What is Endometriosis?
When a patient expresses pain, the physician’s role is not to question its validity, but to seek and understand its true origin.
Dr. Bulent URMAN
Endometriosis, which affects approximately one in ten women, is one of the leading causes of chronic pelvic pain, infertility, and abnormal uterine bleeding. It is also one of the conditions in which treatment approaches vary the most from one individual to another.
ENDOMETRIOSIS
Endometriosis is a chronic and often painful condition characterized by the growth of endometrial tissue—the tissue that normally lines the inside of the uterus—outside the uterus. One of the most common forms of endometriosis is the development of so-called “chocolate cysts” in the ovaries.
These cysts, medically known as endometriomas, are cystic structures filled with a dark brown, chocolate-like fluid. They typically have smooth walls and may develop in one or both ovaries. Endometriomas are most commonly seen in women of reproductive age and may occur not only after the age of 35, but also from the early 20s onward.
Does endometriosis
turn into cancer
over time?
The risk of malignant transformation in endometriomas is very low, estimated to be less than 1%. However, more careful evaluation is recommended in cases where the cyst grows rapidly, is unilateral, or occurs in women approaching menopause.
Treatment Approach
Treatment decisions are individualized, based on the patient’s age, desire for future pregnancy, severity of pain, and ovarian reserve.
In patients who do not wish to conceive, the following options may be considered:
Medical Treatment
Hormonal therapies (such as oral contraceptives, progestins, and GnRH agonists)
These treatments may help reduce pain, but their effects are often temporary. Symptoms may recur after treatment is discontinued.
Levonorgestrel-releasing intrauterine devices (e.g., Mirena®)
In some patients, these devices may provide long-term pain control. However, treatment may be discontinued due to side effects such as irregular bleeding or weight gain.
Surgical Treatment
Laparoscopic surgery is considered one of the most effective treatment options. During surgery, ovarian cysts are carefully removed and visible endometriosis lesions are excised.
Careful inspection and treatment of areas such as the rectovaginal region during surgery may contribute to improved treatment outcomes.
In patients undergoing surgical treatment, significant improvement or resolution of pain has been reported in up to approximately 80% of cases, although individual outcomes may vary.
Treatment approaches vary for each patient. When pain, infertility, or symptoms that affect quality of life are present, an individualized treatment plan should be developed, with careful attention to preserving ovarian reserve at all times.
Patients who want children;
-
If the cyst is less than 4 cm in size and ovarian reserve is good, sometimes only monitoring is recommended. If the cyst is larger than 4 cm, surgery may be considered to reduce the risk of infection and facilitate egg retrieval. However, it is important to remember that surgery may compromise ovarian reserve.
If IVF is planned:
-
There is no clear evidence that endometrioma removal increases pregnancy rates. However, because of the risk of infection during cyst puncture, it may be appropriate to remove large cysts before IVF.
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Although the exact cause is not fully understood, the most widely accepted theory is retrograde menstruation. This theory suggests that during menstruation, some viable endometrial cells pass through the fallopian tubes into the abdominal cavity, where they attach and continue to grow.
Frequently Asked Questions About Endometriosis
The most commonly asked questions about endometriosis, explained in a clear and accessible way, with a rational, evidence-based approach.
Laparoscopic Endometriosis Surgery
Laparoscopy is a procedure in which the abdominal cavity is examined using an endoscope. While laparoscopy was initially used only as a diagnostic tool, today nearly all gynecologic surgeries can be performed using laparoscopic techniques.
For many women, endometriosis-related pain is among the most difficult types of pain to cope with. It may present as cyclic pain that typically begins during menstrual periods, or as chronic pain that can occur on a daily basis.
Endometriosis may be found in nearly half of women who seek medical care due to infertility. It is also well known that women diagnosed with endometriosis frequently seek medical evaluation later because of infertility.