Gynecology and Obstetrics / Gynecological Oncology Surgery Specialist Prof. Dr. Petek Balkanlı noted that endometriosis is the disease that occurs when the tissue called endometrium, which covers the inner surface of the uterus, usually emerges and grows in the organs inside the pelvis
Stating that the ovaries are the most common location of endometriosis, Balkanlı said, “If there is endometriosis in the ovaries, it is called endometrioma. The endometrium tissue consists of cells that thicken every month during the menstrual cycle and bleed for a certain period of time. After it thickens, bleeding occurs, as in the uterus, and because it cannot be expelled, it turns into a hemorrhagic cystic structure. Because the liquid inside the cyst resembles chocolate, it is called a chocolate cyst.” he said.
Those with a family history of diagnosis are at 7 times the risk.
Emphasizing that the chocolate cyst causes infertility at a rate of 40 percent, Balkanlı made the following evaluations:
Endometrial tissue placed in the wrong place can irritate the pelvis, causing pain, adhesions and thus infertility. The endometriosis tissue surrounding the surrounding tissues can form adhesions, in other words, scar tissues called adhesions. These adhesions can lead to obstruction of the tubes and the formation of adhesions between the genital organs, intestine and rectum. Endometriosis is considered a disease of women of reproductive age. Endometriosis can be seen in 5 percent of women in the community. Women with a family history of endometriosis in their first-degree relatives are at 7 times more risk in this regard. Endometriosis can cause infertility in 40% of the cases.
More than 10 percent of women have endometriosis. In most women, it either causes no complaints or can be present with very little complaint. The most common complaints are severe painful menstruation, chronic pelvic pain and pain during intercourse. In some, it can only be seen with infertility. Definitive diagnosis can be made by pathological examination of the surgically removed cyst. Between 24 percent and 50 percent of infertile women have been found to have endometriosis. In women with chronic pelvic pain, the frequency is over 20 percent.
Treatment is aimed at eliminating infertility
Noting that ultrasonography is one of the most important tests for the diagnosis of chocolate cyst, Balkanlı said, “While this examination is effective in the evaluation of lesions in the ovaries, it may be insufficient for lesions in the pelvic region. When a chocolate cyst is suspected in the ultrasonography examination, a marker called Ca125 is examined in the patient’s blood sample and the diagnosis is tried to be supported. The marker may increase in cancers originating from the ovary as well as in endometriosis disease.The definitive diagnosis is made histopathologically only by laparoscopy or open surgery.
There is no definitive treatment for the disease. Treatments for cysts aim to relieve pain and eliminate infertility in women. Medical and surgical treatments are used to achieve this. The principle of medical treatments is based on the fact that the disease is dependent on estrogen. By removing the estrogen effect on the chocolate cyst, it is tried to suppress the endometrial tissue located where it should not be. By continuing the treatment for 3-6 months, the estrogen level in the blood is made as low as in the menopausal period. Surgical method is considered in cysts that exceed 4-5 cm and do not respond to treatment. It has been observed that medical treatments can relieve pain in patients, but are not effective on infertility. Therefore, medical treatment is not recommended for patients with infertility. Surgical treatment is preferred in cases of severe endometriosis. This treatment is applied as a laparoscopic technique or, if necessary, an open operation.