The inner layer called endometrium located inside the uterus; It is prepared every month to host pregnancy, and if pregnancy does not occur, it is the name of the cell layer that is shed as menstrual bleeding due to not receiving enough hormone support.
The settling of the layer called endometrium in the uterus into other tissues in the abdomen is called endometriosis. These disease foci occur mostly in the ovaries due to their proximity to the uterus and tubes. If these cells settle in the ovaries, bleeding occurs as in the uterus after the disease tissue thickens there during the monthly menstrual cycle, and when it cannot be expelled, it turns into a hemorrhagic cystic structure. It is popularly known as chocolate cyst because it resembles the liquid chocolate inside the cyst.
Outside the ovarian tissue; Endometriosis is also seen in the tubes behind the uterus, on the surface of the intestine around or above the tubes, and in surgical wounds on the surface of the bladder.
Who Is Most Seen in Endometriosis (Chocolate Cyst)?
Endometriosis is a disease of women of reproductive age. Its incidence in the population varies between 5-10%. Endometriosis (chocolate cyst) has been detected in 20-40% of women with infertility problems. Endometriosis (chocolate cyst) may progress in some patients without causing any symptoms. Or it may cause severe pain in patients during menstruation and sexual intercourse that is not relieved by painkillers, menstrual irregularity or infertility.
The cause of endometriosis (Chocolate cyst) is not known today. is unknown. Among the causes of its formation, genetic causes are mostly blamed.
What are the Symptoms of Endometriosis (Chocolate Cyst)?
Persistent groin pain
Painful menstruation
Dyspareunia (pain during sexual intercourse)
Inability to become pregnant – Infertility
It is usually diagnosed for the first time during the examinations of the patient who presents with complaints of inability to become pregnant.
Defecation or urination Pain during erection
Side pain, back pain
Premenstrual spotting type bleeding
Increased bloating, nausea, diarrhea and constipation, especially during menstrual period
Blood in the urine or stool
Does Endometriosis (Chocolate Cyst) Cause Infertility?
One of the most important causes of infertility is endometriosis. Even in very small sizes, it can cause infertility through various mechanisms. Studies have shown that laparoscopic treatment of even minimal (low-grade) endometriosis increases the possibility of having children.
The treatment approach for chocolate cysts called endometriomas in the ovary is controversial.
In the past, edometriomas larger than 5 cm had to be operated on, but recently, treatment has been individualized according to the patient's age, desire for children, infertility, pain, suspicion of a tumor in the cyst, or accompanying symptoms. The decision should be made together with the patient.
The severity of pain is not a reliable indicator of the degree of endometriosis disease.
In patients with mild pain, it is severe. While endometriosis can be detected, on the contrary, mild endometriosis can be detected in women with severe pain.
Endometriosis (Chocolate Cyst) can sometimes cause pain in the groin and abdomen, such as PID (infection and abscess of the tubes and ovaries) or ovarian cysts. It may be confused with other conditions. The disease tends to worsen gradually over time.
Diagnosis of Endometriosis (Chocolate Cyst);
The patient's history, It is determined by pelvic examination, ultrasonography, and sometimes MRI (EMAR). CA125 and CA19-9 blood tests can help confirm the diagnosis. Endometrioma is diagnosed by ultrasonography with an accuracy of over 90-95%.
Although endometriosis is not a cancer, it increases CA125, which is a marker and follow-up marker for ovarian cancer. In this case, it may be confused with ovarian cancer. CA19-9'd increased in panxcreatic and large intestine tumors It may increase in endomeriosis.
When endomeriosis involves the nerves in the vagina, intestine, bladder (urinary bladder) and pelvic (lower abdomen) region, it is diagnosed mostly through surgery.
The name of the operation performed; It is a deep pelvic endometriosis surgery guided by loporoscopy. The disease can be completely treated by removing endometriosis foci with laporoscopy (closed surgery).
Endometriosis (Chocolate Cyst) Treatment:
Treatment of endometriosis is carried out in two ways: drug treatment and surgical treatment.
1- Drug treatment;
Firstly, treatment with medication is started. Medicines that suppress endometriosis foci are used to prevent pain during menstruation.
The main drugs used are; Birth control pills are progestins and GnRH analogues.
In this way, ovulation is suppressed and menstrual bleeding is stopped for a certain period of time, providing relief to the patient and regression of cysts.
It is recommended to use drug therapy for a long time to reduce pain. Chocolate cysts do not disappear completely with the treatments applied, but the complaints decrease.
After the treatment ends, the complaints may increase again. However, they help the patient relax during this process. The purpose of the applied treatments; to eliminate pain, eliminate infertility and enable pregnancy.
2.Surgical treatment;
Tissues with endometriosis are removed and the adhesion is removed. and attempts are made to provide normal anatomy. Many women experience pain after surgery. However, endometriosis recurs in most women.
No matter what treatment is given, the probability of the disease reactivating is high until menopause.
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