Treatment of endometriosis cysts

We all know that for women, the greatest harm to the body is gynecological diseases. However, there are many types of gynecological diseases. Among them, endometriosis is a gynecological disease with a high incidence and is relatively common in our daily life. However, if it is not treated in time, endometriosis cysts will appear, which will seriously affect our physical health and sometimes even affect fertility. Let's learn about the treatment methods of endometriosis cysts.

Endometriosis (endometriosis) refers to the appearance of endometrial tissue (glands and stroma) outside the uterine body, and its characteristics are as follows: It is a common disease in women of childbearing age, mainly causing pain and infertility; the incidence rate has a clear upward trend; the symptoms and signs are disproportionate to the severity of the disease; the lesions are extensive and diverse in morphology; they are extremely invasive and can form extensive and severe adhesions; they are hormone-dependent and prone to recurrence.

Treatment of endometriosis cysts

Surgery

·Purpose of surgery: To remove the lesion and restore the anatomy. The surgical procedures are divided into conservative surgery, semi-radical surgery and radical surgery.

Types of surgery and selection principles:

Conservative surgery: preserves the patient's reproductive function, removes visible lesions as much as possible, removes ovarian endometriosis cysts, and separates adhesions. It is suitable for young people or those who need to preserve their reproductive function.

Semi-radical surgery: remove the uterus and lesions but retain the ovaries. It is mainly suitable for those who do not want to have children but wish to retain ovarian endocrine function.

Radical surgery: Resection of the entire uterus and both adnexa as well as all visible lesions. It is suitable for those who are older, have no fertility requirements, have severe symptoms or have not responded to multiple treatments.

Adjunctive surgeries such as uterine nerve removal (LUNA) and presacral neurectomy (PSN) are suitable for midline pain.

·Preoperative preparation: Adequate preoperative preparation and evaluation; full understanding and informed consent, such as the risks of surgery, the possibility of surgical injury, especially urinary system and intestinal injury, and the possibility of laparoscopic surgery converted to open surgery; patients with deep infiltrating endometriosis, especially those with lesions involving the vagina and rectum, should be fully prepared for the intestine; patients with obvious parametrial deep infiltrating lesions should have their ureters and kidneys checked for abnormalities before surgery; assistance from urology and general surgery is required when necessary.

·Main points of surgical implementation: First, separate pelvic adhesions to restore anatomy; peritoneal endometriosis lesions should be removed or destroyed as much as possible to achieve the purpose of reduction; smaller and more superficial lesions can be cauterized or vaporized; deeply infiltrating lesions should be removed.

When endometriosis lesions are difficult to remove completely through surgery or there is a possibility of damage to important organs and tissues, medications such as gonadotropin-releasing hormone agonist (GnRH-a) can be used for treatment for 3 to 6 months before surgery.

When separating adhesions or removing the uterus to deal with uterine blood vessels and ligaments, attention should be paid to ureteral anatomy. If necessary, a ureteral catheter can be placed in the ureter before surgery as an indication. In addition, anti-adhesion preparations can be used in patients after surgery.

Drug treatment

Treatment goals: To inhibit ovarian function, prevent the progression of endometriosis, reduce the activity of endometriosis lesions and reduce the formation of adhesions.

Selection principles:

① It is used for basically confirmed cases, and long-term "experimental treatment" is not advocated;

② There is no standardized solution yet;

③ The efficacy of various treatments is basically the same, but the side effects are different, so the side effects of the drugs should be considered when choosing drugs;

④ The patient’s wishes and financial ability should also be considered.

The available drugs are mainly divided into four categories: oral contraceptives, high-efficiency progestins, androgen derivatives and GnRH-a. Commonly used drug treatment regimens, mechanisms of action, and side effects are as follows:

Treatment of Dysmenorrhea

Treatment principles: ① For patients with combined infertility and nodules or adnexal masses, surgical treatment is the first choice; ② For patients without combined infertility and adnexal masses, drug treatment is the first choice; ③ If drugs are ineffective, surgical treatment can be considered.

Treatment method: Surgical treatment: conservative surgery, semi-radical surgery or radical surgery can be selected according to the patient's specific situation; LUNA and PSN are implemented as appropriate.

Commonly used drug treatments

First-line medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) or oral contraceptives can be used. Oral contraceptives can be taken cyclically or continuously. Those that are effective can continue to be used, while those that are ineffective can be switched to second-line medications.

Second-line medication regimen: Progestins, androgen derivatives and GnRH-a can be used, among which GnRH-a+Add-back is the first choice, which can effectively control the adverse reactions of long-term medication.

If second-line medication is ineffective, surgical treatment should be considered.

Infertility treatment

Treatment principles:

① Comprehensive infertility examination to exclude other infertility factors;

② Drug treatment alone is ineffective;

③ Laparoscopy can be used to evaluate endometriosis lesions and staging;

④ For young patients with mild to moderate endometriosis, natural conception should be expected for half a year after surgery, and fertility guidance should be given; ⑤ For those with high-risk factors (over 35 years old, fallopian tube adhesions, low functional scores, infertility for more than 3 years, especially primary infertility, moderate to severe endometriosis, pelvic adhesions, and incomplete lesion removal), assisted reproductive technology should be actively used to assist pregnancy.

Surgical method: Conservative laparoscopic surgery should try to remove the lesion, separate adhesions and restore the anatomy. When removing endometriotic ovarian cysts, special attention should be paid to protecting normal ovarian tissue. During the operation, the fallopian tubes are insulated to understand the patency of the fallopian tubes, and a hysteroscopy is performed to understand the condition of the uterine cavity.

Assisted reproductive technology: controlled hyperovulation/artificial insemination (COH/IUI), in vitro fertilization-embryo transfer (IVF-ET), selected according to the patient's specific situation.

Having a baby is a very happy thing for women, but there are many gynecological diseases that deprive women of the right to be mothers, so we must pay great attention to the disease. The above is an introduction to the treatment methods of endometriosis cysts, so when gynecological diseases occur, we must go to a regular gynecological specialist hospital for treatment in order to recover from the disease well.