Understanding Endometriosis

Endometriosis (EMS) refers to the appearance of uterine wall tissue (glandular ducts and interstitial space) with growth and development functions in locations other than the uterine mucosa. It is one of the common gynecological chronic diseases, and its prevalence accounts for 10% of maternal chronic diseases. This disease often causes chronic pelvic pain, infertility, etc., which seriously affects the patient's quality of life.

In clinical medicine, endometriosis can be roughly divided into three types: retroperitoneal type, uterine ovarian type and superficial invasive type. The clinical symptoms of endometriosis are varied, mainly pelvic pain, infertility, increased menstruation, etc. Patients usually only seek medical treatment when they suffer from long-term infertility or feel obvious discomfort or pain in daily life, but there are also a few people who have no symptoms. Some atypia symptoms have predictive value for the early diagnosis of endometriosis.

70%~80% of endometriosis patients have varying degrees of pelvic pain. Endometriosis may be considered for women of childbearing age who experience dysmenorrhea, chronic pelvic pain, pain during sexual intercourse, and painful bowel movements. Among them, patients with superficial infiltration have more common and severe pain because the disease is mainly distributed in the anterior pelvis.

(1) Menstrual pain. Most of the typical symptoms of endometriosis are secondary dysmenorrhea and idiopathic exacerbation. The level of menstrual pain is closely related to the menstrual cycle. It occurs 1 to 2 days before menstruation, is most intense on the first day of menstruation, and then gradually eases. Patients with severe dysmenorrhea may not even respond to painkillers. When the disease occurs, they cannot study and work, and their daily life is affected. Even so, because most people take menstrual pain for granted, it is still easy for the condition to be ignored.

(2) Pain during sexual intercourse. Pain during sexual intercourse refers to pain in the vagina and pelvis after intercourse. Pain during sexual intercourse is more obvious before menarche.

(3) Discomfort during bowel movements. Defecation discomfort refers to pain in the anus or lower abdomen during defecation, regardless of whether it is during menstrual period or not, and the symptoms are especially aggravated during menstrual period. Defecation discomfort is closely related to endometriosis, especially superficial invasive endometriosis.

(4)Others. Depending on the location of endometriosis, symptoms such as pain and bleeding may occur in the relevant area. Patients with endometriosis that occurs in the stomach and duodenum may experience gastrointestinal symptoms, constipation, diarrhea, and blood in the stool. Patients with endometriosis of the bladder and urethra have symptoms such as difficulty urinating, pain in the bladder, and occasional hematuria.

Generally, endometriosis cannot be diagnosed based on these symptoms alone, but it is indeed the most common presenting medical history of endometriosis patients in clinical medicine. Therefore, to master the treatment of endometriosis, it is necessary to have a certain understanding of the various pain manifestations.

It is particularly important to note that menstrual pain and other symptoms in adolescent and pediatric patients are easily overlooked. Most endometriosis patients already have symptoms during puberty, especially more menstrual pain. However, adolescent patients may not need to seek medical treatment because their parents or themselves think that menstrual pain is normal, and medical doctors may think that menstrual pain is a common condition. As a result, young patients, especially those without a sexual history, lack necessary examinations, resulting in delayed diagnosis of endometriosis. Therefore, improving the scientific education of endometriosis may be helpful for the early diagnosis of the disease.