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Endometriosis / Chocolate Cysts

Traditional Chinese Medicine (TCM)Obstetrics and Gynaecology

Endometriosis is a common gynaecological condition in which endometrial cells grow outside the uterus, causing chronic inflammation, resulting in a wide range of symptoms and affecting the patient's quality of life. Endometriosis affects about 10% of women of reproductive age worldwide. [1]

Endometriosis is a condition where the lining of the uterus grows outside of the uterus and can cause pain, irregular periods and fertility problems in women. The most common places for the growths to appear are the ovaries, pelvis and abdomen, and if it affects the ovaries, it can cause cysts known as "chocolate cysts". Although there is no cure for endometriosis, symptoms can be managed with medication or surgery.

Symptoms

Symptoms of endometriosis include:

Menstrual pain
Chronic pelvic pain
Pain during or after sex
Excessive menstrual blood or irregular periods
Painful urination and defecation
Infertility

Causes and risk factors

The cause of endometriosis has not yet been determined by the medical profession. One of the theories is that it is caused by the backflow of menstrual blood. During menstruation, menstrual blood accompanied by endometrial cells flows backwards into the pelvis, causing endometrial tissue to grow outside the uterus. The ectopic endometrium will also periodically thicken and shed, and bleed.

If the endometrial tissue is lodged in the ovaries, when the menstrual blood accumulates in the ovaries, the menstrual blood oxidises to a brownish colour similar to that of chocolate and forms a cyst, commonly known as a "chocolate tumour".

If the endometrial tissue grows in the muscular layer of the uterus, adenomyosis will form.

If the endometrial tissue grows in the abdominal cavity or on the surface of the peritoneum, it is prone to inflammation and pain. Continuous inflammation will cause scarring and adhesion between surrounding tissues and organs, and even affect the normal functioning of organs.

Risk groups for endometriosis include:

Never been pregnant
Have a family history of endometriosis.
Having a menstrual cycle of less than 27 days
Heavy menstrual flow that lasts more than 7 days
Early menarche

Diagnosis

The doctor will perform the following tests to help make a diagnosis:

Pelvic examination
Imaging tests, including ultrasound or MRI (to detect ovarian endometriomas, adhesions and deep nodules)
Depending on the circumstances, the doctor may need to perform laparoscopic surgery and tissue sampling to help confirm the diagnosis.

Treatment

Currently, there is no cure for endometriosis, but the main focus is on treating the symptoms. Depending on age, symptoms and the need to have children, it can be treated with medication or surgery.

Function

Drugs:

Pain medications: paracetamol, non-steroidal anti-inflammatory painkillers (NSAIDs)
Hormonal therapy (oral contraceptives, new oral luteinising hormones, medicated IUDs, etc.)

Relief of symptoms and menstrual pains
Reduce the severity of endometriosis

Surgery

Excision of lesions, adhesions and other tissues

Impact

The symptoms of endometriosis are so varied that it is not easy for the general public to recognise that they have the condition. Endometriosis can cause significant disruption to a person's life:

Inability to go to work or school
Affecting the sexual health of the patient and/or his/her partner.

In addition, many people delay treatment due to unawareness of symptoms (e.g. menstrual cramps), which further reduces their quality of life and may lead to infertility.

Prevention

There is no known way to prevent endometriosis. However, the following measures are recommended to help diagnose endometriosis early and manage the progression of the disease:

Women can undergo regular gynecologic check-ups
Maintaining a healthy lifestyle, e.g. appropriate exercise, healthy diet, etc.
Raise awareness of the condition and seek medical advice if you experience any symptoms that suggest endometriosis.

Endometriosis can affect the chances of pregnancy and may even lead to infertility. Patients with fertility needs can discuss with their doctors about appropriate treatments, such as surgery to remove the ectopic endometrial tissue, which may improve their chances of pregnancy. Early consultation with an obstetrician and gynecologist is recommended for possible treatments. Reproductive medicine specialists can also be consulted for fertility treatments if necessary.

Although the symptoms of uterine fibroids and adenomyosis are very similar in that they can cause menstrual pain and interfere with pregnancy, the causes are different. Adenomyosis is caused by ectopic endometrial tissue growing in the muscular layer of the uterus, whereas fibroids are benign tumors caused by abnormal growth of cells in the muscular layer of the uterus.

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^1.World Health Organization - endometriosis. Retrieved February 3, 2023, from https://www.who.int/zh/news-room/fact-sheets/detail/endometriosis