Patient's question:
I started experiencing menstrual cramps when I was in my senior year of high school, and it has been going on for 8 or 9 years now. Before, the pain was intermittent, but now it occurs every time, and the timing is irregular. Usually, it's the worst on the first day, to the point where I can barely stay in bed. The pain continues intermittently into the second day, sometimes even the third day. I break out in cold sweat and vomit uncontrollably, feeling better only when bile comes out. I can't drink a drop of water, let alone eat food. I've taken medication, but it doesn't help, and the pain isn't the kind that goes away after a while. I don't know how to solve this problem, and I also experience diarrhea for two days after my period ends.First follow-up question: If it is indeed an intrauterine issue, is there an effective treatment?
Doctor's answer:
Hello: The treatment plan should be comprehensive, considering factors such as the patient's age, the severity of the condition, and whether there are fertility requirements. Treatment should be tailored to the individual.I. Surgical Treatment: The earliest method used for treating endometriosis, it remains one of the primary approaches to this day. Surgery is mainly suitable for patients with severe conditions or those experiencing severe pain that does not respond to medication.
（1）Conservative Surgery: Only the endometrial implants are removed while preserving the ovaries and uterus. It is suitable for younger patients who wish to preserve their fertility. Approximately 50%-60% of patients can become pregnant after surgery. However, the recurrence rate of pain is relatively high.
（2）Semi (Semi): Endometrial implants are removed along with the uterus, while at least part of the ovaries are preserved. It is suitable for women who have already given birth, are over 35 years old, suffer from persistent pain, or have concurrent uterine conditions. Semi can effectively alleviate menstrual pain and has a very low risk of recurrence after surgery.
（3）Radical Surgery: Both bilateral adnexa and the uterus are removed, which can completely cure endometriosis. It is suitable for women in menopause. In recent years, laparoscopic surgery has been widely used to treat endometriosis. All surgeries that can be performed through open surgery can also be done laparoscopically. Additionally, laparoscopic surgery offers advantages such as minimal trauma, faster recovery, and reduced postoperative pelvic adhesions.
The symptom relief rate and pregnancy rate after laparoscopic surgery can achieve the same results as open surgery. It is gaining increasing attention.
II. Medication Treatment: Suitable for patients with mild conditions and small chocolate cysts. The treatment duration is generally 6-9 months. If used as adjuvant therapy before or after surgery, the duration can be shortened to 3-6 months.
（1）Danazol