endometriosis

What is Endometriosis?

Endometriosis(Chocolate Cyst Disease) is often caused by reproductive diseases. It is an extraordinary disease that is seen in the age of 10 and 10 years, sometimes in the form of a chocolate cyst that is detected incidentally without causing any complaints, and sometimes it does not provide much relief despite many medical treatments and operations. It is one of the important examples of the phrase "there is no disease, there is a patient" that we use in medicine. It is seen in 1 in 10 women of reproductive age. Endometriosis is the settlement of the layer lining the uterus (endometrium) in organs outside the uterus. Endometriosis is most commonly seen in the ovaries (65-70%). Apart from this, the organs where it is seen are the peritoneal membrane lining the abdomen, tubes, vagina, intestines, bladder, ureter, umbilicus (belly button), old operation stitch areas, lungs, diaphragm, spinal canal, brain, eye, breast tissue, heart, arms and hands. It has been reported as spleen.

Why and how does endometriosis occur?

 

Endometriosis is a disease that was first described in 1860, but its cause and treatment are still debated. Different theories have been put forward to explain why. It is not known exactly why this disease affects women and what factors cause it. One of the most accepted theories is that during menstruation, endometrial tissue flows back into the peritoneal cavity, that is, the abdominal cavity, through the tubes and new endometriosis foci form. In recent years, it has been investigated that genetic predisposition may also play a role in the formation of this disease, but a direct genetic factor responsible has not been found yet. It is suggested that, as a result of inadequate immune response, this escaping endometrial tissue forms endometriosis foci in the peritoneal membrane surrounding the abdominal cavity and in genital organs such as ovaries and tubes. According to another theory, in response to effects such as increased estrogen, some changes (metaplasia) occur in the peritoneal and ovarian cells and endometriosis develops. Another theory suggests that endometrial tissue spreads through blood and lymph vessels and thus endometriosis occurs. Some scientists also believe that some environmental factors (such as dioxin, which is an intermediate product in the chemical industry, PVC and paper production) suggested that auxin) is effective in the formation of endometriosis. In other words, there are different theories explaining the occurrence of endometriosis, and endometriosis remains a disease with many unknowns. The resulting endometriosis foci grow and bleed according to the changes in the estrogen hormone in the menstrual cycle, spread deeper, causing pain and adhesions in the areas where they are located. While the immune system tries to eliminate endometriosis foci, an inflammatory condition occurs, resulting in scar tissues and serious adhesions.

What is the frequency of endometriosis?

 

Endometriosis is a reproductive age disease and is most common in the 30s. It is seen in 70% of women with painful menstruation, painful intercourse and chronic groin pain. It is seen in 30-40% of women with infertility problems. It is generally seen in one in every 10 women of reproductive age (15-49 years). Although endometriosis is not common in the 13-19 age group, which we call adolescents, the frequency of endometriosis is 70% in young girls who have severe menstrual pain and do not respond to painkillers.

What are the risk factors for endometriosis?

 

• Frequent, heavy and long menstruation,
• Early onset of menstruation,
• Late menopause,
• White Race,
• Infertility,
• Congenital uterine anomalies,
• Having a family member affected by endometriosis (it is 3 times more common in women with a family history of endometriosis),
• Eating fatty foods,
• Excessive meat consumption,
• Excessive caffeine consumption,
• Thin and tall,
• Being blonde or brunette

is considered among the risk factors.

What are the symptoms of endometriosis?

 

• Painful menstruation
• Chronic groin pain
• Painful sexual intercourse (pain in the anus and groin)
• Infertility
• Diarrhea and constipation
• Bleeding from the anus, bloody stools
• Menstrual irregularity, premenstrual spotting
• Painful and bleeding urination
• Some women with endometriosis There may be no symptoms, the diagnosis is made by ultrasound or by seeing it during surgery.

How is endometriosis diagnosed?

 

First of all, the patient's complaints and personal story. is taken. Here, it is definitely discussed with the patient whether there are any specific complaints regarding endometriosis. Then, ultrasonography is performed along with Gynecological Examination and examination. Tenderness, expression of pain, and limited movement of the uterus and ovaries during pelvic examination may suggest endometriosis. From time to time, blue-purple nodular lesions can be seen behind the cervix during speculum examination. This simple finding indicates the presence of Deep Infiltrative Endometriosis in the deep tissues of the pelvis. For this reason, pelvic examination with a speculum is very important in making the diagnosis.

Another helpful method is blood tests, the most frequently requested being Ca 125 and Ca 19-9. However, the sensitivity of these tests in detecting endometriosis is low and they are only requested as an additional examination.

The most informative of the auxiliary methods in diagnosis is Ultrasonography. In ultrasonography, chocolate cysts in the ovary, which we call endometriomas, serious adhesions between the ovaries and the uterus, and occasionally endometriotic nodules in the intestine, rectum, bladder, and around the ureter (the tube that carries urine from the kidney to the bladder) can be seen.

Magnetic Resonance Imaging (MRI), which is an advanced imaging method, is especially useful in cases where endometriosis affects the deep pelvic tissues, which we call deep endometriosis. Standard MRI is not sufficient here. This MRI must be able to take very sensitive images and special equipment must be used to increase the image quality in the relevant area during shooting. These features are available at a very limited number of imaging centers. It is also very important that the interpreting radiologist is experienced in these matters.

The definitive diagnosis of endometriosis is made by laparoscopy and tissue biopsy. During laparoscopy, endometriosis can be evaluated as mild (stage 1-2) and severe (stage 3-4).

In another classification, endometriosis was evaluated in 3 groups: peritoneal endometriosis, ovarian endometriosis and deep endometriosis. It is stated. Although it is easy to detect endometriosis in the peritoneum, that is, the abdominal membrane and ovary, during laparoscopy, deep endometriosis may be overlooked during the operation because it involves the deep pelvic tissues.

 

Are There Any Special Blood Tests Required in the Diagnosis or Follow-up of Endometriosis? ?

 

Especially Ca 125, Ca 19-9 and Human Epididymis Protein 4 (HE4) may be requested. They are not routinely requested from every patient. However, these tests have low sensitivity in detecting endometriosis and can only be requested as an additional test. It may be requested in special cases. Another blood test that may be requested is HE4. It is especially used to distinguish endometriosis from malignant ovarian masses.

 

How is the Definitive Diagnosis of Endometriosis Made?

 

The definitive diagnosis of endometriosis can be made by laparoscopy or laparoscopy. It is also performed by laparotomy and tissue biopsy. During laparoscopy or laparotomy, endometriosis can be evaluated as mild (stage 1-2) or severe (stage 3-4). In another classification, endometriosis is evaluated in 3 groups: peritoneal endometriosis, ovarian endometriosis and deep endometriosis. Although it is easy to detect endometriosis in the peritoneum and ovary during laparoscopy, deep endometriosis may be overlooked during the operation because it involves the deep pelvic tissues. In the presence of deep endometriosis, it is extremely important for the physician to be experienced in both diagnosis and treatment management.

How is Endometriosis Treated?

Endometriosis can be definitively treated and completely eliminated. It is not a disease that can be cured. The stage and severity of endometriosis disease affect the treatment approach. Two important determining factors in treatment are pain and infertility (desire for children). There are two basic approaches to the treatment of endometriosis: Medical Treatment (use of medication) and Surgical Treatment.

 

Medicine. What is Used in Treatment?

The aim of treatment with medical drugs is to suppress endometriosis lesions by creating a low estrogenic state, reduce inflammation, and stop the progression of endometriosis lesions. Drug treatment includes painkillers, birth control pills, progesterone specifically for endometriosis treatment. There are drugs containing pelvic acid (also available in our country), devices containing intrauterine progesterone (spiral), monthly or quarterly injections, which we call GnRH analogues, and aromatase inhibitors. There is a difference between these in terms of side effects and price. Regardless of the drug treatment, endometriosis can recur at a rate of 50% after treatment.

 

In Surgical Treatment

The purpose of surgical treatment is; The aim is to ensure normal anatomy, to open adhesions, to remove ovarian cysts in a way that causes minimal damage to the remaining ovarian tissue, to burn or cut out endometriosis foci in the peritoneum with cautery, and to remove deep endometriosis nodules, if any. Surgery in the treatment of endometriosis should be preventive surgery, and only endometriosis foci should be destroyed. Surgery at an early age should be avoided unless necessary, because symptoms return within a year in half of the women after surgery, and re-operation may be required in half of the cases within 5 years after surgery. Administering medical drug therapy after surgery may delay the reappearance of symptoms.

 

In Which Situations Is Surgical Treatment Not Considered?

• In those who do not have children,
• Adolescents
• In those with very low ovarian reserve
• In those with double-sided chocolate cysts
• In patients who have previously undergone repeated operations

 

Agrış< If the complaint is prominent, both medical and surgical treatment may be recommended. However, one of the most important points to know for treatment is that surgical treatment is the most effective method for pain. Here, the woman's fertility and age become important. While there is no limitation regarding surgery in women who have children, surgical treatment is not considered in those who do not have children, those who have bilateral chocolate cysts, and patients who have previously undergone surgery.

It is appropriate to perform it. While post-surgical medical treatment is not required in early-stage endometriosis, post-surgical medical treatment is beneficial in preventing recurrence in advanced-stage endometriosis.

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