It is a type of disease that is mostly seen in the reproductive age, sometimes appearing by chance as a chocolate cyst that causes no complaint at all, and sometimes requiring surgery yet without great relief being achieved. This disease, whose cause is not exactly known, begins when the endometrium layer inside the uterus settles in another place and, in that area, causes thickening and shedding with bleeding just as inside the uterus.
Chocolate Cyst Risk Factors
Having endometriosis in the family, having periods before the age of 11, entering the menopause late, having frequent periods, periods lasting longer than 7 days, heavy menstrual bleeding, congenital uterine anomalies, a high consumption of meat and fatty foods, having children late, being tall, thin and fair-skinned, infertility, the white race, high caffeine consumption, and being thin and tall are among the risk factors.
What Are the Symptoms of Endometriosis?
Symptoms such as painful periods, chronic groin pain, painful sexual intercourse, infertility, diarrhoea and constipation, bleeding from the back passage, blood in the stool, irregular periods, spotting before the period, and painful and bloody urination can be a sign of endometriosis. In some women with endometriosis there may be no symptom at all; the diagnosis is made with ultrasound or by seeing it during an operation.
How Is Endometriosis Diagnosed?
Following the patient’s complaints, a gynaecological examination and ultrasound are performed. During the pelvic examination, tenderness, an expression of pain and limited movement of the uterus and ovaries can suggest endometriosis. From time to time, during the speculum examination, blue-purple nodular lesions can be seen behind the cervix; this simple finding indicates the presence of deep infiltrative (involving and advancing into the surroundings) endometriosis in the deep tissues of the pelvis. For this reason, pelvic examination with a speculum is very important in making the diagnosis. Another alternative method is blood tests. Most often Ca 125 and Ca 19-9 are requested. However, the sensitivity of these tests in recognising endometriosis is low and they are requested only as an additional investigation. Magnetic resonance imaging (MRI) is useful especially in situations of what we call deep endometriosis, where the endometriosis involves the deep pelvic tissues. The definitive diagnosis of endometriosis is made by performing a tissue biopsy with laparoscopy. During laparoscopy, endometriosis can be assessed as mild (stage 1-2) and severe (stage 3-4).
How Is Endometriosis Treated?
Endometriosis is not a disease that can be definitively treated and completely eliminated. The treatment of endometriosis is divided into 2 methods: medical treatment (the use of medication) and surgical treatment. In drug treatment, the aim of treatment with medical drugs is to create a low-oestrogen state and thereby suppress the endometriosis lesions, reduce the inflammation and stop the progression of the endometriosis lesions. Drug treatment includes painkillers, contraceptive pills, medicines containing progesterone specific to the treatment of endometriosis, intrauterine devices containing progesterone (the coil), the monthly or 3-monthly injections we call GnRH analogues, and aromatase inhibitors. In surgical treatment, the aim is to restore the normal anatomy, to open up the adhesions, to remove the ovarian cysts in a way that causes the least damage to the remaining ovarian tissue, to burn the endometriosis foci on the peritoneum with cautery or to cut them out, and, if there are any, to remove the deep endometriosis nodules. Applying medical drug treatment after surgery can delay the reappearance of the symptoms.