Patient's question:
Detailed medical history and consultation purpose: I am a 37-year-old female. In April 2003, I underwent an induced abortion at 67 days of pregnancy. One month after the surgery, I experienced continuous vaginal bleeding and abdominal pain. A B examination revealed abnormal echo masses in the uterus, followed by a D&C procedure. After that, I had no symptoms for a while and did not have a B check-up.One year later (April 2004), I began experiencing lower abdominal pain and irregular menstruation with very light flow. Hospital examinations confirmed that I have endometriosis. Currently, I have been suffering from this condition for over two years, and despite various treatments, my condition remains unresolved.
The current symptoms include an enlarged uterus with uneven echoes, localized low echoes in the posterior segment, and abnormal findings in both the left and right ovaries.
Doctor's answer:
The most fundamental biological characteristic of endometriosis is estrogen dependence. Currently, drugs used to treat endometriosis work through different mechanisms such as antagonizing estrogen effects, inhibiting estrogen synthesis or release. Therefore, the main treatment drugs include progesterones, testosterone derivatives, and gonadotropin-releasing hormone agonists (GnRH-a). During pain, progesterones are undoubtedly the first-line drugs. Surgical treatment for endometriosis mainly includes the following methods: (1) minimally invasive surgery, used for patients with mild endometriosis accompanied by infertility, with limited surgical intervention on lesions. (2) conservative surgery, which involves removing macroscopically visible lesions. (3) semi-conservative surgery, which involves removing the uterus while preserving the ovaries. (4) radical surgery, which involves removing the entire uterus and bilateral adnexa. Conservative surgery is generally performed via laparoscopy. Patients who require hysterectomy usually have obvious symptoms and severe pelvic adhesions, making open surgery safer. Currently, the main indications for surgical treatment of endometriosis are infertility and endometriotic cysts. The efficacy and prognosis of laparoscopic and open surgery for treating endometriosis are similar.