Some female friends start experiencing dysmenorrhea after giving birth, and it becomes increasingly severe. What could be the reason? It could be endometriosis. Let’s learn more about it below.
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What is endometriosis?
Endometriosis occurs when endometrial tissue appears outside the uterus. The ectopic endometrium can invade any part of the body, but most cases are limited to pelvic organs and the peritoneal wall. Common ectopic locations include the ovaries, uterine ligaments, uterus, adjacent peritoneum, and rectovaginal septum. Endometriosis is a hormone-dependent disease, and its progression may temporarily halt during pregnancy or hormonal treatment; after menopause, the lesions can gradually shrink and be absorbed.
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Clinical manifestations of endometriosis
Endometriosis commonly occurs in young to middle-aged women, with 20% to 30% being asymptomatic. Primary or secondary infertility accounts for 17% to 30%. Dysmenorrhea is the main symptom and tends to worsen progressively; pain and chronic pelvic pain may also occur. Menstrual irregularities are also common symptoms. When the intestinal tract is involved, symptoms may include constipation or diarrhea, urgency with defecation, and blood in stools; if the urinary tract is involved, symptoms such as frequent urination, urgency, painful urination, and hematuria may appear.
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Diagnosis of endometriosis
1. Imaging studies are important methods for diagnosing ovarian, bladder, and rectal endometriosis; the sensitivity and specificity of ultrasound diagnostics are over 96%.
2. Blood CA125 testing: CA125 levels may be elevated in patients with endometriosis, and this elevation is more significant in severe cases. The CA125 value in peritoneal fluid is more meaningful than in venous serum. While CA125 levels provide some reference value for diagnosing endometriosis, a diagnosis should not rely solely on CA125. Dynamic monitoring of CA125 can help assess treatment efficacy and predict recurrence.
3. Laparoscopy is currently the best method for diagnosing endometriosis.
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Treatment of endometriosis
Expectant management involves regular monitoring of the condition, suitable for mild symptoms, with gynecological ultrasound and serum CA125 tests every 3 to 6 months as needed. Medication can be provided for pain relief if necessary.
Pharmacological treatment is used for chronic pelvic pain, significant menstrual pain, patients wishing to conceive, and those without ovarian cyst formation. This includes oral contraceptives (such as drospirenone and ethinyl estradiol tablets, ethinyl estradiol and cyproterone acetate tablets), progestins, danazol, and gonadotropin-releasing hormone agonists. Medication treatments should be conducted under a doctor’s guidance.
Surgical treatment may include surgeries that preserve reproductive function, surgeries that preserve ovarian function, and radical surgeries (removal of the uterus, bilateral appendages, and pelvic lesions).
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