doctor may also feel a mass in the adnexa.
What tests are done for endometriosis?
Endometriosis is generally diagnosed through color ultrasound and CA-125 blood tests. If the endometrial tissue is located within the uterine muscle, it forms adenomyosis, at which point the ultrasound will show an enlarged uterus and uneven muscle wall echogenicity. Blood tests for the tumor marker CA-125, if elevated above the normal level of 35, generally indicate adenomyosis. If the endometrial tissue is located in the ovaries, it can form ovarian chocolate cysts, which are visible on the ultrasound as ovarian sections and echoes, with typical ultrasound reports indicating ovarian chocolate cysts. Therefore, routine examinations for endometriosis typically include color ultrasound and blood tests, which can confirm the diagnosis.
How is endometriosis treated?
The treatment methods for endometriosis depend on the patient's age, the severity of symptoms, and whether they have childbearing requirements. For younger patients who wish to have children, conservative treatment methods are preferable, followed by ovulation induction therapy. For older patients with more severe symptoms, surgical treatment may be considered. If the patient does not have immediate childbearing requirements, a hormonal intrauterine device (IUD) can be placed in the uterus. This device releases progesterone and provides excellent treatment results for endometriosis. If the symptoms of endometriosis are severe, manifesting in pronounced dysmenorrhea, excessive menstrual bleeding, or ovarian cysts, then surgical treatment should be considered.
How to treat endometriosis in the pelvic cavity?
When women suffer from pelvic endometriosis and the symptoms are not too severe—for instance, if the pain is relatively mild—they can be clinically observed during menstruation. If dysmenorrhea occurs, oral administration of non-steroidal anti-inflammatory drugs such as indomethacin can help alleviate the symptoms. However, some women may experience more severe symptoms and may require pseudopregnancy treatment with drugs, such as oral contraceptives or progestin-based medications. Another approach involves using GnRH analogues, a method known as 'medical oophorectomy.' If symptoms are severe and treatments are ineffective, surgical intervention might be considered. Surgical options include electrocoagulation of endometriotic lesions in the pelvis, sharp or blunt dissection of adhesions, which can also improve the pelvic environment and potentially enhance fertility in women. (Note: Medication should be taken under the guidance of a doctor.)
Does endometriosis hurt?
When a woman has endometriosis, she rarely experiences pain outside of her menstrual period, except in specific circumstances, such as during intercourse, where contact might be made with the ectopic endometrial lesions, causing severe pain, also known as dyspareunia. During menstruation, because the ectopic endometrial tissue is still active, it can undergo congestion, edema, rupture, and bleeding, leading to severe dysmenorrhea. Additionally, during the menstrual period, it can also cause an increase in prostaglandin secretion within the uterine cavity, enhancing the uterus's excitability, leading to dysmenorrhea.
Does endometriosis require the removal of the uterus?
Endometrial displacement, depending on the specific location of the displacement, calls for different treatments. When the endometrial glands and stroma invade the myometrium, it is called adenomyosis. Treatment is based on the patient's symptoms, age, and fertility requirements. If there are fertility requirements, or the patient is near menopause, medicinal treatment can be tried to alleviate symptoms. For younger patients with adenomyosis who have reproductive needs, focal excision surgery can be considered. For patients with severe symptoms, who either have no reproductive needs or for whom medicinal treatment is ineffective, a total hysterectomy may be considered.
Can endometriosis turn into cancer?
The answer is no. First, let's explain what endometriosis is. Endometriosis is when the endometrium, or the lining of the uterus, is found outside of its normal location, including in the muscular layer of the uterus, the ovaries, the pelvic cavity, or the intestines; it can occur in any of these areas. This condition is known as endometriosis. Endometriosis within the uterus is a benign condition, but it can lead to severe painful menstruation and chocolate cysts. If the menstrual pain is very severe, there may be a possibility of needing a hysterectomy in the future. If a chocolate cyst occurs, surgery might also be necessary.