Diagnosis and treatment of endometriosis

Endometriosis can be intervened through drug treatment, surgical treatment and other methods. The disease may be related to reflux of menstrual blood, immune abnormalities, genetics and other factors. It usually presents with symptoms such as dysmenorrhea, chronic pelvic pain, and dyspareunia.

1. Drug treatment

Drug therapy is suitable for mild to moderate patients or as postoperative adjuvant therapy. Commonly used medications include nonsteroidal anti-inflammatory drugs such as ibuprofen extended-release capsules to relieve pain ； Oral contraceptives, such as ethinyl estradiol and cyproterone tablets, reduce endometrial growth by inhibiting ovulation ； Gonadotropin-releasing hormone agonists, such as leuprolide acetate microspheres, can reduce estrogen levels. Drug treatment needs to last for 3-6 months, and liver and kidney function need to be reviewed regularly.

2. Laparoscopic surgery

Laparoscopic resection of ectopic lesions is the preferred surgical method and is suitable for patients with cysts exceeding 4 cm in diameter or infertile patients. Surgery can remove ovarian chocolate cysts, pelvic adhesions and other lesions. During the operation, fallopian tube fluid can be drained to evaluate fertility function. The postoperative recurrence rate is related to the scope of the lesion, and it needs to be combined with drug consolidation treatment.

3. Radical surgery

For severe patients with no need for reproduction, total hysterectomy combined with bilateral adnexectomy may be considered. This surgery can completely eliminate the lesions, but it will lead to early menopause and requires post-operative hormone replacement therapy. The risk of cardiovascular disease needs to be assessed during surgery, and calcium should be supplemented after surgery to prevent osteoporosis.

4. Pain management

Chronic pain patients can use a stepped analgesic regimen. For mild pain, use hot compress, acupuncture and other physical therapies ； Moderate pain combined with neuromodulatory drugs such as gabapentin capsules ； For intractable pain, sacral neuromodulation may be considered. Pain diaries can help evaluate the effectiveness of treatment and avoid overuse of analgesic medications.

5. Fertility protection

Patients with combined infertility should undergo early fertility evaluation. Young patients can undergo laparoscopic surgery to preserve ovarian function, and the best window for pregnancy is 6 to 12 months after surgery. Assisted reproductive technology is recommended for patients with advanced age or fallopian tube damage. It is necessary to control the activity of ectopic lesions before ovulation induction, and use long-acting GnRH-a pretreatment before embryo transfer.

Patients with endometriosis should maintain a regular schedule and avoid strenuous exercise that aggravates pelvic congestion. Pay attention to dietary iron supplementation to prevent anemia, and limit red meat intake to reduce inflammatory reactions. Repeat ultrasound every 3-6 months to monitor changes in lesions. If abnormal bleeding or pain worsens, timely treatment is required. Psychological counseling can help improve the anxiety caused by the disease, and you can join patient support groups to get support.