What is endometriosis?

Endometriosiswhy?

It is defined as the presence of the layer covering the inner wall of the uterus outside the uterus, where it should not be. It is detected in approximately 7% of women of reproductive age. This rate is 25% in women with persistent groin pain or difficulty conceiving.

Why?endometriosis develops?

Although the reason is not known exactly, the most current and accepted view is that the bleeding during menstruation escapes into the abdominal cavity and cannot be cleaned there due to genetic reasons and sticks to it. (also called retrograde menstruation)

RiskWhat are the factors?

It shows multiple genetic transmission. If a first degree relative (mother, sibling) has endometriosis, the probability of having endometriosis increases 7 times. If there is an identical twin, the risk increases 9 times.

Complaints

Constant groin pain, painful menstruation, pain during intercourse and infertility can be seen. In some cases, painful stool removal may occur. However, in some advanced cases, there may be no complaints at all. Endometriosis does not cause miscarriages.

EndometriosisCan it be prevented?

Unfortunately, endometriosis is not a preventable disease.

Endometriosisdoes it progress?

If left untreated, endometriosis is a progressive disease.

Diagnosis:

Definitive diagnosis is made by seeing the lesions and pathological examination. Lesions are usually seen by laparoscopy. Lesions that are red, yellowish, brown, or white in color can typically be seen on the peritoneum. Endometriosis can cause the tubes, ovaries, uterus, and intestines to stick together. This disease is graded according to the degree of adhesions and the location of the endometriosis foci. Classification is made between 1-4 according to the severity of the disease.

The tumor marker called Ca-125 is also elevated in endometriosis. This marker is also elevated in ovarian cancers. In some cases of endometriosis, Ca-125 levels may be as high as in ovarian cancers. In this case, differential diagnosis should be made.
If endometriosis settles on the ovary and becomes a cyst, it is called an endometrioma (chocolate cyst). Click here for detailed information about chocolate cysts.

Treatment:

Treatment is planned according to the patient’s complaints. If there is an infertility problem, if stage 1-2 endometriosis is detected in laparoscopy, pregnancy rates increase by burning the foci, removing them, and opening the adhesions. In the non-surgical group, vaccination treatment can be applied 2-3 times. If pregnancy still does not occur, IVF should be planned. If there is advanced stage (3-4) endometriosis, in vitro fertilization should be planned directly.

Click to watch the operation of removing and burning endometriosis foci.

Click to watch the laparoscopic removal surgery of chocolate cysts (Endometrioma).

If the patient’s main complaint is pain, laparoscopic surgery will reduce the patient’s pain complaints by removing the foci, burning them and opening the adhesions. Combined birth control pills should be given after surgery (They should usually be used without interruption). Those who do not benefit from this surgery can be given drugs that cause temporary menopause (Zoladex monthly injection, etc.) for 6 months. These drugs should not be used for more than 6 months. Even if the drug is stopped in 6 months of use, there will be relief for 1-2 years. But then the complaints will start again. Another method is to insert an intrauterine device that releases hormones into the uterus (Mirena).

The best method for resistant pain is to burn and remove the pain nerves of the inguinal region laparoscopically (Presacral neurectomy, English = Presacral neurectomy). This method is very effective and the 5-year success rate is 85%. Constipation can be observed in 5% of patients, as the nerves are removed. This method is very difficult surgically and requires experience. Since the surgery is performed in an area very close to the great vessels, life-threatening may occur in case of injury to the great vessels.

Please click to watch presacral neurectomy surgery.
In some cases of endometriosis, if the patient has completed his family, it may even be necessary to remove the uterus and ovaries.

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