ENDOMETRIOSIS AND ENDOMETRIOSA (CHOCOLATE TAXISTS)
It occurs when the endometrium layer, which is seen in 1 out of every 10 women in the reproductive age, settles in the extra-uterine organs, especially in the ovaries. Cysts that develop when these cells invade the ovaries are called endometrioma or chocolate cyst. Endometriosis is most commonly seen in the ovaries (ovaries) at a rate of 65-70%. Apart from that, the most common tissues where endometriosis is located are: Fallopian tubes, the peritoneum tissue around the intestine and uterus. Each time the menstrual period comes, bleeding occurs inside the cyst. This bleeding accumulates inside and turns into a dark brown liquid over time. Because this fluid resembles melted chocolate, these cysts are called chocolate cysts.
While some women with endometriosis have no complaints, others may experience severe pain and inability to conceive. There are many treatment options for endometriosis. Endometriosis treatment should be personalized according to the patient’s characteristics.
Causes of Endometriosis (Chocolate Cyst)
The cause of endometriosis is not known for certain, but it is thought that genetic causes are the most common causes. Apart from this, many theories have been proposed for the formation of endometriosis:
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The menstrual blood flow, which occurs every month, passes backwards through the tubes and settles into the abdomen.
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Inability to destroy the tissue that is expelled from the body with menstrual bleeding due to problems in the immune system
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It is the spread of endometrial tissue to other organs as a result of lymph and blood flow.
None of these theories alone can explain endometriosis. Probably several factors work together.
How does endometriosis manifest?
The most common symptom; long-term abdominal pain.
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This pain is especially pronounced before and during menstruation. In addition, the pain increases during sexual intercourse.
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If there is intestinal involvement with bowel movements, if there is urinary bladder involvement; severe pain when urinating.
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Even in some patients; There may be bloody stools, even bloody urination.
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In some patients; It can cause menstrual irregularity, excessive menstrual bleeding.
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Intra-abdominal adhesions
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difficulty conceiving
However, in most patients, endometriosis progresses insidiously and does not give any symptoms.
How is endometriosis diagnosed?
A detailed physical/pelvic examination is performed, and imaging methods (usg-MR) are often preferred in suspicious cases. However, the definitive diagnosis of the presence of endometriosis in a person is made by pathological examination of the biopsy taken during the surgery, which is a surgical procedure, Laparoscopy.
How is endometriosis treated?
The treatment varies according to the patient’s complaints, the severity and stage of the disease, and whether there is a child expectation. The two most important factors determining the treatment are pain and inability to conceive. There are 2 basic approaches in the treatment of endometriosis: medical treatment (drug use) and surgical treatment. (medical or surgical treatment)
Medical Treatment:
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In those who do not have children,
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Especially in those with severe pain
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Those with very low ovarian reserve
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Those with double-sided chocolate cyst
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Medical agents such as painkillers, hormonal suppressive agents (birth control pills, progestogen agents, GnRH agonists) are often preferred in patients who have had previous repetitive operations. It is not possible to completely get rid of the disease with these drugs, but they slow the progression of the disease.
Patients Recommended for Surgery (Surgical Treatment):
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Treatment-resistant very severe pain and inability to respond to drug therapy
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inability to conceive
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If malignancy is suspected (malignant tumor)
Adhesions are corrected with surgical methods and anatomical restoration is performed.
Laparoscopy (closed surgery) should almost always be preferred in endometriosis surgeries.
Within a few months following the surgery, 80-90% of the patients will have a regression in their pain complaints.
It is possible for postoperative pain to recur in the future (within 2 years after surgery in 40-80% of patients). How severe the disease was during the first operation; the more likely the pain will come back.
