Endometriosis, one of the common diseases of women of reproductive age, is a serious problem that limits the quality of life today and progresses insidiously. In short, it can be defined as the endometrium tissue, which is a tissue sensitive to hormones that must be present in the inner layer of the uterus, settles in other organs outside the uterus and grows and develops in the area where it is placed and causes disease. This insidious disease, which causes different symptoms according to the symptoms and severity of the region where the disease is located, can often be confused with other diseases. Sometimes it doesn’t even show any signs. Thus, years can pass without being diagnosed.

What symptoms should be taken into account?

Common symptoms and complaints seen in endometriosis may include:

Painful menstrual periods (Dysmenorrhea): Pelvic pain and cramps usually begin before menstrual bleeding and continue for a few days during the cycle. There may also be lower back and abdominal pain. These pains can be quite severe.
Pain during intercourse: Endometriosis has pain during or after intercourse.
Pain during defecation or urination: There may be complaints of pain during defecation or urination, which are more common during menstrual periods.
Excessive bleeding: From time to time, there may be excessive bleeding during periods or abnormal bleeding between periods.
Infertility: Endometriosis can be detected in about half of the couples who have difficulty in conceiving.
Other signs and symptoms: Symptoms such as fatigue, diarrhea, constipation, bloating, and nausea can be seen, especially during menstrual periods.

It is very important for people who have severe pain during their menstrual periods, especially if they have problems with having a child, to suspect this situation and consult a doctor.

What are the reasons?

There is no known cause of endometriosis, but genetic predisposition is important. Women who have endometriosis in their mother or sister are at higher risk of contracting the disease. Environmental factors also play a role in the development of the disease.

Why does endometriosis predispose to infertility?

3 issues are very important for pregnancy to occur; Open tubes with 2 traffics and a smooth inner layer of the uterus, normal seprm number and movement, and finally a healthy ovulation.

In the presence of endometriosis, there may be problems in the tubes, the uterus may not be smooth, the sperm may not fertilize the egg due to inflammation, or the embryo formed may not be able to attach to the inner layer in a healthy way. These tests should be carefully reviewed when endometriosis is suspected or in the presence of a chocolate cyst. In some cases, even a special camera can be used to look inside the abdomen, which we call laparoscopy. However, not every endometriosis disease causes infertility. Some patients can get pregnant naturally.

How is it diagnosed?

Unfortunately, a lot of time is lost in the diagnosis of endomeriosis, the symptoms of which are similar to many other diseases. Sometimes, 7 or 10 years after the onset of the symptoms, the patient may have just been diagnosed with endometriosis. For this reason, it is important for women to consult an obstetrician without hesitation, taking into account the symptoms of young girls. As with any disease, first of all, the patient’s complaints and personal history are taken for diagnosis. Then gynecological examination and ultrasonography are performed.

The most informative method for diagnosing endometriosis is ultrasonography. MRI and computed tomography, which are advanced imaging methods, are especially useful in cases called deep endometriosis. The definitive diagnosis of endometriosis is made by laparoscopy and tissue biopsy.

How is treatment planned?

Endometriosis treatment may vary depending on the extent, level of the disease, symptoms and whether pregnancy is considered or not. Medication, surgery, or the use of both methods may be involved. If pregnancy is desired, treatment is planned by evaluating age and ovarian capacity. The questions of which treatment will be applied to whom and for how long are shaped between the patient and the physician according to the patient’s condition.

In the treatment of infertility, if the examinations of the couple are good, it can be waited or vaccinated. However, in cases with low ovarian reserve, previous ovarian surgery, advanced age (> 37) and sperm problems, IVF treatment can be considered without delay. Surgical treatment is applied in cases of persistent pain that restricts functions and does not respond to drug therapy, in cases where endometriosis tissue diagnosis is deemed necessary, and in cases of intestinal or urinary tract obstruction. Endometriosis surgery should be performed in the relevant centers by obstetricians experienced in minimally invasive surgery and endometriosis surgery.

Will the treated chocolate cyst recur?

Chocolate cysts are the advanced stage of endometriosis disease. It can be single or 2-sided and can reach large sizes. Especially large painful cysts can be cleaned laparoscopically. Although he has undergone a surgical operation, there are a considerable number of cases that do not recur for a lifetime. Here, the experience of the surgeon and the method he uses are very important.

Post-operative drug therapy reduces the likelihood of recurrence of endometriosis. Birth control pills, progesterone, GnRH analogues can be used in treatment after endometriosis (chocolate cyst) operations. Since pregnancy and childbirth have a delaying effect on the endometrioma (we would like to remind you that pregnancy does not eliminate the disease), being able to get pregnant without delay at the end of the treatment becomes important in terms of increasing the risk of infertility (infertility) of new cysts that may occur.

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