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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Endometriosis symptoms

When women suffer from endometriosis, the typical symptom is progressively worsening dysmenorrhea. What is progressively worsening dysmenorrhea? It is mainly because the ectopic endometrial tissue also becomes congested, swollen, and sheds each month during menstruation, causing the ectopic lesions to gradually enlarge, thus making the dysmenorrhea increasingly painful. Some women may have ovarian endometriomas or ectopic endometrial lesions in the posterior cul-de-sac of the vagina, which can also cause severe pain during intercourse. Ovarian endometriomas can also affect the normal ovulation of the ovaries, leading to menstrual cycle disorders, such as irregular menstruation or increased menstrual flow, among other phenomena. Endometriosis can also alter the pelvic environment, leading to difficulties in conception for women.

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Written by Yue Hua
Obstetrics and Gynecology
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Does endometriosis need treatment?

Whether or not endometriosis requires treatment entirely depends on the patient's symptoms. If it is a mild case of endometriosis without severe symptoms, the patient can undergo regular follow-up visits. However, if the patient experiences severe abdominal pain during menstruation, it depends on whether the patient has reproductive demands. If there are reproductive demands, medication can be administered; clinically, high-dose progestogens are commonly used to prevent the ectopic endometrial tissue from continuing to grow. If the patient has no desire for childbirth and suffers from severe pain, a hysterectomy and bilateral adnexectomy may be performed.

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Written by Zhang Xiu Rong
Obstetrics and Gynecology
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Endometriosis Clinical Manifestations

Endometriosis is clinically most evident in dysmenorrhea, which tends to worsen progressively. The clinical presentation varies depending on where the endometrial tissue is located. If the tissue is located on the ovaries, it can form ovarian chocolate cysts. Generally, chocolate cysts can affect fertility, leading to anovulation and the appearance of ovarian chocolate-like cysts. Treatment typically involves surgical intervention, which is characterized by a high risk of recurrence after surgery. If there is no immediate plan for pregnancy, there is also a possibility of recurrence. Additionally, if endometriosis involves the uterus, it can lead to a uniformly enlarged uterus and uneven uterine wall echoes, resulting in adenomyosis. Therefore, the most typical clinical manifestation of endometriosis is progressively worsening dysmenorrhea.

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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 Xu Xiao Ming
Obstetrics and Gynecology
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Causes of endometriosis

The causes of endometriosis are not yet fully understood, but the theory of endometrial implantation is recognized by most experts and scholars. The main reason is that during menstruation, endometrial glandular epithelium and stromal cells can retrograde with menstrual blood, enter the pelvic cavity through the fallopian tubes, implant on the ovaries and adjacent pelvic peritoneum, and grow and spread there, forming pelvic endometriosis. Most clinical and experimental data also support this theory, indicating that approximately 70%-90% of women experience menstrual blood retrograde. Additionally, congenital vaginal atresia can also lead to endometriosis, as well as iatrogenic endometrial implantation, such as abdominal scar implantation after cesarean section or endometriosis at the perineal incision site after childbirth. These factors may also contribute to the development of endometriosis.