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Endometriosis Treatment

Endometriosis

Endometriosis is a common disease that can cause abdominal pain and difficulty conceiving. Although the reason is not known exactly, the theory that is widely accepted is that menstrual blood is poured into the abdominal cavity through the tubes and occurs when cells settle and multiply there.

What Causes Endometriosis?

Although the reason is not known exactly, the commonly accepted theory is that menstrual blood is poured into the abdominal cavity via tubes and endometrial cells settle and multiply there.

In endometriosis, cells that normally grow inside the uterus and are shed every month, which we call endometrial cells, settle in areas outside the uterus. Frequently, their localization is in the areas between the ovaries, tubes, uterus, intestines and peritoneum. When they settle in the ovary and cause a cyst, they are called endometrioma (chocolate cyst). They are almost always benign and can be easily diagnosed by ultrasonography.

Where Does Endometriosis Occur?

The places where endometriosis is often located are the areas between the ovaries, tubes, uterus, intestines and peritoneum. When they settle in the ovary and cause a cyst, they are called endometrioma (chocolate cyst). They are almost always benign and can be easily diagnosed by ultrasonography.

Less frequently, there may be involvement in the lungs, in the presence of severe disease, the intestines and urinary bladder.

What Are the Symptoms of Women with Endometriosis?

The most prominent complaints are abdominal pain, palpable abdominal mass and difficulty in getting pregnant.

Some patients with endometriosis may have no symptoms. However, the most common symptom is abdominal pain. Although pain is especially during menstruation, it can also occur during non-menstrual period, during sexual intercourse, or during urination or defecation if bowel and urinary tract involvement is present. Endometriosis is staged in 4 different classes, from Stage I to IV. Staging can only be done by laparoscopy. There is no relationship between the extent (stage) of the disease and the severity of symptoms. Although some patients have advanced endometriosis, they do not have any pain complaints, and sometimes they may have very intense pain in mild disease.

Why Can Endometriosis Prevent Conceiving?

Endometriosis can cause difficulty in conceiving by disrupting the anatomical relationship of the uterus, tube and ovaries, which are the abdominal organs, or by causing obstruction in the tubes and a fluid-filled tube, namely hydrosalpenx. However, endometriosis does not have a negative effect on pregnancy.

Endometriosis is staged in 4 different classes, from Stage I to IV. Staging can only be done by laparoscopy.

What are the Symptoms of Endometriosis in the Intestines?

Intestines can be affected due to adhesions between them and the surrounding organs, and in this case, the patient may complain of constipation. Or, if endometriosis foci invade the intestinal wall, it may cause bleeding during defecation.

Why Can Endometriosis Prevent Conceiving?

Endometriosis can disrupt the anatomical relationship of the uterus, tubes and ovaries, which are the abdominal organs. It can cause severe adhesions between all female reproductive organs and intestines, or it can cause obstruction in the tubes, causing a fluid-filled tube, namely hydrosalpenx. As a result of all these negativities, the relationship of the uterus, tube and ovary may be disrupted and may cause difficulty in conceiving.

In addition, the mere presence of chocolate cyst can have a negative effect on the surrounding healthy ovarian tissue, reducing the number of eggs, that is, the ovarian reserve.

However, endometriosis does not have a negative effect on pregnancy. It does not increase the risk of miscarriage or baby with anomalies.

What are the Endometriosis Treatment Options?

In patients who do not desire pregnancy, medical treatment may be considered. However, medical treatment options can be beneficial in terms of relieving the patient’s complaints. If the disease is completely permeable and there is a cyst, it does not have a destructive effect. The medical treatment options that can be used for this purpose are painkillers in the non-steroidal anti-inflammatory group, combined birth control pills, preparations containing progesterone, and the use of GnRH agonists.

Removal of the cyst in the ovarian tissue or burning of the endometriosis foci in the abdomen by laparoscopy, and in the presence of severe disease, the adhesions between the intra-abdominal structures can be opened and the organ functions (bowels, urinary tracts, etc.) can be corrected.

However, we stay away from surgical treatment as much as possible, except in patients with suspected cancer, severe pain complaints but no response to medical treatment, very large cysts, or rupture of the cyst wall and leakage of the cyst contents into the abdominal cavity. Because even the best hands on the ovarian tissue carry the risk of loss of healthy ovarian tissue and decrease in ovarian reserve. In addition, endometriosis is a recurrent condition and surgery may not always contribute to pain relief.

How Is Endometriosis Treated?

Treatment should be planned according to the woman’s symptoms and whether she wants to conceive or not.

In patients who do not want to be pregnant;

Depending on the woman’s complaints, medical treatment may be considered. However, medical treatment options can be beneficial in terms of relieving the patient’s complaints. If the disease is completely permeable and there is a cyst, it does not have a destructive effect. Medical treatment options that can be used for this purpose are painkillers in the non-steroidal anti-inflammatory group, combined birth control pills, preparations containing progesterone and drugs containing GnRH agonists.

Laparoscopy may also be an option for patients who do not respond to medical treatment, have severe pain, and have difficulty in maintaining their daily life. By performing laparoscopy, removal of the cyst in the ovarian tissue or burning of the endometriosis foci in the abdomen, and in the presence of severe disease, the adhesions between the intra-abdominal structures can be opened and the organ functions (bowels, urinary tracts, etc.) can be corrected.

However, we stay away from surgical treatment as much as possible, except in patients with suspected cancer, severe pain complaints but no response to medical treatment, very large cysts, or rupture of the cyst wall and leakage of the cyst contents into the abdominal cavity. Because even the best hands on the ovarian tissue carry the risk of loss of healthy ovarian tissue and decrease in ovarian reserve. In addition, endometriosis is a recurrent condition and surgery may not always contribute to pain relief.

In patients who want pregnancy;

It is not true that every patient with endometriosis can become pregnant with treatment. Spontaneous pregnancy can also be achieved in couples whose tubes are open, who ovulate regularly and who do not have sperm problems belonging to the spouse. For this reason, in a couple who applied with the complaint of inability to conceive, it is important to first investigate whether there is an additional factor on the side of the woman or man that may cause the inability to become pregnant.

In couples who are young, do not have a problem that may affect the permeability of the tubes, have a short period of not being able to conceive and have no male problems, it may be an option to wait for spontaneous pregnancy for a while, or ovulation vaccination can be applied in patients with suitable conditions. You can find detailed information about vaccination treatment in our vaccination treatment article.

If the woman’s age is 38 years or older, the period of not being able to conceive has exceeded 2-3 years, if a male problem is detected (lack or absence of sperm (azoospermia), sexual dysfunction, etc.) and severe adhesions in the abdomen with a previous operation If there is a history of tuberculosis and tuberculosis, IVF treatment may be considered.

In patients with an IVF plan, we would like to avoid surgery unless there is a suspicion of cancer or other medical necessity. It is accepted that in vitro fertilization in the presence of endometrioma cysts does not have a negative effect on egg or embryo quality or pregnancy rates. In our study, in which we presented our own data, which was accepted in an international journal, we reported that pregnancy rates were similar in women with and without endometrioma with the same characteristics. For this reason, we prefer to apply IVF treatment without surgical treatment in couples for whom we have decided to undergo IVF treatment.

What are the Treatment Options for Infertile Couples?

First of all, it is important to investigate whether there is an additional factor on the side of the woman or man that may cause concomitant inability to conceive. Especially in the presence of women aged 38 and above, if the period of not being able to conceive exceeds 2-3 years, if a male problem is detected (lack or absence of sperm (azoospermia), sexual dysfunction, etc.) and severe adhesions in the abdomen with a previous operation If there is a history of tuberculosis and tuberculosis, IVF treatment may be considered.

In patients with an IVF plan, we would like to avoid surgery unless there is a suspicion of cancer or other medical necessity. It is accepted that in vitro fertilization in the presence of endometrioma cysts does not have a negative effect on egg or embryo quality or pregnancy rates. In our study, in which we presented our own data, which was accepted in an international journal, we reported that pregnancy rates were similar in women with and without endometrioma with the same characteristics. For this reason, we prefer to apply IVF treatment without surgical treatment in couples for whom we have decided to undergo IVF treatment.

In couples who are young, do not have a problem that may affect the permeability of the tubes, have a short period of not being able to conceive and have no male problems, it may be an option to wait for spontaneous pregnancy for a while, or ovulation vaccination can be applied in patients with suitable conditions.

Frequently Asked Questions About Endometriosis

Does endometriosis cause trouble getting pregnant?

If it causes adhesions in the abdomen, obstruction in the tubes and a disorder in the anatomical relationship of the uterus, tube and ovary, endometriosis may cause problems in conceiving on its own. Otherwise, only the presence of isolated foci of endometriosis in the abdomen or the presence of endometrioma cysts in the ovary is not necessarily a contraindication to pregnancy.

How can you tell you have endometriosis?

The most common complaint in patients with endometriosis is severe inguinal pain during menstruation. In addition, some of the patients may have abdominal pain during non-menstrual period or pain during sexual intercourse. In addition, trouble getting pregnant can be added to the picture in most patients.

Finding an endometrioma cyst on ultrasonography in the pelvic examination is sufficient to make the diagnosis. However, ovarian cyst formation is not seen in every patient with endometriosis. In some parts, there may be involvement only in the membrane called the peritoneum, which covers the inner wall of the abdomen. In this case, that is, in the presence of early-stage endometriosis, the only way to make a diagnosis is to see the foci laparoscopically, as endometriosis foci cannot be seen by ultrasonography. However, nowadays we almost always do not perform laparoscopy for diagnosis purposes only.

How should the treatment be in the presence of hydrosalpenx?

If the end of the tubes opening into the abdominal cavity is blocked and there is fluid accumulation in the tube, we call this situation hydrosalpenx. The presence of hyrosalpenx is a condition that significantly reduces the chance of conception, increases the risk of ectopic pregnancy and increases the risk of miscarriage. For this reason, removing the hydrosalpenx tube before attempting pregnancy or, if there is a very severe adhesion, at least disconnecting it from the uterus will increase the chance of success after the treatment.

Ankara Endometriosis Surgery

As I mentioned above, we stay away from surgery in the presence of endometriosis unless it is absolutely necessary. Because even after laparoscopic surgeries performed in the best hands, there may be loss of healthy ovarian tissue, decrease in the number of eggs, and adhesions in the abdomen.

However, in patients with severe abdominal pain, unresponsive to medical treatment, rupture of the cyst wall, or in the presence of hydrosalpenx, surgery with the laparoscopy technique can be considered.

Contact information :

Author : Prof. Dr. Mehtap Polat
Telephone : +90 530 011 41 33
E-mail : [email protected]

Prof. Dr. Mehtap Polat

18 yılı aşkın meslek hayatım boyunca mesaimin neredeyse tama yakını bebek sahibi olmak isteyen çiftlere yönelik tedavilerle geçti. Çocuk isteği olan ve tedavi gereği olan çiftlerin bu süreçte ne kadar kırılgan, naif ve hassas olduklarının farkındayım. Bu nedenle hastalarımla yaptığım ilk görüşme anından itibaren, kendilerine olabilecek en yüksek başarı oranını sunmak için bilimsel veriler ışığında güncel, kaliteli, özenli ve çifte özel bireyselleştirilmiş tedavi uygulamanın gayreti içindeyim..

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