The endometrium "runs away from home", will taking birth control pills work?

Author: Yu Qi, Chief Physician, Peking Union Medical College Hospital

Reviewer: Bai Wenpei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

Under normal circumstances, the endometrium "lives" inside the uterus and covers the inner surface of the uterine cavity. If it does not stay in this place honestly, "runs" to other places, and "runs away from home", it is called endometriosis.

Figure 1 Original copyright image, no permission to reprint

1. Where might the endometrium spread to?

Endometriosis can be divided into extrinsic endometriosis and intrinsic endometriosis.

Intrinsic endometriosis means that it has not spread too far, such as spreading to the myometrium, which we call adenomyosis.

As we all know, the ectopic endometrium growing in the myometrium of the uterus will grow and bleed every month with the arrival of menstruation. It will form blood bags, but the muscles are very dense and there is no room for expansion, so one of its characteristics is that it is extremely painful. It hurts every month, starting when menstruation is about to come, and it will be more painful when menstruation comes. It will last for several days before it slowly eases.

External endometriosis is the formation of a blood bag in the abdominal cavity. If the ectopic endometrium grows in the abdominal cavity, the blood bag can grow a little bigger, because the abdominal cavity is larger and can accommodate it to a certain extent, so the pain will not be so severe.

Some ectopic endometrium can grow in the intestines, which can cause blood in the stool. Especially when it grows in the rectum or colon, blood in the stool may occur once a month. Some people may not find that this bleeding pattern is related to menstruation, so they suspect cancer. Sometimes they go for a barium meal examination, which looks like rectal cancer or colon cancer. Then they do a colonoscopy and take a biopsy, and then they find out that it is endometriosis.

So ectopic endometrium can grow in a variety of places and have a variety of types.

2. What are the dangers of endometriosis?

First, pain, especially when endometriosis grows to the myometrium, the patient will experience severe pain, which is very deadly. Many people cannot stand this pain, and when menstruation comes, they can't go to work and have to rest at home for several days. This phenomenon is very common.

Second, various abdominal masses are not important if they do not compress the surrounding tissues and organs, because they are not tumors and the probability of becoming cancerous is very low. They are just a bag of old blood.

Third, organ compression symptoms. If the abdominal mass is relatively large or close to important organs, it can compress certain organs. For example, if it compresses the ureter, it will cause dysuria and hydronephrosis; if it compresses the rectum, it will cause constipation. However, this kind of compression symptom is generally not common.

Fourth, infertility is the most important issue that will affect fertility. At present, the mechanism that causes infertility is mainly immune. The body can secrete many immune factors. When there is a large amount of ectopic endometrium in the abdominal cavity, the number of macrophages in the abdominal cavity will increase greatly. Macrophages are originally an immune regulation mechanism of the human body. When there are foreign objects, such as bacteria invading the body, macrophages will gather where there are bacteria and "eat" them. After the increase of macrophages, if you want to get pregnant, the sperm will go from the cervix and uterus, overcome various obstacles, and run into the fallopian tube. When it comes out of the fallopian tube, it will meet the egg and will be fertilized soon, but it will be surrounded and "eaten" by a large number of macrophages.

Figure 2 Original copyright image, no permission to reprint

Among these four hazards, there are mainly two major problems: one is pain and the other is infertility.

3. How to treat endometriosis if there is no desire to have children?

If the patient has no desire to have children and is in severe pain, combined treatment with laparoscopy and drugs is a very important treatment method.

Laparoscopic treatment is to see where the ectopic endometrium is and to remove the endometriotic lesions through physical methods such as electrocautery, laser, ultrasound, etc. This is an operation often performed under laparoscopy.

There are many types of therapeutic drugs, one of which is a relatively simple drug, the oral contraceptive pill.

Taking oral contraceptives can suppress the endometrium. People who have taken oral contraceptives may have this feeling: after using it for a period of time, they find that the menstrual volume is getting less and less. This is because the endometrium in place is suppressed, which is reflected in the reduction of menstrual volume. The same is true for the ectopic endometrium. The bleeding of the ectopic endometrium will also become less and less, so the pain will gradually decrease.

There are some medication methods now, such as continuous use of oral contraceptives. As we all know, oral contraceptives are generally used for contraception, and they are taken for 21 days, stopped for 7 days, taken for 21 days, and stopped for 7 days. However, in order to treat endometriosis and relieve pain, we can continue to take the medicine and take several boxes in a row, such as taking it for three consecutive months, controlling menstruation for three months, and then stopping to see the effect. Generally speaking, this treatment effect is still very good.