Patient's question:
Severe menstrual pain for 4 years, possibly caused by artificial abortion and scraping the uterine cavity.Doctor's answer:
Typical symptoms include lower abdominal pain, dysmenorrhea, dyspareunia, and infertility.1. Lower abdominal pain and dysmenorrhea: The characteristics are secondary and progressive worsening. Initially, there is no dysmenorrhea in the first few years after menarche, but it may appear after several years or more than 10 years, with gradually increasing severity. The pain is often located in the deep lower abdomen and lumbosacral region, most commonly in the middle pelvis, and may radiate to both sides of the pelvis and pelvic wall, as well as to the vagina, perineum, anus, or thighs. It usually occurs at the start of menstruation and persists throughout the menstrual period. The severity of pain is not proportional to the size of the lesion. Approximately 20%–35% of patients may have no dysmenorrhea. Some patients may experience abdominal pain that is not synchronized with menstruation, and a few may have chronic lower abdominal pain that intensifies during menstruation.
2. Dyspareunia: Deep dyspareunia is common when endometrial tissue involves the rectouterine pouch and uterosacral ligaments, especially during the premenstrual period.
3. Irregular menstruation: Menorrhagia, prolonged menstrual periods, or spotting before menstruation are common.
4. Infertility: About 40% of patients with endometriosis are infertile, primarily due to pelvic adhesions, fallopian tube obstruction or decreased motility, which affects the transport of ova, or complications such as unruptured follicle luteinization syndrome, insufficient ovarian luteal function, or autoimmune reactions that interfere with fertilization and implantation.
5. Other symptoms:
- Intestinal lesions may cause diarrhea, constipation, or cyclic bleeding.
- Involvement of the urinary system may lead to dysuria, urinary frequency, difficulty urinating, or cyclic hematuria.
- Remote endometrial lesions may cause menstrual hemoptysis or epistaxis.
- In cases of ruptured ovarian endometrial cysts, sudden severe lower abdominal pain may occur, accompanied by nausea, vomiting, and rectal fullness. Rupture often happens before or during menstruation.
Advice:
- Chinese medicine: (blood-activating and stasis-resolving) decoctions should be taken warm after meals. For (heat-inflammation and stasis), , (clearing heat and cooling blood, blood-activating and stasis-resolving) decoctions should be brewed for a shorter time and taken cool or slightly warm.
- Hormone therapy: The course of treatment is long, so active cooperation is required. Particularly for women who have not borne children, adherence to medication is essential. Progestin therapy may cause low-grade fever, nausea, fatigue, loss of appetite, or amenorrhea. Before starting treatment, patients should be fully informed to alleviate concerns and maintain medication adherence. Stopping medication prematurely may lead to uterine bleeding. Amenorrhea is a normal occurrence and will typically return to normal within a few months after discontinuation.
- Surgery: If drug treatment is ineffective and chronic pain persists, surgical options may be considered based on age and fertility requirements, including conservative surgery to preserve fertility, semi-conservative surgery to preserve ovarian function, and radical surgery.