Supervisor: National Health Commission of the PRC
Sponsored by: Chinese Medical Doctor Association
China Medical University
Sponsored by: Chinese Medical Doctor Association
China Medical University
Endometriosis is a common disease in women of reproductive age. Pain is one of the most common reasons for patients with endometriosis seeking medical treatment，and seriously affects women's quality of life.The pathogensis of endometriosis-associated pain is complex and the manifestations are various，making its diagnosis and treatment still a clinical challenge.It is necessary to conduct a comprehensive evaluation of the patient's pain characteristics in clinical practice in order to make a correct diagnosis as early as possible. Typically，a combination of medication，surgical treatment，and psychological intervention is required for the treatment，in order to make an individualized treatment plan for patients. This article provides a brief discussion on the diagnosis，treatment and management of endometriosis-associated pain.
Pain is one of the main clinical manifestations of adenomyosis.The pathogenesis of adenomyosis-associated pain is complex，involving multiple interrelated mechanisms. Ultrasound and magnetic resonance imaging play crucial roles in diagnosis and typing of adenomyosis. Currently，there is no consensus on typing and pain characteristics across different types. Exogenous pain may have more obvious symptoms，and responds well to progesterone treatment. Hysterectomy serves as the radical treatment.For patients desiring uterine preservation，lesion excision，endometrial ablation，or minimally invasive or non-invasive treatment may be alternatives. The long-term management requires making individualized strategies based on the patient's age，fertility demand，symptom severity and lesion characteristics.
Chronic pelvic pain （CPP） refers to the pain located in the pelvic region that persists for more than six months. Its causes are complex，and reproductive tract malformations are one of the organ diseases that can lead to CPP. Unlike classic non-cyclical CPP，CPP caused by obstructive reproductive tract malformations often has a cyclical characteristic due to poor menstrual blood flow. Relatively rare reproductive tract malformations are prone to misdiagnosis. This article summarizes the characteristics of reproductive tract malformations that cause CPP，hoping to enhance understanding of these malformations，facilitate early identification，and promote active intervention and management
Pelvic inflammatory disease （PID） refers to a group of infectious diseases affecting the female upper reproductive tract，including endometritis，salpingitis，tubo-ovarian abscess，and pelvic peritonitis. Persistent and recurrent inflammation often leads to chronic pelvic pain，significantly impacting women's physical and mental health as well as their quality of life. Currently，there is still a lack of diagnostic methods that are both sensitive and specific，as well as cost-effective treatment options. This article provides a review of the current status of the diagnosis and treatment of chronic pelvic pain following PID.
Myofascial pelvic pain syndrome is a major cause of chronic pelvic pain，often accompanied by lower urinary tract and bowel symptoms and sexual disorders，with a complex and highly heterogeneous pathophysiology，which makes diagnosis challenging and necessitates multidimensional assessment. Physical therapy is the first-line treatment，while multidisciplinary comprehensive intervention is recommended in complex cases. Establishing standardized diagnosis and treatment pathways，integrated with intelligent monitoring technologies，can optimize the entire cycle of patient management，which contributes to pelvic floor functional rehabilitation，and improves quality of life.
Pelvic congestion syndrome（PCS） is a significant cause of chronic pelvic pain （CPP） in women，characterized by persistent or cyclic pelvic pain resulting from pelvic venous valve insufficiency and venous dilation. This article summarizes the etiology and pathogenesis of PCS-related CPP，focusing on its clinical manifestations，diagnostic methods，and differential diagnosis，and including the role of imaging examination and venography in establishing a definitive diagnosis. Additionally，the article summarizes various treatment strategies for PCS，diccussing in detail the conservative management，interventional approaches，and the indications and efficacy of surgical treatment. Furthermore，the importance of multidisciplinary collaboration in managing PCS is emphasized.Diagnostic and therapeutic challenges and directions for future research are also expolored. By deepening the understanding of the role of PCS in CPP and optimizing the diagnostic and therapeutic regimens，more precise and individualized treatments can be provided to improve patients' quality of life.
Chronic pelvic pain (CPP) refers to persistent pain in the pelvic region and surrounding tissues. Its causes are complex and often involve multiple body systems. CPP is especially common in women of reproductive age and can severely affect quality of life,physical health, and psychological well-being, while also creating a significant social and economic burden. Besides well-known causes such as endometiosis,adenomyosis, pelvic inflammatory disease, pelvic floor dysfunction, and pelvic congestion syndrome, this article also discusses other gynecological factors that may contribute to CPP, including uterine fibroids, adnexal masses, and pelvic adhesions.The aim is to provide a broader understanding to support future diagnosis and management of chronic pelvic pain.
Chronic pelvic pain （CPP） in women refers to non-periodic pain symptoms originating from pelvic organs and structures，usually lasting for more than six months，or periodic pain accompanied by significant cognitive，behavioral，sexual and emotional consequences. CPP is a clinically common and easily overlooked reproductive disease，which seriously affects the physical and mental health of patients. Non-gynecological common diseases that cause CPP include interstitial cystitis/bladder pain syndrome，irritable bowel syndrome，inflammatory bowel disease，myofascial pain syndrome and psychological disorders，etc. These diseases are often neglected by gynecologists，which affects the diagnosis and treatment effect. This paper intends to explore the identification and management of non-gynecological common diseases causing CPP，in order to enhance the alertness and management ability of clinicians in non-gynecological diseases causing CPP.
Objective To investigate the accuracy of intraoperative frozen section examination in mesenchymal tumors of the uterine corpus and determine its clinical application value. Methods The clinical and pathological data of patients were analyzed retrospectively, who underwent surgical treatment and intraoperative frozen section examination and were diagnosed with mesenchymal tumors of the uterine corpus by routine pathological examination at Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2011 to March 2023. The concordance rate and discordance rate between diagnosis by intraoperative frozen section examination and diagnosis by routine pathological examination were calculated，as well as the deferral rate of diagnosis. The sensitivity，specificity，positive predictive value and negative predictive value of intraoperative frozen section examination in benign，borderline and malignant mesenchymal tumors of the uterine corpus were figured out respectively. The proportion of patients who underwent a change in surgical procedure was calculated. Results （1） General characteristics：A total of 1756 patients with mesenchymal tumors of the uterine corpus underwent intraoperative frozen section examination，of which 1696 （96.58%） were benign，23 （1.31%） were borderline，and 37 （2.11%） were malignant. The median age was 44（38-48）years old. （2） The frozen section and routine pathological diagnoses were concordant in 1673 cases （95.27%） and discordant in 16 cases（0.91%），and deferred diagnosis was in 67 cases （3.82%）. The concordance rates of benign，borderline and malignant mesenchymal tumors were 97.29%，8.7% and 56.76%，respectively. （3） The sensitivity of intraoperative frozen section examination for benign，borderline and malignant mesenchymal tumors of the uterine corpus was 99.82%，20.00% and 80.77%，respectively； the specificity was 63.89%，99.88% and 99.94%，respectively； the positive predictive values were 99.21%，50.00% and 95.45%，respectively； the negative predictive values were 88.46%，99.53% and 99.70%，respectively. （4）A total of 8 cases underwent a change in surgical procedure，accounting for 44.44% （8/18） of the patients who needed it. Conclusions The overall accuracy of intraoperative frozen section examination for mesenchymal tumors of the uterine corpus is generally high. The positive prediction value of intraoperative frozen section examination in malignant mesenchymal tumors is high，and the rate of misdiagnosis as malignancy is very low. A secondary surgery can be avoided by a change in the surgical procedure according to intraoperative frozen section examination.
Objective To investigate the distribution and risk factors of reproductive tract infection（RTI） in women of childbearing age visiting medical institutions. Methods A total of 3，159 women aged 18-49 years visting the gynecology outpatient department of six medical institutions from January 2021 to December 2022 were included in our study. Cervical exfoliated cells were collected for the detection of ten common RTI pathogens，and relevant demographic characteristics were also collected. The distribution of RTI infections was analyzed，and logistic regression was used to analyze the association of RTI with demographic characteristics and smoking status. Results The mean age of the study subjects was 34.6±6.7 years. The positive detection rate of any RTI pathogen was 45.7%，and the detection rate of any Ureaplasma species was 41.8%. The pathogens with the top three positive detection rates were Ureaplasma parvum3（Up3） （17.6%），Up6 （13.4%） and Ureaplasma urealyticum （Uu） （10.2%）. Among those with RTI，78.0% were single infection and 22.0% were multiple infection. The rates of RTI were significantly higher in women with junior high school education or below，with average monthly family income more than 20 000 CNY，being unmarried，and with smoking habit（P<0.05）. Conclusions The infection rates of RTI-related pathogens in women in gynecology outpatient department are relatively high. The most common RTI pathogens is Ureaplasma species，especially Up3，Up6 and Uu，and single infection is prevalent. At the same time，it is necessary to further strengthen health education for high-risk groups of RTI，such as those with lower education level，lower monthly family income，and smokers，to promote the reproductive health-related knowledge in them. Maintaining the balance of the vaginal microecology and actively treating lower reproductive tract infections in a standardized routine might play a crucial role in enhancing women's reproductive health.
Objective Observation of the clinical efficacy and safety of gynecological Duanhongyin capsules in the treatment of abnormal uterine bleeding after placement of subcutaneous implanted contraceptive with pregnene. Methods This study is a randomized controlled trial，using a numerical table method to randomly select 60 patients from the Family Planning Center of Hangzhou Obstetrics and Gynecology Hospital from August 2022 to November 2024 who experienced abnormal uterine bleeding after receiving subcutaneous implantation of etoposide contraceptive，divided into a treatment group and a control group，with 30 cases in each group.The control group did not receive any medication intervention treatment except for counseling and comfort. The research group added gynecological Duanhongyin capsules for treatment. Observe the effective rate of two treatment groups，the duration of abnormal uterine bleeding and vaginal bleeding，the recurrence rate of abnormal uterine bleeding，the continuation rate of subcutaneous implant contraception，hormone levels in the body，and endometrial thickness，and conduct safety evaluation. Results The total effective rate of clinical treatment in the research group was 86.67%，significantly higher than the control group's 3.33% （P<0.001）；The median number of vaginal bleeding days in the first month after medication was 5.5 （4.0，10.0），the median number of vaginal bleeding days in the second month after medication was 5.0 （4.0，10.0），and the median number of vaginal bleeding days in the third month after medication was 5.0 （4.0，8.5），all of which showed statistically significant differences compared to the control group （P<0.001）.The recurrence rate of abnormal uterine bleeding after 3 months of observation and treatment was 20.00% in the study group （100.00% in the control group），and the follow-up removal rate was only 36.67% in the study group （96.67% in the control group），with significant statistical differences （all P<0.001）. The incidence of complications and other adverse events was similar between the study group and the control group，with no statistically significant differences （all P>0.05）. Conclusion Gynecological Duanhongyin capsules have shown significant clinical efficacy and medication safety in treating abnormal uterine bleeding caused by subcutaneous implantation of contraceptive agents.
Objective To study the clinical efficacy of Guizhi Fuling capsules combined with metformin in patients with polycystic ovary syndrome （PCOS） and insulin resistance. Methods A total of 108 patients with PCOS and insulin resistance admitted to Jiangnan Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine from July 2021 to May 2024 were selected and divided into study group and control group according to the random number table method，with 54 cases in each group. The control group was treated with metformin，and the study group was combined with Guizhi Poria capsule on this basis. The clinical efficacy， estrogen and sex hormone levels and pregnancy-related indicators before and after treatment were compared between the two groups. Results （1） The improvement rate of menstrual disorders，clinical symptoms，and return to normal sex hormone levels in the study group were significantly higher than those in the control group [97.67% （42/43） vs. 80.95% （34/42），92.59% （50/54） vs. 77.78% （42/54），94.44% （51/54） vs. 79.63% （43/54），all P<0.05]. （2） After treatment，the normal range rate of progesterone，testosterone and estradiol in the study group was significantly higher than that in the control group [83.33% （45/54） vs. 55.56% （30/54），88.89% （48/54） vs. 53.70% （29/54），85.19% （46/54） vs. 59.26% （32/54），P<0.05]. （3） The menstrual recovery rate，ovulation rate and pregnancy rate of the study group were significantly higher than those of the control group [98.15% （53/54） vs. 62.96% （34/54），81.48% （44/54） vs. 51.85% （28/54），48.15% （26/54） vs. 14.81% （8/54） （P<0.05）. Conclusion Guizhi Fuling capsule combined with metformin in the treatment of PCOS and insulin resistance can further improve the efficacy， regulate estrogen secretion and increase pregnancy rate.
