Patient's question:
In April of this year, I had an endometrioma removal surgery and also had my right ovary removed. The doctor said it was endometriosis. After the surgery, I felt that my menstrual cycle was not as regular as before, and I also experienced menstrual cramps. The doctor said that the symptoms would become more severe in the future, and the only way to cure it is to remove the ovaries. I heard that traditional Chinese medicine has some methods for treating this condition. I would like to learn more about it.Doctor's answer:
Hello, the treatment of traditional Chinese medicine requires syndrome differentiation and treatment based on the patient's condition. The treatment methods are mainly divided into two categories: surgery and medication, 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. Surgical treatment is mainly suitable for patients with severe conditions or those with severe pain that does not respond to medication.
#### (1) Conservative Surgery:
Only endometriotic lesions are removed, while the ovaries and uterus are preserved. This is suitable for young patients who wish to preserve fertility. Approximately 50%-60% of patients can become pregnant after surgery. However, the recurrence rate of pain is relatively high.
#### (2) Semi-radical Surgery:
Endometriotic lesions are removed along with the uterus, while at least part of the ovaries must be preserved. This is suitable for patients who have already given birth, are over 35 years old, have persistent pain, or have concurrent uterine lesions. Semi-radical surgery can effectively cure dysmenorrhea, and the recurrence rate of endometriosis after surgery is very low.
#### (3) Radical Surgery:
Both bilateral adnexa and the uterus are removed, which can completely cure endometriosis. This is suitable for women in menopause. In recent years, laparoscopic surgery has been widely used to treat endometriosis. All surgeries that can be performed via open surgery can also be done laparoscopically. Additionally, laparoscopic surgery has advantages such as minimal trauma, faster recovery, and reduced postoperative pelvic adhesion. The symptom relief rate and pregnancy rate after laparoscopic surgery can achieve the same effects as open surgery, making it increasingly valued.
### II. Medication Treatment:
This is suitable for patients with mild conditions and small chocolate cysts. The course of treatment is generally 6-9 months. If used as adjuvant treatment before or after surgery, the course can be shortened to 3-6 months.
#### (1) Danazol:
Although it has more common side effects, most are not severe and do not require discontinuation of the medication. In rare cases of elevated liver function, the medication should be stopped promptly, and liver-protective treatment should be provided.
#### (2) Norethisterone:
It has mild side effects and is easy to use.
#### (3) Progestogen Drugs:
Examples include Fuchang Pian, Funing Pian, and An Gong Huangtai Pian. These are suitable for patients with limited financial resources who cannot take danazol or norethisterone. However, their effect on fertility is relatively small, and liver function should be checked regularly during use.
#### (4) Contraceptives:
Such as Compound 18-Methyl, but note that the estrogen in contraceptives can stimulate the growth of uterine fibroids. Therefore, caution is advised for patients with fibroids.
#### (5) Gonadotropin-Releasing Hormone Agonists:
Long-term use may cause osteoporosis. This is suitable for women in menopause, especially those with uterine fibroids.
#### (6) Tamoxifen:
It does not suppress ovulation, effectively relieves dysmenorrhea, has few side effects, and is less effective in treating endometriotic signs. It is suitable for patients with severe symptoms but mild signs.
The concentrations and dosages of the above medications must be followed as prescribed by the doctor.