子宫内膜异位症（ Endometriosis）中西医诊疗

子宫内膜异位症是指原本生长于子宫内的子宫内膜在身体的其他部位生长导致的病变。异位子宫内膜可以附着在卵巢、输卵管、子宫的体部、子宫外表面、肠道或其他部位（罕见于肺、鼻腔、脑部）。

Endometriosis happens when tissue normally found inside the uterus grows in other parts of the body. It may attach to the ovaries, fallopian tubes, the exterior of the uterus, the bowel, or other internal parts. As hormones change during the menstrual cycle, this tissue breaks down and may cause pain around the time of your period and longterm painful adhesionsor scar tissue. More than 5.5 million American women have symptoms of endometriosis.

子宫内膜异位症的症状（Endometriosis Symptoms）

月经前、经期或月经后的疼痛是最常见的症状。对一些女性来说，这种疼痛可能会导致局部功能和行为障碍，尤其是发生在性交过程中或之后、排便或排尿时的疼痛。它有时会引起骨盆和腰骶部的疼痛。当然，许多患有子宫内膜异位症的女性症状轻微或没有症状，提示这些症状的发生可能与异位内膜生长的位置有关。

Pain just before, during, or after menstruation is the most common symptom. For some women, this pain may be disabling and may happen during or after sex, or during bowel movements or urination. It sometimes causes ongoing pain in the pelvis and lower back. Many women with endometriosis have mild or no symptoms, though. The symptoms may be related to the location of the growths.

原发性痛经还是子宫内膜异位症？（Just Cramps or Endometriosis?）

大多数女性的月经期都有轻微的疼痛。这些症状可能会从非处方止痛药中得到缓解（包括非甾体止痛药或活血化瘀中药）。如果疼痛持续2天以上，或影响你正常生活，或在月经结束后继续，必须警惕子宫内膜异位症的可能，告诉你的妇科医生（也包括作者）。

Most women have some mild pain with their menstrual periods. They may get relief from over-the-counter pain medications. If the pain lasts more than 2 days, keeps you from doing normal activities, or remains after your period is over, tell your doctor.

子宫内膜异位症和青少年（Endometriosis and Teens）

子宫内膜异位症可以从第一次月经开始，并伴随女性一生直至绝经。如果你的月经相关疼痛足以干扰你的生活，千万不要单独忍受，医师的指导和治疗会有很大帮助。首先应该是症状跟踪随访，并适当服用止痛药。这一点，基本上对青少年女性患者的治疗选择与成人相同。

Endometriosis pain can begin with the first menstrual period. If your menstrual pain is strong enough to interfere with activities, you should consult your physician. The first step may be tracking the symptoms and taking pain medication, but ultimately the treatment options for teens are the same as for adults.

子宫内膜异位症与不孕（Endometriosis and Infertility）

有时，子宫内膜异位症的第一个或唯一症状就是怀孕的问题。有三分之一的女性患有不孕症，原因尚不清楚。伤疤可能是罪魁祸首。好消息是，医学治疗可以帮助人们克服不育，而怀孕本身可以缓解子宫内膜异位症的症状。

Sometimes the first -- or only -- symptom of endometriosis is trouble getting pregnant. Infertility affects about a third of women with the condition, for reasons that aren't well understood. Scarring may be to blame. The good news is that medical treatments can help someone overcome infertility, and pregnancy itself can relieve some symptoms of endometriosis.

子宫内膜异位症的病因（What Causes Endometriosis?）

研究人员们并不能完全确定子宫内膜组织为什么会在子宫外生长，但提出了有几种支持理论。有理论认为遗传原因导致，一些异位子宫内膜细胞可能从出生起就存在。另一种理论认为，含有子宫内膜细胞的经血会通过输卵管回流到盆腔，而不是从阴道中排出，这些细胞被认为会粘附在器官上，并随着时间的推移不断增加和出血。细胞也可以通过其他方式移动到其他部位，例如在剖腹产时的人为因素和肺、鼻腔等处的血行播散。

Doctors don't know why endometrial tissue grows outside of the uterus, but they have several theories. Heredity plays a role, and some endometrial cells may be present from birth.Another theory suggests that menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These cells are thought to stick to organs and keep growing and bleeding over time. Cells could also move to the pelvic cavity other ways, such as during a C-section delivery.

子宫内膜异位症的易感人群（Endometriosis: Who Is at Risk?）

子宫内膜异位症常见于一下女性人群：年龄30-40岁；未生育；经期长于7天

月经周期短于28天；月经初潮发生于12岁前；家族中有子宫内膜异位症病史（妈妈或姐妹）

The condition is more common in women who:Are in their 30s and 40s；Have not had children；Have periods longer than 7 days；Have cycles shorter than 28 days；Started their period before age 12；Have a mother or sister who had endometriosis

诊断-伴随症状（Diagnosis-Tracking Symptoms）

症状的模式可以帮助鉴别子宫内膜异位症，包括：疼痛发生的时间规律；疼痛严重程度；疼痛持续时间；改善或诱发、加重因素；生活质量影响；疼痛与性生活或大小便的关系及影响

Your pattern of symptoms can help to identify endometriosis, including:

When the pain happens；How bad it is；How long it lasts；A change or worseningof pain；Pain that limits your activities；Pain during sex, bowel movements, or urination.

诊断-盆腔检查（Diagnosis: Pelvic Exam）

首先医生会做盆腔内诊（妇科检查）来了解你的卵巢、子宫和宫颈是否有任何异常。检查有时会提示是否有卵巢囊肿或子宫内膜异位造成的瘢痕性内异结节。当然，医生还会排出鉴别其他可能导致类似症状的盆腔疾病。

Your doctor will do a pelvic exam to check your ovaries, uterus, and cervix for anything unusual. An exam can sometimes reveal an ovarian cyst or internal scarring that may be due to endometriosis. The doctor also looks for other pelvic conditions that could cause symptoms similar to endometriosis.

诊断：盆腔影像学检查（Diagnosis: Pelvic Scans）

以目前的技术，虽然不可能单独使用影像技术来确认子宫内膜异位，但医生可能会要求进行超声、CT扫描或MRI检查以帮助诊断。通过扫描使用声波、X射线或带有射频脉冲的磁场来形成图像并解读分析，这些可能能够检测出不同程度的子宫内膜增生或囊肿。

Although it isn't possible to confirm endometriosis with scanning techniques alone, your doctor may order an ultrasound, CT scan, or MRI to help with diagnosis. These may be able to detect larger endometrial growths or cysts. The scans use sound waves, X-rays, or magnetic fields with radiofrequency pulses to create the images.

诊断-腹腔镜技术（Diagnosis-Laparoscopy）

腹腔镜检查是目前公认的确定盆腔子宫内膜异位的唯一可靠方法。妇科医生通过肚脐上的一个小切口使腹部膨胀。通过切口插入的腹腔镜观察设备。有必要的话，妇科手术医生可以将小块组织取出后进行病理检查（组织活检）——以确认诊断结果。（当然，国内的医生通常在手术过程中就进行冰冻病理检查，并采取治疗措施）

Laparoscopy is the only sure way to determine if you have endometriosis. A surgeon inflates the abdomen with gas through a small incision in the navel. A laparoscope is a viewing instrument that's inserted through the incision. The surgeon can take small pieces of tissue for a lab to examine -- called a biopsy -- to confirm the diagnosis.

治疗-止痛药物（Treatment-Pain Medicine）

止痛药物，如对乙酰氨基酚和非甾体类抗炎药（NSAIDs），如布洛芬或萘普生等，常用于缓解子宫内膜异位带来的疼痛和痉挛。但这些药物只缓解症状，而不是就子宫内膜异位症进行根因治疗。

Pain medications, such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or naproxen, often help relieve the pain and cramping that comes with endometriosis. But these drugs only treat the symptoms and not the underlying endometriosis.

治疗-口服避孕药（Treatment-Birth Control Pills）

口服避孕药能控制雌激素和黄体酮的水平，使你的月经周期稳定而规律，并减少月经量。口服避孕药能减轻子宫内膜异位症的痛苦。适应症允许下，医生会推荐避孕药连续口服治疗或孕激素治疗方案。给药途径有多种，孕激素治疗也有通过皮下注射或宫内节育器缓释的方法。但一旦停止服用药片后，子宫内膜异位症又会失去控制。

Oral contraceptives manage levels of estrogen and progestin, which make your menstrual periods shorter and lighter. That often eases the pain of endometriosis. Your doctor may prescribe pills to be taken continuously, with no breaks for a menstrual period, or progestin-only therapy. Progestin-only therapy can also be given by injection. Endometriosis symptoms may return after you stop taking the pills.

治疗-曼月乐（Treatment-Mirena）

曼月乐是通过缓释左炔诺孕酮（20ug/d）抑制子宫内膜的激素宫内避孕系统；左炔诺孕酮缓释不仅可实现避孕目的，对于缓解痛经、减少月经量均有明显效果，也是治疗子宫内膜异位症的有效手段。

Manurin inhibits the hormone intrauterine contraceptive system of the endometrium by releasing levonorgestrel（20ug/d）. The sustained release of levonorgestrel is not only effective in preventing pregnancy, but also effective in relieving dysmenorrhea and reducing menstrual flow.

治疗-其他内分泌干预方案（Treatment-Other Hormone Therapies）

根据现有理论，可以通过药物模拟更年期状态，以摆脱子宫内膜异位症的症状，抑制子宫内膜异位症发展。GnRH agonists（促性腺激素释放激素激动剂，商品名如醋酸亮丙瑞林、那法瑞林和诺雷德），可以阻止女性雌孕激素的产生。但它们会产生一过性潮热、阴道干涩、疲劳、情绪变化和骨质流失等不良反应。也可以通过促性腺激素抑制剂（合成雄激素，达那唑）来拮抗雌激素。此药物的副作用可能包括体重增加，乳房缩小，粉刺，面部毛发增多，声音男性化和情绪变化，并有可能对子代出生缺陷造成影响。

These drugs mimic menopause, getting rid of periods along with endometriosis symptoms. GnRH agonists, such as Lupron, Synarel, and Zoladex, block female hormones from being made. They can cause hot flashes, vaginal dryness, fatigue, mood changes, and bone loss. Danocrine works mainly by lowering estrogen. Side effects can include weight gain, smaller breasts, acne, facial hair, voice and mood changes, and birth defects.

治疗：手术切除（Treatment: Excision）

通过腹腔镜检查，医生可以分离可见的粘连，并切除子宫内膜异位增生病灶。大多数女性都能有很快效缓解疼痛。然而，没有有效预防复发的治疗措施，手术一年后，大约45%的女性会出现症状。随着时间的推移，症状复发的可能性会持续升高。因此术前-术中-术后的激素疗法及综合预防措施需要跟进，以期改善结果。

During a laparoscopy, the surgeon may remove visible endometrial growths or adhesions. Most women have immediate pain relief. A year after the surgery, though, about 45% of women will have a return of symptoms. The likelihood of symptoms returning rises over time. Hormone therapy started soon after surgery may improve the outcome.

治疗-开放手术（Treatment-Open Surgery）

Severe cases of endometriosis may require laparotomy, or open abdominal surgery, to remove growths, or a hysterectomy -- removal of the uterus and possibly all or part of the ovaries.

严重的子宫内膜异位症可能需要进行经腹手术，必要时需切除子宫，部分或全部卵巢组织，甚至还需要切除部分直肠。

治疗-中药内服（Treatment - internal medicine）

早在距今2000多年前的中医学古籍《黄帝内经》和稍后的古医籍《金匮要略》最早记载了痛经（症瘕）的症状表现及，并制定了多首治疗症瘕和痛经的著名方剂。内异症的主要病机是瘀血蓄积少腹、阻滞冲任而引起气血失调，胞宫胞络功能失常，治疗以活血化瘀为基本治则，常用药物有桃仁、红花、丹参、赤芍、三棱、莪术、蒲黄、五灵脂、延胡索、乳香、没药、土鳖虫、香附等。

As early as 2000 years ago, the ancient Chinese medical book《Huangdi neijing》and later the ancient medical book《Synopsis of golden chamber》first recorded symptoms of dysmenorrhea, and formulated a number of famous prescriptions for the treatment ofabdominal mass and dysmenorrhea.The main pathogenesis of endometriosis is the accumulation of stagnant blood and less abdomen, blockage and impingement, resulting in the imbalance of qi and blood, and the dysfunction of cytokines.The treatment is based on promoting blood circulation and removing blood stasis, and the commonly used drugs include peach kernel, safflower, salvia miltiorrhiza, red peony root, three rhizome, zedoary rhizome, pu huang, wuling lipids, yanhusuo, frankincense, myrrh, woodworm, and perfume.

治疗-中医外治（Treatment - TCM external treatment）

具有中医特色的外治诸法如：中药保留灌肠、针刺法、灸法、穴贴压法、中药贴敷法，可以发挥活血散瘀、消瘕止痛、软坚散结之功效，治疗子宫内膜异位症不仅具有理论支持，拥有令人满意的疗效，对于手术后恢复和预防复发都有很大价值。

The methods of external treatment are as follows: retention enema of traditional Chinese medicine, acupuncture, moxibustion, acupoint pressure and Chinese medicine application。It can exert the functions of promoting blood circulation and removing blood stasis, relieving pain, as well as resolving hard lump.It's very valuable for recovery and preventing relapseafter surgery。

子宫内膜异位症与妊娠（Getting Pregnant With Endometriosis）

大多患有子宫内膜异位症的女性在妊娠结局影响不大。但是中度至重度子宫内膜异位的女性的怀孕率显著低于正常水平，需要通过腹腔镜手术提高自然生育率。如果手术评估自然受孕困难，体外受精是一种选择，精子和卵子结合在实验室中产生的胚胎被植入子宫。

Many women with endometriosis don't have trouble getting pregnant. But laparoscopic surgery can improve the pregnancy rate of women who have moderate to severe endometriosis. In vitro fertilization is an option if infertility persists. The sperm and egg are combined in a lab and the resulting embryo is implanted into the uterus.

子宫内膜异位的应对（Coping With Endometriosis）

虽然没有办法防止子宫内膜异位症，但你可以选择生活方式来帮助你感觉更好。经常锻炼可以通过改善你的血液流动和促进内啡肽来缓解疼痛，这是身体的天然止痛药。针灸、瑜伽、按摩和冥想也可以帮助改善负面情绪并缓解症状。

Although there is no way to prevent endometriosis, you can make lifestyle choices that will help you feel better. Regular exercise may help relieve pain by improving your blood flow and boosting endorphins, the body's natural pain relievers. Acupuncture, yoga, massage, and meditation also may help Improve negative emotionsand ease symptoms.

子宫内膜异位症的自然终结？（An End to Endometriosis?）

对大多数女性来说，子宫内膜异位症随着绝经期的消退而逐渐消退。一些女性在怀孕期间发现子宫内膜异位消退了。在某些情况下，症状可能会消失。大约有三分之一的患有轻微子宫内膜异位症的女性会发现她们的症状会自行解决。如果是这样，你真该好好庆祝下！

For most women, endometriosis recedes with menopause. Some women findrelief from endometriosis during pregnancy. In some cases, symptoms may simply go away. About one-third of women with mild endometriosis will find that their symptoms resolve on their own.If so, you should celebrate!