Endometriosis, which is one of the most important causes of infertility, has many different symptoms and is often diagnosed only when the woman cannot become pregnant. Dr. Art Women's Health Center. More professionals named senai aksoy answers questions about endometriosis.
: What is Endometriosis?
Dr. Senai Aksoy: Endometriosis is defined as the presence of endometrial tissues that lay inside the uterus and fall out of menstruation outside the uterine cavity. It is often found in the back of the uterus, in the rectovaginal space (the space between the vagina and the last part of the intestine), on the last part of the intestine, in the tubes, ovaries, the posterior ligaments holding the uterus, the bladder and the intra-abdominal side walls.
: Is endometriosis a genetic disease?
Dr. Senai Aksoy: Studies have reported an increased risk of sisters 6 times compared to their husbands' sisters and another study 8 times higher than other women. Affected sisters may experience the disease more seriously than others. However, the mode of genetic transmission is unknown.
: How often does endometriosis occur?
Dr. Senai Aksoy: It is known that it can be found between 2% and 5% in general women and 30-40% in women who do not have children.
: What is the cause of endometriosis?
Dr. Senai Aksoy: Not a single theory can explain all the facts. There are various opinions on this issue:
• Endometrial tissue migrates from the tubes into the abdomen, causing illness. Women cannot explain how they can be formed in women whose tubes have been tied or have been removed from the uterus.
• Normally, every month, spilled and discarded tissues are formed as a result of an abnormality in the immune system, which can be attached to any part of the body.
• Occurring as a result of a genetic congenital disorder due to the frequency in some families,
• It is caused by the change of the intraabdominal tissue to endometrial tissue as a result of recurrent inflammation,
• Endometrial tissue is formed by spreading blood and lymph flow from uterus to abdomen.
: Why does endometriosis cause infertility?
Dr. Senai Aksoy: Endometriosis is a known cause of fertility problems in cases where normal anatomy is clearly disrupted. In fact, 30-40% of endometriosis patients are fertile. This is 2-3 times the general population.
Monthly conception rate decreases to 12 - 36% in these patients. The long-term conception rate is normal in patients with minimal endometriosis where the anatomy is not impaired. It has been shown that the rate of conception does not increase by treating minimal endometriosis. Endometrial tissue grows and develops every month with the effect of cyclic hormones in women and sheds menstruously at the end of the month. When it infiltrates harmlessly out of the body, chronic inflammation causes adhesion, scarring, and ultimately the capture and reproduction of the reproductive organs. It is caught between adhesions and scar tissue, which leads to infertility. As the disease progresses, old endometrial tissues spread and dead scar tissue is formed. Even in mild forms (stage 1 - 2), fertility is affected. Active, young diseased tissues secrete substances called prostoglandins and other chemicals. This causes spasm and contraction of the reproductive organs. The tube cannot catch the egg, the stimulated uterus may reject the embryo. In addition, it affects sperm and prevents its ability to pierce the egg. Although the mechanism is not fully understood, it may lead to anovulation. It prevents implantation by causing luteal-phase defect or luteinized unexploded follicle syndrome. Some researchers argue that the woman's body creates antibodies against these mis-placed endometrial tissues, which may result in a high spontaneous abortion rate (up to 3 times).
: What are the symptoms of endometriosis?
Dr. Senai Aksoy: 33% of women have no complaints. The symptoms vary depending on the depth of the disease: 70% do not have children, 28-67% have pain during intercourse or menstruation, 12-74% have excessive bleeding, recurrent pregnancy loss up to 50%, as low as 50% weight, excess weight in 13%, increased back pain during menstruation in 25 - 31%, intra-abdominal adhesions in 24-50%, nodules on internal ligaments in 34%, non-ovulation in 17%, irregular in 12% menstrual menstrual pain, breech pain in 4%. Most patients are between 20 and 35 years old.
: How is endometriosis diagnosed?
Dr. Senai Aksoy: Any complaints about menstruation suggest endometriosis. Unexplained infertility, irregular menses, intermediate bleeding, painful menstruation and / or sexual intercourse are suspected in case of pain. Endometriotic foci are investigated during gynecologic examination. However, the only definitive diagnostic procedure is by direct visualization of the abdomen and biopsy from the tissue. That is to do laparoscopy.
: How is surgical treatment of endometriosis performed?
Dr. Senai Aksoy: The severity of the disease, the history of infertility, the desire to become pregnant and the age determine the type and severity of surgical treatment. Unfortunately, even removing a woman's uterus cannot improve pain relief in 30% of patients. Initial surgical intervention is very effective in patients with impaired tube-ovarian relationship, but recurrent interventions are less effective in improving fertility. The most common surgical procedures performed by laparoscopy are removal of the adhesions surrounding the ovary - tube - uterus, endometriotic lesions, removal of ovarian endometriomas, incision of the lesions, cauterization or vaporization. Burning and cutting the uterosacral nerve (LUNA) is useful in relieving pain.