What is Endometriosis?

Endometriosis, also known as “chocolate cyst”, takes its name from “endometrium”, which means the layer lining the inside of the uterus and which thickens and sheds every month during menstruation. Tissue resembling the endometrium, which should originally be located in the inner layer of the uterus, is also located outside the uterus in patients with endometriosis. These foci of endometriosis outside the uterus cause pain and infertility. Like the endometrium lining the uterus, endometriosis foci respond to the hormones that govern the menstrual cycle. During menstruation, there is thickening and bleeding in these areas as in the uterus. However, the bleeding that occurs here cannot be expelled from the body and collects to form chocolate cysts. The bleeding causes adhesions and damage to other organs (intestines, bladder).

Where are endometrial implants (diseased tissue) most commonly found?

Endometriosis is most commonly found in the ovaries but can also occur in the areas listed below.

• Fallopian tubes
• Ties supporting the womb
• Intestines
• Bladder
• Vagina
• The inner space between the vagina and the rectum (intestine)
• The outer circumference of the uterus
• Borders surrounding the inguinal cavity
• Scars from abdominal surgery

Chocolate cyst is a disease that can occur in one in 10 women and can make life difficult for those who suffer from this disease. Since the complaints caused by the disease are similar to other gynecological disorders, it may take a long time for patients to be diagnosed and treated correctly.

What are the Symptoms of Endometriosis?

The most common symptoms of endometriosis;

• Severe pain before and during menstruation,
• Pain during and after sexual intercourse,
• Infertility
• Not wanting to go to the toilet,
• Gas and bloating in the abdomen,
• Chronic fatigue,
• Depression
• Irregular or excessive bleeding.

Other symptoms include fatigue, painful bowel movements during menstruation, pain in the lower back, diarrhea or constipation during menstruation and other bowel disorders. Endometriosis can sometimes be asymptomatic and can be seen during a gynecological examination. If the cysts become very large, they can cause serious problems such as pain, rupture of the cyst wall and, although rare in endometrioma (chocolate) cysts, cancer can occur in the cyst wall.

What are the Causes of Endometriosis?

The causes of endometriosis are not fully understood. Several causes have been suggested, but even these do not fully explain endometriosis. Recent studies have shown that environmental toxins such as dioxin and PCBs, which act like hormones in the body and damage the immune system, cause endometriosis. It has been found to occur in women who consume too much animal foods such as red meat.

How is Endometriosis Diagnosed?

In order to diagnose endometriosis, symptoms of the disease must be observed and a pathological examination of the tissue fragment must be performed. For pathologic examination, the patient undergoes a laparoscopic procedure, which allows for a definitive diagnosis and treatment. In addition, large chocolate cysts can be seen with ultrasound. The doctor should be able to distinguish them from other ovarian cysts. Transvaginal ultrasonography plays an important role in the differential diagnosis of ovarian cysts seen during the examination. In addition, the measurement of certain tumor markers in the blood helps in the diagnosis. The tests used for these are Ca125 and HE 4.

How is Endometriosis Treated?

It is possible to remove or eliminate endometriosis lesions laparoscopically or surgically. However, as with other diseases and treatments, the risk of recurrence is high. Supportive treatments such as reducing animal food consumption, exercising and avoiding stress can significantly improve the response to treatment. The reason for the risk of recurrence of the disease is that, although there are individual differences in the treatments, the 2-year recurrence frequency of the disease is around 20% and the risk increases as the duration increases.

Does Chocolate Cyst Cause Infertility?

Chocolate cyst is a disease that causes infertility. If the chocolate cyst is advanced and has not been cured by surgical operation, the patient can have a baby with IVF treatment. Early diagnosis of the disease will greatly affect the success rate of IVF treatment.