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ENDOMETRIOSIS AND CHOCOLATE CYSTS

Uterine membrane tissue (menstrual tissue) is a disease characterized by settling in an area outside the uterine membrane. It occurs in approximately 3-10% of reproductive age women. It occurs in 25-35% of patients presenting for infertility and in approximately 20% of patients operated for inguinal pain. It is the second most common pathology seen in gynecology after fibroids. It is rarely seen after menopause. Endometriosis is more common in some families. If the person's 1st degree relative is affected, it can be seen 7 times more.

The disease can be seen in many places in the body, but the most common seen in ovaries, the space behind the uterus called Douglas, which connects to the abdominal wall of the uterus, peritoneum, and egg canals (tubes). Although it is more rare, it can be seen in the intestines, urinary tract, lungs, bone, skin, vagina and cervix. The symptoms of the disease usually vary according to the location of the disease.

 
 

The disease may be microscopic or visible in the above-mentioned regions. It usually causes adhesions where it occurs. Although patients may have no symptoms, they may cause pain, bleeding disorders and infertility. The most common symptoms of the disease are chronic inguinal pain, menstrual pain, sexual intercourse pain, menstrual irregularities and infertility. Complaints generally occur during menstrual periods in cases other than female organs (eg: urine in menstrual periods, abdominal pain, constipation, bleeding with cough etc.)

Diagnosis of the disease requires suspicion and detailed examination of the patient. In the gynecological examination, the areas where endometriosis can be located are evaluated in detail. Ultrasonography examines the presence of chocolate cysts in the ovaries.

If it is, the medicated uterine film is evaluated for signs of endometriosis. The tumor marker CA-125 may increase in this disease, but it is not a definite test for diagnosis. The definitive diagnosis of endometriosis is made by laparoscopy and examination of the lesions in pathology (gold standard for diagnosis).

Complaints of the patient and child request play an important role in the treatment. In unmarried women who do not plan children, treatment is usually performed because of pain. First of all, it is sometimes useful to give patients painkiller during regular menstrual periods or to use regular birth control pills, but when these drugs are not sufficient, surgical treatment is appropriate. Surgery should be performed laparoscopically as long as possible. In the operation, chocolate cysts are usually removed and treatment is tried to be achieved by burning or removing other visible disease foci. Postoperatively, patients are usually started on birth control pills without interruption. Endometriosis can re-occur at the rate of 50% in the first 2 years after surgery. Patients should be given detailed information about the disease.

Treatment plan may vary in patients presenting for infertility. If the disease has caused obstruction in the egg canals, it is appropriate to undergo IVF treatment. If the patient also has chocolate cysts in the ovaries, surgery is not considered unless it is 3-4 cm or more. During the removal of chocolate cysts by surgery, even in the best hands, the ovarian tissue is also lost, ie the patient's ovarian reserve may be reduced. This situation must be explained to the patient in detail.