What to do about dysmenorrhea caused by endometriosis?

Written by Zhang Lu
Obstetrics
Updated on September 02, 2024
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There are two types of dysmenorrhea, primary dysmenorrhea and secondary dysmenorrhea. An important cause of secondary dysmenorrhea is endometriosis. The dysmenorrhea caused by endometriosis comes from specific diseases, and the interventions include the following aspects: First, symptomatic treatment should be conducted first, which means using pain relief medication to alleviate the pain. In clinical practice, various pain relief medications can be used for dysmenorrhea caused by endometriosis. Second, treatment should be aimed at the cause of the dysmenorrhea. Treatment for endometriosis currently includes both medicinal and surgical approaches. If surgical treatment is chosen, it can involve the removal of ectopic cysts or pelvic ectopic cysts, among other conditions; if medicinal treatment is chosen, methods such as pseudopregnancy or artificial menopause can be used.

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Written by Shen Li Wen
Obstetrics and Gynecology
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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.

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Written by Zhang Lu
Obstetrics
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How is endometriosis diagnosed?

Endometriosis refers to the occurrence of endometrial tissue outside the uterine cavity, a common gynecological condition that often leads to painful menstruation, pain during intercourse, and infertility. Diagnosing endometriosis involves several approaches. First, inquire about the patient's clinical symptoms, including any painful menstruation and pain during intercourse. Second, a pelvic ultrasound should be performed to observe the situation inside the pelvis, assessing for any ovarian endometriotic cysts or pelvic endometriotic lesions. Third, a blood test for CA-125 can be conducted, as the levels of CA-125 tend to increase with endometriosis. Fourth, laparoscopy can be used to collect local tissue for pathological examination, which is the gold standard in diagnosing endometriosis.

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Written by Hou Jie
Obstetrics and Gynecology
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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.

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Written by Shen Li Wen
Obstetrics and Gynecology
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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.

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Written by Shen Li Wen
Obstetrics and Gynecology
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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.)