没有女人期待“每月的那个时候”.” Most of us experience mood swings, bloating 和 cramps, which are never fun. But for those who have 子宫内膜异位, getting a period is often particularly unbearable. For them, an average period is anything but average, with debilitating cramps.

在一个典型的月经周期, the lining inside the uterus — the endometrium — builds up 和 is then shed. 对于患有子宫内膜异位症的女性, 子宫内膜生长在子宫外, usually around the ovaries or beneath the uterus in an area called the posterior cul-de-sac. As the lining builds up 和 breaks down, it causes small amounts of bleeding inside the pelvis. 这会导致疼痛、炎症、肿胀和疤痕. 

如果你认为你可能患有子宫内膜异位症，你并不孤单. 这种情况每年影响成千上万的女性.

注意以下五个症状

约翰霍普金斯妇科医生 哈拉·辛普森，m.s.D. 说子宫内膜异位症有五种常见症状. 以下是你应该注意的: 

1. 痛苦的时期. 我们大多数人在经期都会抽筋, but women with 子宫内膜异位 often have debilitating pain that can prevent them from working or taking care of themselves or family members. 经期轻微不适可能是正常的, but pain that stops a woman from working or going to school or other daily activities is not normal 和 should be evaluated by a gynecologist,辛普森说.
2. 慢性盆腔疼痛. Sometimes, women have chronic 和 severe pelvic pain even when they don’t have their periods. 这可能是由于晚期或难治性疾病和疤痕.
3. 性交疼痛. This common symptom, also known as dyspareunia, can be due to 子宫内膜异位 beneath the uterus. During penetration, women with 子宫内膜异位 might have intense, localized pain. 
4. 卵巢囊肿. While many 卵巢囊肿 are normal 和 will resolve without treatment, cysts associated with 子宫内膜异位 (endometriomas)are another hallmark of 子宫内膜异位. They can become large 和 painful 和 may need to be surgically removed.
5. 不孕不育. 不孕不育 is defined as not conceiving within one year despite regular sexual intercourse without contraception. 关于 25% to 50% of women living with infertility have 子宫内膜异位, which can lead to infertility by causing scar tissue as well as damage 和 inflammation to the fallopian tubes. 研究 also shows that 子宫内膜异位 can affect egg quality 和 reduce the number of eggs in the body. 

These five symptoms aren’t exclusive to 子宫内膜异位, Simpson says.

“It is difficult to determine based on symptoms alone what the source of pain is — i.e., 子宫内膜异位 versus other conditions — which is why I advise all patients to see a medical practitioner if you have pain with your periods. Additional symptoms that may suggest 子宫内膜异位 can include dyspareunia — pain with intercourse — 和/or dyschezia (pain with bowel movements). 盆腔疼痛也可能是由疤痕组织引起的, 以前的感染, 盆底肌痛或其他, nongynecologic syndromes such as painful bladder syndrome 和 irritable or 炎症性肠综合征.

“Importantly,” Simpson points out, “many women with 子宫内膜异位 do not have pain or symptoms.”

诊断和治疗子宫内膜异位症

如果你有上述任何症状，请去看妇科医生. Women with infertility might be referred to a reproductive endocrinologist or a fertility specialist. 有些医生专门治疗盆腔疼痛和子宫内膜异位症. 

To confirm a diagnosis, your doctor will likely perform a minimally invasive 腹腔镜检查.

“子宫内膜异位症只能通过手术诊断，”辛普森解释说. “Dysmenorrhea or pain with the menstrual period is one of the hallmark symptoms of 子宫内膜异位, 但它可能发生在高达90%的女性中, 严重症状发生率高达30%. 据估计，7%-15%的女性患有子宫内膜异位症. Due to the high frequency of dysmenorrhea in the general population as compared to the lower incidence of 子宫内膜异位, we often start with conservative therapy such as anti-inflammatories — ibuprofen — 和/or birth control.”

“Surgical evaluation is typically performed in women with refractory pain — pain that does not improve with conservative therapy — women suffering from infertility or women with large endometriomas, 哪些不太可能通过保守治疗得到改善.”

在微创腹腔镜检查过程中, 一个瘦, 点亮的管子插入腹部的一个小切口. This allows the doctor to see the pelvic organs 和 take a small amount of tissue for biopsy to make a diagnosis.

“If pain or symptoms persist despite conservative therapy or following diagnostic 腹腔镜检查, it may be warranted to seek out an 子宫内膜异位 or pelvic pain center/specialist for further evaluation,辛普森说.

经常, symptoms can be controlled with medications such as birth control pills, 或促性腺激素释放激素激动剂或拮抗剂(如.g.醋酸leuprolide和elagolix). Both suppress the pituitary gl和 from releasing hormones that stimulate 子宫内膜异位. Other conservative options that may help with 子宫内膜异位 symptoms include:

• 服用消炎止痛药, 比如布洛芬, 按照药物标签上的建议定期服用, approximately 24 hours before the anticipated start of your period 和 until the end of it.
• Use heat, such as taking a warm bath or applying a heating pad to the back 和 lower abdomen.
• 如果你有肠道症状，如腹胀或恶心, dietary changes such as reducing processed foods 和 dairy may help.
• Regular exercise can help increase endorphins 和 improve mental 和 physical well-being.

“经期伴有严重的盆腔疼痛是不正常的，”辛普森说. “妇女应该寻求对其症状的评估和治疗, 和 get a second opinion if they suspect 子宫内膜异位 和 it has not been addressed by their primary physician.”