What is Simple Ovarian Cyst (Follicle Cyst):
When ovarian cysts are mentioned; They are the most common cysts (75%). Follicles (fluid-filled sacs) that the woman grows every month and contain egg cells; These are cysts that do not crack for any reason (due to lack of ovulation). The size of the cyst is usually 3cm, rarely 5cm. Ovarian follicle cysts usually disappear on their own within 2 months. There is no solid image on ultrasound. Only the simple liquid image is available. It is detected during random checks. It is more common in young people.
What are the symptoms of simple ovarian cyst:It usually does not cause any serious symptoms. Sometimes it may manifest itself with a 1-2 week menstrual delay (without pregnancy occurring). It does not cause serious groin pain. The event called cyst burst does not occur in these cases, although it is rare; 3-5cc of watery serous fluid drains into the abdomen. There is no need for surgical intervention. The pain disappears in 2-3 days. The formation of Simple Ovarian Cysts is caused by hormonal disorder (thyroid or prolactin hormones) or stress.
Treatment of Simple Ovarian Cysts:Usually no treatment is required, it disappears on its own within 1-2 months. For cysts that do not disappear, it is necessary to use a birth control pill for 2 months in the treatment. Cysts larger than 5cm must be controlled and monitored.
Ovarian Chocolate Cysts (endometriomas)
Ovarian chocolate cysts (endometriomas) are located in this follicle (egg). ) cysts, both in terms of formation and treatment. On ultrasound, solid components are seen within the cyst. Chocolate Cyst (Endometrioma); When endometriosis, which will be explained in detail in the following paragraph, occurs in the ovaries, it appears as cysts. These are cysts that contain chocolate-like liquid due to bleeding into the cyst during each menstrual period. Endometriosis cysts over 3cm in the ovary are called chocolate cysts or endometriomas.
Note:simple ovarian cysts (follicle cysts) and ovarian chocolate cysts (endometriomas) are benign ovarian cysts. .
What is Endometriosis?
ENDOMETRIOSIS; Cells of the endometrium (inner glands of the uterus) outside the endometrium (ovaries, tubes, peritoneum) It depends on its location in places such as the body, neighboring organs, parectal region) and as a result of this; It is a benign disease that causes pelvic pain, menstrual pain, pain during sexual intercourse and infertility (at a rate of 20%).
What are the Formation Theories of Endometriosis?
1 -Sampson Theory: theory of retrograde menstruation and implantation. It is the theory of menstruation that leaks back through the tubes (into the abdominal cavity) during each menstrual period. It is the most accepted theory.
2-Celamic metaplasia theory: Metaplasia of mesenchymal cells is also in question here. The occurrence of endometriosis, especially in the ovaries, urinary system organs and chest cavity, causes this theory of formation to be accepted.
Chocolate Cyst: Endometrioma
When endometriosis occurs in the ovaries, cysts form. It is seen as . These are cysts that contain chocolate-like liquid due to bleeding into the cyst during each menstrual period. Endometriosis cysts in the ovary over 3cm are called chocolate cysts or endometriomas.
Causes of Endometriosis (Etiology)
1-Genetic transmission: 6 in women with a family history of endometriosis. It becomes twice as high.
2-Matrix metalloproteinases are increased. Since they are resistant to progesterone, estrogen degradation decreases.
3-Apoptosis (destruction decreased)
4-Aromatase activity increased. (estrogen production increased)
a)Sterioidogenic activity increased.(SF1)
b)Prostaglandin and cyclogenase type 2 increased.
c)Progesterone B in ectopic endometrium is not released, so estrogen is not inactive. There is no transition from E2 (active estrogen) to E1 (inactive estrogen)
d)17b hydroxysteroid dehydrogenase 1 activity increased, thus the transition from E 1 (inactive estrogen) to E 2 (active estrogen) happens
e)17 beta hydroxydehydrogenase 2 activity is absent, so there is no transition from E 2 (active) to E 1 inactive
Immunobiology in Endometriosis
The immune system is impaired. Macrophages, monocytes and NK (natural killer cells) cannot do their job properly. Inflammatory cytokines, mediators and growth factors increased. These also increase inflammation and implantation (adhesion).
What are the Causes of Pain in Endometriosis?
1-Stokine Increase in blood pressure: increases inflammation.
2-Focal bleeding
3-Irritation of nerve endings
Staging in Endometriosis
Size, depth, It is performed according to localization.
Stage 1: Minimal endometriosis
Stage 2: Mild”
Stage 3: Moderate”
Stage 4: Severe”
WHY DOES INFERTILITY HAPPEN IN ENDOMETRIOSIS?
1-Deterioration in oocyte (egg) quality
2-Decreased endometrial receptivity (implantation of the embryo decreases)
3- Distorted anatomy: Formation of adhesions causes mechanical effect.
4-Deterioration in embryo quality
5-Mechanical and toxic effect: Making it difficult to retain the embryo in the endometrium.
The incidence of endometriosis in infertile women is 20% to 20%. It is 40.
Surgical procedures are no longer performed in the treatment of infertility in Stage 1 and Stage 2 Endometriosis. Instead, controlled ovarian hyperstimulation (COH) + IUI (intrauterine insemination) is recommended. In Vitro Fertilization (ICSI) is recommended for Stage 3 and Stage 4 Endometriosis.
There is no need to remove endometriomas below 3 cm in In Vitro Fertilization treatment. Because it reduces the egg reserve. Endometriomas larger than 4cm are surgically removed.
In vitro fertilization success chances in Stage 3 and Stage 4 endometriosis; It is lower than infertility due to tubal factors.
Diagnosis of Endometriosis
1-The gold standard is laparoscopy.
2-Ultrasonography (USG) and x-ray( MRI)
3-Pelvic examination, especially during menstruation. It is 5 times more useful in diagnosis than examination performed at other times.
4- CA-125: If it is lower than 65, it is mild endometriosis, if it is more than 100, it is severe endometriosis.
What is CA-125? ?
It is a superficial tissue antigen originating from the coelamic epithelium and the müllerian duct.
In Which Situations Does CA-125 Increase?
1-Menstruation
2-Pregnant women
3-Epithelial ovarian cancers
4-Endometriosis
5-Pancreatitis
6-Chronic liver disease
7-Pelvic in inflammatory disease
8-Adenomyosis
9-Myomas
Signs of Genital Endometriosis
1-Dysmenorrhea (menstrual pain)
2-Dysparenia (pain during sexual intercourse)
3-Chronic pelvic pain
4-Infertility
TREATMENT OF ENDOMETRIOSIS
A-Medical Treatment
1-Oral contraceptives (birth control pills): They are given continuously, the aim here is to stop the patient from menstruating (amenorrhea). Thus, endometriosis foci disappear since there will be no escape from the tubes during menstruation.
2-Progestims: depo prevera. or mirena (intrauterine system) for rectovaginal endometriosis
3-Danasol: 17 Alpha ethinyl testosterone is given at 600 to 800mg per day. Its mechanism of action is to release androgens, inhibit LH, create chronic anovulation, and reduce enzyme activities that increase aromatase (estrogen production). It ensures the metabolism of estrogens, in short, it has andoregenic, antiprogestenic and anti-estrogenic effects.
4-Gestinon: has a danasol-like effect.
5-GNRH analogues: they inhibit the pituitary gland and cause amenorrhea (amenorrhea). They cause endometrial atrophy by causing endometrial atrophy. As estrogen decreases, to prevent osteoporosis; It is necessary to give alendronate, active vitamin D3 and calcium together with these drugs.
6-Pentoxifylline: It is given to strengthen the immune system.
B-Surgical Treatment
1-Surgery is abandoned for infertility in Stage 1 and Stage 2 endometriosis. If there is dyspareunia (pain during sexual intercourse) or dysmenorrhea (menstrual pain) instead of infertility, these lesions are cauterized with laparoscopy.
2-In Stage 3, if the endometriomas (chocolate cysts) in the ovaries are over 4cm, they are removed for in vitro fertilization. It is necessary.
3- In rectovaginal endometriosis (Stage 4), these must be removed surgically. Because it causes very severe pain in the anus. When these masses are removed; There is no possibility of recurrence after the surgical procedure. Because this type of endometriosis consists of celamic epithelial metaplasia.
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