9 Qs患有子宫内膜异位症的女性总是询问医生

子宫内膜异位症影响大约10%的育龄妇女，尽管它的一些症状（如消化问题）可能出现得更早。除了卵巢和输卵管，子宫内膜样组织可以生长在支撑子宫的韧带上；子宫和直肠之间以及子宫和膀胱之间的空间；子宫的外表面；还有盆腔的衬里。子宫内膜异位症会导致疤痕组织的形成，从而影响女性的生育能力。疼痛期、疲劳、背痛、性交疼痛、胃肠道问题和尿路疼痛都是典型症状。

子宫内膜异位症没有一个明确的病因，因此很难确切地确定为什么有些女性会患上它。据约翰·霍普金斯医学院称，子宫内膜异位症是免疫和内分泌（激素）系统的失衡。根据子宫内膜异位症协会的说法，生长在子宫壁之外的子宫内膜样组织会引起不同程度的疼痛，影响消化健康，有时还会导致不孕症。当免疫系统反应过度时，炎症就会发生，这可能会导致微生物组（肠道，它容纳了我们大部分的免疫系统）的变化。当这种情况发生时，可能会导致便秘或腹泻。

在这种情况下，了解家族史很重要。如果你的近亲患有子宫内膜异位症，你的风险会增加7到10倍。家庭研究还表明，二级和三级亲属可能会受到子宫内膜异位症的影响，这进一步证实了遗传学起作用的理论。此外，在对同卵双胞胎和异卵双胞胎的研究中，同卵双胞胎有相似的症状，而异卵双胞胎有不同程度的症状。因此，对一些人来说，自然（遗传学）可能是这种情况的关键，而养育（环境）也可能是其中的因素。

“在美国，诊断延误了10年，”洛杉矶和纽约市高级妇科腹腔镜中心主任、医学博士艾里斯·科林·奥布奇说。这种延迟是由于将胃肠道不适、原因不明的不孕症、尿路疼痛和背痛等症状联系起来，然后再将其与子宫内膜异位症联系起来，通常需要时间。机器人外科专家奥布奇博士说，腹腔镜既是诊断性的，也是治疗性的。她通过在肚脐附近做一个小切口来检查子宫外是否存在子宫内膜样组织（在做了一次完整的体格检查并记录了健康史后）。

Early diagnosis and a multidisciplinary approach to pain management is important. “I encourage diet changes, mental health assistance, yoga, meditation, and physical therapy prior to surgery,” Dr. Orbuch advises. Endometriosis can coexist with bladder pain syndrome (interstitial cystitis). Women who have it experience pelvic pain that can be accompanied by lower urinary tract symptoms, such as urgency to urinate and increased urinary frequency, even at night. Go-to pain relievers and anti-inflammatory drugs such as aspirin and ibuprofen can help—but they manage symptoms and are not treatments for endometriosis. Hormonal contraception, on the other hand, may prevent new lesions.

Combination birth control pills that use both estrogen and progestin (the Pill) are a common method to help alleviate symptoms and pain from endometriosis. Hormones can also be delivered by a vaginal contraceptive ring (Nuvaring) or a patch (Ortho Evra) that you wear on your skin and change weekly. Hormonal contraception is regularly used for long-term management of symptoms and to keep endometriosis from worsening. You may experience some side effects, including weight changes, nausea, nutrient depletion, mood changes, and GI disturbances, according to the Mayo Clinic.

Excision surgery—meaning, a doctor cuts out any abnormal endometrial implants—is also done to treat endometriosis (although some doctors think hormonal contraception may be a better option to prevent lesions from occurring long-term). Dr. Orbuch recommends that endo patients who are considering surgery find a specialist who specializes in excision. “Ask your OB/GYN: ‘What percentage of your practice is devoted to endometriosis versus delivering babies?’” she advises, before adding that hysterectomy isnotthe standard of care. And FYI: “The only time hysterectomy is needed is when endometriosis is found in the muscles within the uterus,” a condition known as adenomyosis, she adds.

Physical therapist and nutritionist Jandra Mueller, who sees endo patients at the Pelvic Health and Rehabilitation Center in Encinitas, CA, notes that because most women with endometriosis also have irritable bowel syndrome, dietary changes sometimes help with pain and digestive problems. She’s seen success in her patients who adopt an anti-inflammatory diet (no dairy or gluten, plenty of whole foods, and little to no processed foods or alcohol). Mueller also recommends pelvic floor therapy and low-impact exercise as lifestyle treatments.

子宫内膜异位,when caught in its earlier stages, can be very treatable. Because this ailment affects many different systems in the body, it may take some time to be diagnosed. Keeping a monthly food journal and tracking your menstrual cycle and symptoms is one way to help your doctor figure out your specific triggers and provide an individualized treatment approach. Once symptoms improve, getting pregnant is easier, too. While anecdotal, Mueller says that one of her patients experienced a spontaneous (unplanned!) pregnancy shortly after having surgery and tweaking her diet by eating more whole foods, fruits, and veggies.