WHAT IS ENDOMETRIOSIS?
Endometriosis is the presence of the endometrium, which normally forms the innermost part of the uterus, outside the uterus. This disease is usually seen in the lower parts of the abdomen. However, it can be seen all over the body. Endometriosis, which is estimated to be seen in 5-10 percent of women of reproductive age, is among the most important causes of infertility. It is very important to have a regular gynecological examination in order to determine the endometriosis disease, which affects approximately 2 million women in our country every year. Endometriosis can prevent the egg from reaching the tubes due to the adhesions it forms in the reproductive organs. Sometimes, it can prevent pregnancy by clogging the ends of the tubes, that is, causing “tubal obstruction”.
WHAT ARE THE SYMPTOMS OF ENDOMETRIOSIS?
Problems that are symptoms of endometriosis can be listed as follows:
Constant severe pain in the lower abdomen
Severe pain during sexual intercourse or menstruation
Abdominal bloating
Difficulty and pain when going to the toilet, sometimes diarrhea
Frequent urination and blood in the urine
Spotting type bleeding before menstruation
Pain during menstrual period
flank pain, back pain
WHAT CAUSES ENDOMETRIOSIS?
In addition to the risk factors that cause endometriosis, there are also factors that provide protection from this disease. While pregnancy, giving birth more than once and breastfeeding are among the main protective factors; Endometriosis is less common in women with obesity, who have a high body mass index and especially a high waist-hip ratio. When the menstrual period in women begins, the ‘endometrium’ layer in the uterus is thrown out, while the same layer can be poured back into the abdominal cavity through the tubes. While this refluxing blood cleans up in women with a healthy immune system, chocolate cysts form in those with a problem in the immune system. The endometrium layer in the abdominal cavity adheres to the tubes, ovaries, even the intestine or urinary bladder and causes inflammation. In the later stages of the disease, bleeding, tissue healing and adhesions in the abdomen occur. Since the disease causes inflammation in the abdominal cavity and causes adhesions in the tubes and ovaries, the disease disrupts the compatibility of the inner wall of the uterus for pregnancy and leads to a decrease in ovarian reserve, thus leading to infertility.
HOW IS ENDOMETRIOSIS DIAGNOSED?
First of all, the patient’s detailed anamnesis and complaints are taken by the obstetrician and gynecologist. Diagnosis of the disease, endometrial tissue; After surgical removal of the gland and its functioning part, it is placed by seeing it microscopically. Findings obtained from the patient’s history such as menstrual pain, lower abdominal pain, pain during sexual intercourse, infertility, excessive menstrual bleeding, and pain during toileting are important for the diagnosis of the disease. In addition, ultrasonography and MRI are valuable diagnostic methods in the diagnosis of this disease. However, microscopic examination of lesions removed by laparoscopy is the most valuable diagnostic method. In addition, gynecological examination is very important in the diagnosis. 70% of severe endometriosis cases can be diagnosed with a gynecological examination.
HOW IS ENDOMETRIOSIS TREATED?
Endometriosis is a treatable problem. The treatment is planned individually according to the effects of the disease on the woman. While there is no place for drug therapy to suppress the disease in a woman with endometriosis and infertility problems, the treatment is individualized in these women. A wide range of treatments can be applied, from waiting-observation therapy to assisted reproductive techniques and surgery. While women with endometriosis who are in the forefront of pain can benefit from medical treatment, surgical treatment comes to the fore in advanced cases.
If the person has the complaint of not being able to conceive, assisted reproductive techniques such as vaccination and in vitro fertilization are used in the first stage. Patients who have undergone IVF treatment can become pregnant by overcoming endometriosis. There is no need to treat the disease before pregnancy and then apply the in vitro fertilization method. If there is no response from assisted reproductive methods, the disease is treated surgically. In the surgical method; With laparoscopic surgery, removal of chocolate cysts, opening of adhesions and bringing the tubes to their normal anatomy come to the fore.
WHAT ARE THE RISK FACTORS IN ENDOMETRIOSIS?
Some of the risk factors determined for endometriosis disease, although not clear, are some of the cases such as onset of menstruation at an early age, frequent menstruation for 21 days, never having given birth, having a large amount of menstrual bleeding, having long-haired red hair, blue-green eyes, and freckles. are:
Infertility
Congenital structural defect of female reproductive organs
alcohol, caffeine
Diet rich in fat and red meat
Dioskin or DES exposure
low body mass index
First degree relative with endometriosis
Endometriosis, which does not cause any complaints, is less common in blacks than in whites, but more common in Asians.
Does endometriosis prevent conception?
Endometriosis is seen in 5-10 percent of all women of reproductive age in our country. However, this rate can go up to 25-30 percent in women who have problems with getting pregnant. Endometriosis can prevent pregnancy for different reasons. Endometriosis; By forming adhesions in the reproductive organs, it can prevent the egg from reaching the tubes. Sometimes, it can prevent pregnancy by clogging the ends of the tubes, that is, causing ‘tubal obstruction’. There is also the possibility of endometriosis forming a chocolate cyst called endometrioma. These cysts can settle in the ovaries and prevent a healthy ovulation, as well as reduce the chance of pregnancy by reducing the reserve. Cytokines and humoral factors secreted from endometriosis foci may adversely affect embryo development and attachment. After treatment, pregnancy increases by 40 percent after a two-year wait. However, if the person still cannot get pregnant by normal means, in vitro fertilization can be tried.