2. Endometriosis is a common and frequent disease in
gynecology. It is a common benign infiltrative disease in
women of reproductive age, characterized by proliferation,
infiltration, metastasis, and recurrence.
It is one of the complex gynecological
diseases, which seriously affects young
and middle-aged female health and
quality of life.
3. Symptoms of endometriosis
(1) Dysmenorrhea
(2) Menstrual abnormalities
(3) Infertility
(4) Painful intercourse
(5) Other
4. Dysmenorrhea is the most typical symptom
of endometriosis. It is secondary to
progressive aggravation and often starts 1
to 2 days before menstruation and is most
severe on the first day of menstruation.
Gradually decreases and disappears when
menstruation is clean.
5. In the severe stage, the pain is unbearable, and
even an increase in the number of painkillers is not
practical. The pain is caused by the inflammatory
reaction of the local tissue stimulated by bleeding
inside the endometriosis lesion.
6. It may be manifested as excessive
menstruation or period disorders. Most
menstrual irregularities are related to
endometriosis affecting ovarian function.
Patients with endometriosis may
experience ovarian dysfunction, such as
abnormal ovulation.
7. Patients with endometriosis are often associated with
infertility, with an infertility rate of 40% to 50% among
patients with endometriosis. The main reason is that
endometriosis often causes adhesions around the
fallopian tubes that affect oocyte retrieval; or ovarian
lesions that affect ovulation.
8. Endometriosis in the rectal sulcus and vagina, the rectal
septum can cause painful intercourse (deep tenderness),
increased bowel movements during menstruation, and
pain (urgency and heaviness).
9. In endometriosis to the bladder, there is regular urinary
frequency, painful urination, and hematuria. Endometriosis
in the abdominal wall scar and umbilicus presents with
periodic localized masses and pain. Patients with intestinal
endometriosis may present with abdominal pain, diarrhea
or constipation, and even small amounts of blood in the
stool. When the ectopic endometrium invades and
compresses the ureter, back pain and hematuria on one
side may occur but is extremely rare.
11. Treatments vary depending on the
severity of the condition, the patient's
age, and fertility status. If the disease is
severe or manifests as heavy
dysmenorrhea or pelvic examination
reveals solid endometriosis nodules,
drug or surgical treatment is necessary.
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Conservative medication can be used for young
patients or those who still need to have children to
treat endometriosis without removing the uterus.
Herbal medicines such as the herbal medicine Fuyan
Pill can cure endometriosis effectively and safely.
13. Generally, a few months of consistent
medication use can significantly
control and relieve the pain, and the
disease can be cured. Medication can
avoid complications and after-effects
of surgical treatment and also reduce
the risk of post-operative infection.
14. It is generally believed that chocolate cysts are
occurring on the ovaries, which are often larger. Or
endometriotic nodules are happening in other parts
of the uterus, more than 2 cm in diameter.
15. They are not easily controlled by medication and
require surgery. Or, if the condition does not improve
after six months or even a year of drugs, surgical
removal should also be considered.
16. If the patient is young and has no children,
surgery is usually performed to remove only
the endometriotic lesion while preserving the
uterus and normal ovarian tissue, called
conservative surgery. This type of surgery
keeps the possibility of fertility but has a
greater chance of recurrence.
17. Still, the normal ovarian tissue is
preserved, called a semi-
conservative procedure. This
method has better results than
conservative surgery in the long
run, but it does not prevent a
recurrence.
If the patient has children and is older (>35 years old), the
uterus can be removed along with the endometriotic lesion.
18. Suppose the patient is nearing
menopause or the endometriosis is
too extensive to be completely
eradicated. In that case, the uterus
and ovaries should be removed
together during surgery, called
radical surgery.
19. After a precise diagnosis of endometriosis, medication or
conservative surgical treatment is feasible according to the
patient's age, fertility requirements, the severity of the
disease, symptoms, and extent of the lesion, and overall
consideration. Laparoscopic treatment is also available for
infertility. The goal of treatment is to control the symptoms
and have a baby!