Endometriosis

Written by Xu Xiao Ming
Obstetrics and Gynecology
Updated on February 23, 2025
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Endometriosis means that the endometrial tissue, which normally lines the uterus, grows in other locations. It can grow on the ovaries, inside the muscular layer of the uterus, or in the pelvic cavity. The ectopic endometrial tissue responds to changes in the body's estrogen levels during each menstrual cycle, creating symptoms similar to menstrual bleeding. If it grows on the ovaries, it may form a "chocolate cyst" on the ovaries that gradually enlarges with each menstrual cycle. If it grows within the muscular layer of the uterus, it can lead to adenomyosis, causing significant pain during menstruation. If it grows in the pelvic cavity, it can lead to the formation of pelvic lesions. Therefore, it is recommended that patients with such conditions seek prompt medical treatment.

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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.)

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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 Yue Hua
Obstetrics and Gynecology
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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.

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Written by Yue Hua
Obstetrics and Gynecology
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Can endometriosis lead to pregnancy?

Endometriosis can lead to pregnancy, but about 50% of those affected may not conceive. This is because the disease can cause abnormal anatomical structures in the female pelvic, leading to extensive adhesions around the fallopian tubes, thus affecting the movement of the tubes. This, in turn, impairs their function in transporting the fertilized egg. Therefore, for patients wishing to conceive, it is advisable to monitor follicular development with an ultrasound and have intercourse during the ovulation period, which could increase the chances of pregnancy.

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Written by Li Shun Hua
Obstetrics and Gynecology
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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.