What is endometriosis and in which parts of the body does it occur?

Endometriosis is the condition in which the membrane lining the uterus (endometrium) is found outside the uterus and forms various disease structures. It is most commonly found in the lower part of the abdomen where the genital organs are located, respectively the ovaries, the depression in front and behind the uterus, the membrane covering the lower part of the abdomen, the ovarian ducts, the uterine ligaments, the lower part of the large intestine, etc. is seen. It can also be seen in parts of the body distant from this area, such as the kidneys, lungs and liver.

How does it occur?

There is no single accepted explanation for its formation. Many factors have been suggested as the cause. The main ones are;

1- Endometrium cells settle in these areas with the blood flowing into the abdomen from the channels during menstrual bleeding.

2- Settlement of endometrial cells to distant areas through blood vessels and lymph channels.

3- The cells lining the inner part of the abdomen change into endometrial cells for various reasons

4- Deficiency in the cellular immune systems of women with endometriosis

5- Observation of changes in the intra-abdominal fluids of women with endometriosis that facilitate the formation of endometriosis

It is generally accepted that several factors, rather than a single factor, are effective in the formation of the disease.

What age does it affect women?

It most commonly affects women between the ages of 25 and 35. It is never seen before puberty. It is a disease of menstrual age. It is very rare after menopause.

What kind of changes does the disease cause in the area where it is located?

The disease can cause many different lesions in the body. A few mm. Small, dot-shaped, red, black, yellow-brown or transparent colorless lesions may occur or may appear as thin or dense adhesions between adjacent organs.

Sometimes it is in the form of lesions that are not visible from the surface and affect deep tissues. Such lesions cause a lot of pain. One of the most common forms is chocolate cysts seen in the ovaries. These cysts are several mm in size. 10cm from They can reach large sizes. It is called a chocolate cyst because the blood flowing into the cyst every month becomes dense brown over time.

Does endometriosis turn into cancer?

Very rarely, it can turn into some types of cancer. Some types of cancer are observed at an earlier age, especially in women with chocolate cysts in their ovaries, compared to other women.

What complaints does the disease cause?

Pain in the lower abdomen, painful menstruationpainful sexual intercourse, extramenstrual bleeding and infertility are the most common complaints. The severity of complaints varies depending on the prevalence of the disease and the region and organ it affects.

Up to 30% of patients have chronic pelvic (lower abdominal) pain. It can be crampy or stabbing and usually increases during menstruation. Painful menstruation is also one of the common complaints. The severity of menstrual pain is related to the prevalence of the disease. Endometriosis, which settles in the deep areas of the lower abdomen and uterine ligaments, causes pain during sexual intercourse.

Menstrual bleeding disorders are also seen in approximately 30% of patients. Frequent menstruation, infrequent menstruation, bleeding between two periods or before menstruation are the most common bleeding disorders we encounter.

About 30-40% of women with endometriosis have infertility problems. Adhesions caused by the disease, ovulation problems, and difficulties in embryos attaching to the uterus are the main causes of infertility.

How is the diagnosis made?

First of all, the possibility of endometriosis should be considered in women with chronic lower abdominal pain, painful menstruation, painful sexual intercourse, abnormal menstrual bleeding and infertility complaints. We should also keep in mind that many women with endometriosis may not have any complaints. While no findings may be detected during the examination of these women, sensitivity in the female organs and existing cysts in the ovaries may be detected. Chocolate cysts in the ovaries can be diagnosed almost certainly during ultrasound examination. Blood CA-125 values ​​are high in patients with endometriosis. However, this test may be elevated in many conditions other than endometriosis. Therefore, it can be used as a confirmatory rather than a diagnostic tool.

The most definitive diagnosis is made by observing the lower abdomen with laparoscopy, detecting lesions, taking a biopsy and sending it to pathology. The disease is divided into 4 classes: very mild, mild, moderate and severe, according to the recommendation of the American Society for Reproductive Medicine.

Is there a definitive treatment method? If so, what are they?

Unfortunately, there is no treatment that will completely eliminate the disease from the body. The disease may sometimes remain at the same level for years, completely silently, without progressing at all, or it may increase. After menopause, the disease enters a period of remission.

There is no single treatment method for every patient. The type of treatment varies depending on the severity of the patient's symptoms, the extent of the disease, whether she wants to become pregnant, and her age. If we review the treatment methods in order:

1- Monitoring: If the patient has no or very few complaints, if mild endometriosis is suspected, and if she does not want pregnancy, painkillers that inhibit prostaglandin synthesis can be given.

2- Drug suppression therapy: Birth control pills, progesterone derivatives, testosterone derivatives and pseudo-menopausal hormones (GnRH derivatives) can be used to suppress and regress the disease. Side effects may occur when using these drugs for a long time.