The appearance of the endometrium, which covers the inner layer of the uterus, outside the uterus is called endometriosis . The tissues belonging to this are usually seen around the female reproductive organs, that is, on the uterus and ovaries, but can be detected in the intestine, bladder, even diaphragm and lung.
Endometriosis is not a cancer, however, it is a condition that can cause menstrual pain, groin pain, and infertility. While the complaints are very mild in some patients, they can be severe enough to prevent daily life in some patients.
Since the endometrium, which is the inner layer of the uterus, is sensitive to female hormones, endometriosis foci are also sensitive to female hormones and may be affected by periods when female hormones change, such as menopause and pregnancy.
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Endometriosis in the Ovaries (endometrioma)
Foci in the ovaries are called endometriomas or chocolate cysts . The reason for the formation of chocolate cysts is the bleeding of endometriosis foci located in the ovaries at various periods and the resulting blood accumulations.
In almost one third of endometriosis cases, the ovaries are involved and endometriomas are seen.
Although endometriomas are benign tumors, they often adhere to neighboring organs such as the bowel, bladder, uterus, and may cause related complaints. These adhesions are one of the reasons that make surgical treatment of endometriomas difficult.
Who Is It Seen?
Although it varies depending on age and the diagnostic methods used, endometriosis can be detected in 10% of women of reproductive age.
It is not easy to determine the true frequency of this condition because some women have almost no complaints, while women with complaints related to this condition can be confused with other diseases.
Endometriosis is more common in some groups: endometriosis is seen at a rate of almost 50% in infertile women, and it is also common in women with groin pain and painful menstruation.
How is it formed?
The most emphasized hypothesis in the formation of this situation is that during normal menstrual bleeding in women, this bleeding shows a back flow to the abdomen of the patients through the tubes and that the glands that make up the inner layer of the uterus reach and adhere to the intra-abdominal organs in this way. This is called the reverse menstrual flow mechanism.
Once the glands forming the uterine layer (endometrium) settle on the surface of the intra-abdominal organs, they cause bleeding and inflammation in each menstrual period, leading to complaints such as inguinal pain, menstrual cramps and pain during sexual intercourse, which are specific to endometriosis.
Laboratory Findings
There is no specific laboratory test for the diagnosis of this condition. A common test in patients with this condition, especially those with chocolate cysts, is the CA-125 test, and it is often elevated.
A high CA-125 test in endometriomas does not mean you have cancer!
It is often seen that patients are stressed for the high CA-125 test, in this case, the important thing to do is to talk to your doctor about the importance of this situation. If the existing ovarian cyst does not have irregular areas with signs of cancer or parts that show blood, there is no need to worry.
When Should Surgery Be Done?
Not every patient with endometriosis needs surgery!
Conditions requiring surgery; These are conditions that need to be surgically corrected, such as the presence of pain that does not respond to medical treatment, limitation of daily functions, and associated intestinal or urinary obstructions.
Surgery for this disease can be performed by an experienced surgeon, mostly with closed surgery (laparoscopic or robotic).
Does it Cause Cancer?
In some studies, it has been shown that it may be associated with some types of ovarian cancer (ovarian cancer). However, it is not considered a pre-cancerous (premalignant) condition and screening is not recommended.
Likewise, no evidence has been shown that removal of endometriomas as a precaution prevents progression to cancer.