Endometriosis and its Treatment

This disease is a disease that occurs in women of reproductive age, develops when the inner lining of the uterus (endometrium) settles in different places than its normal location, and progresses with a long-term inflammatory reaction. This disease is often diagnosed late and puts patients in social and physical difficulties. While endometriosis is seen in 6-10% of women of reproductive age, it is seen in 30-50% of those with infertility and long-term pelvic pain complaints. The average age at diagnosis is 35. Early menstruation, short interval between menstrual periods, increased bleeding duration and amount, low number of births, short breastfeeding period, excessive alcohol and caffeine consumption, and exposure to dioxin in the environment are high risk factors for this disease. The fact that this condition is more common in identical twins indicates genetic predisposition. Many theories have been put forward regarding the mechanism of the disease. The disease can often manifest itself as peritoneal endometriosis (lesions located on the abdominal lining), ovarian endometrioma (chocolate cysts located in the ovaries) and rectovaginal deep infiltrated nodules (painful tissue thickenings located in the wall between the hindgut and the vagina).

Most commonly. The complaints seen are dysmenorrhea (painful menstruation) 90%, pelvic pain (groin pain) 87%, dyspareunia (painful sexual intercourse) 68% and infertility (65%), respectively. Sometimes it may be accompanied by irregular bleeding. The prevalence of the disease and the complaints it causes are variable. The diagnosis is made by considering endometriosis in a patient who complains of pain. The examination may be completely normal, but during deep examination of the posterior vaginal wall, pain, adhesive lesions on the ovaries, and the uterus being fixed to the back may be observed. Laparoscopy is the ideal surgical method for both diagnosis and removal of adhesions, release of tissues, and removal of lesions. With transvaginal ultrasound, ovarian endometriomas (chocolate cysts) can be diagnosed with 84-100% sensitivity and 90-100% specificity. MRI is a more sensitive but expensive alternative. CA125 test is not routinely recommended because it is not specific and sensitive.

Treatment of endometriosis, which has no definitive treatment, should be patient-oriented. The aim is to preserve fertility, treat pain and prevent disease recurrence. should be reduced. The plan is determined by taking into account the degree of complaints, location of lesions, stage of the disease, desire for pregnancy, previous surgical and medical treatments, ovarian reserve and, most importantly, the patient's choice. For those with pain, drug treatment should be chosen, if there is infertility, treatment of the causes found, and if pregnancy does not occur and there is no reason other than endometriosis, surgery and/or IVF should be chosen. However, it should not be forgotten that repeated surgeries reduce ovarian reserves. For this reason, surgical treatment should be limited to painful cases that do not respond to medical treatment and should be considered when the risk of cancer cannot be excluded or in the presence of very large cysts.

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