What is endometriosis?
Endometriosis , also known as chocolate cyst , is a chronic disease characterized by the presence of endometrial tissue lining the inner surface of the uterus in the ovaries, fallopian tubes or areas other than the uterus such as the abdominal cavity. In this misplaced endometrial tissue, there is a menstrual cycle just like in the uterus. If endometriosis (chocolate cyst) is located in the ovaries, it negatively affects the quality of the eggs and also the functioning of the fallopian tubes and causes adhesion in the interior of the abdominal cavity. This disease is usually not noticed until infertility occurs because the symptoms are underestimated. The only definitive way to diagnose endometriosis is to look into the abdomen with a camera by entering through the navel with a laparoscopic method.
What is endometriosis (chocolate cyst)?
Endometriosis is a painful disease that develops as a result of the growth of the endometrium layer lining the uterus in another area outside the uterus. Endometriosis is most common in the ovaries, fallopian tubes, and tissue covering the pelvis. Although it is a common disease affecting approximately 176 million women of reproductive age worldwide, its awareness rate is very low. Although the disease can affect women of all age groups, it is most common in women in their 30s and 40s.
What are the causes of endometriosis (chocolate cyst)?
It is not known exactly what the cause of the disease is. However, there are some theories developed for the cause:
- Genetic factors: The disease tends to be passed on in families and affects some ethnic groups more than others. If a person has a family history of endometriosis, the risk of developing the disease is higher in that person than in the normal population.
- Reverse menstruation: With the menstrual bleeding, the endometrial tissue lining the uterus is discharged from the body through the vagina. If backward bleeding occurs, the endometrial tissue flows from the fallopian tubes into the abdominal cavity, settling in the organs there, causing endometriosis.
- Problems in the body’s natural defense against disease and infection due to a problem with the immune system may be a factor in the development of endometriosis.
- The spread of endometrial cells to various parts of the body through the blood circulation or lymphatic system and their placement in various organs. The lymphatic system is part of the immune system and consists of a series of tubes and glands.
None of these theories can fully explain why endometriosis occurs. The situation may be due to a combination of different factors.
What are the symptoms of endometriosis (chocolate cyst)?
The most important symptom seen in endometriosis is groin pain, which is usually associated with menstrual periods. Although most women have painful menstrual periods, those with endometriosis have a much more severe pain. The severity of the pain may increase over time. Common symptoms and complaints seen in endometriosis can include:
- Painful menstrual periods (Dysmenorrhea). Pelvic pain and cramps usually start before menstrual bleeding and continue for a few days during the cycle. There may also be lower back and abdominal pain.
- Pain during intercourse. Pain is seen during or after intercourse in endometriosis.
- Pain during bowel movements or urination. There may be complaints of pain during defecation or urination, which are more common during menstrual periods.
- Excessive bleeding. Occasionally, excessive bleeding during periods or abnormal bleeding between periods may occur.
- Infertility. Endometriosis is usually diagnosed in those seeking medical help for infertility for the first time.
- Other signs and symptoms. Symptoms such as fatigue, diarrhea, constipation, bloating and nausea can be seen, especially during menstrual periods.
The severity of pain is not a reliable indicator of the degree of endometriosis. In mild endometriosis, there may be severe pain, on the contrary, severe endometriosis can be detected in women with mild pain. Endometriosis can sometimes be confused with other conditions that can cause pain in the groin and abdomen, such as pelvic inflammatory disease (PID) or ovarian cysts. It can also be confused with irritable bowel syndrome with diarrhea, constipation and abdominal cramps. Restless bowel syndrome may accompany endometriosis, complicating the diagnosis.
Despite intense discomfort, many women do not realize the disease until they try to conceive. As the disease tends to worsen gradually over time, approximately 30 to 40% of women with endometriosis will experience infertility problems. Because there is no way for the blood flowing from the misplaced endometrial tissue to the abdominal cavity to exit the body.
How is endometriosis (chocolate cyst) diagnosed?
To diagnose endometriosis and other conditions that can cause pelvic pain, the doctor will ask the patient about their complaints and medical history. Tests to check the physical cues of endometriosis include:
- Pelvic exam. With pelvic or gynecological examination, abnormalities in the reproductive organs and cystic structures due to endometriosis can be detected.
- Ultrasound. High frequency sound waves are used in ultrasound to view the internal organs of the body. To capture images, a device called a transducer is inserted into the abdomen or vagina (transvaginal ultrasound). Both ultrasound examinations can be done in order to view the reproductive organs in the best way. It may not be possible to diagnose endometriosis with a standard ultrasound. If cysts associated with endometriosis occur in the patient, they can be detected by USG.
- Magnetic resonance imaging (MRI). MRI is an examination that uses magnetic fields and radio waves to obtain detailed images of organs and tissues. MRI helps diagnose and plan surgery. It gives detailed information about the location and size of endometrial tissues located outside the uterus.
- Laparoscopy. Laparoscopy is performed under general anesthesia by entering into the abdomen through a small incision made near the navel. The procedure is performed with the help of a thin tube called a laparoscope with an illuminated camera at its end. Information about the location, scope and size of endometrial implants can be obtained with laparoscopy, where endometrial tissues located outside the uterus are searched. If deemed necessary, a tissue sample (biopsy) can be taken for further testing. The disease can be completely cured by removing the endometriosis foci during laparoscopy. Thus, diagnosis and treatment are completed with only one operation.
How is endometriosis (chocolate cyst) treated?
Endometriosis treatment can be done with medication or surgery. Sometimes both medications and surgical treatment may be required. First of all, drugs are tried in treatment. Surgical treatment options are evaluated when drugs are not successful.
Nonsteroidal anti-inflammatory drugs are prescribed to relieve pain and cramps during menstrual periods. Women who do not have a pregnancy plan can start hormone therapy along with pain relief. Hormone supplementation is effective in reducing or eliminating endometriosis pain. During the menstrual cycle, hormones produced in the body first rise and then fall, causing pathological endometrial tissues to thicken, break down and bleed. Hormone supplementation can slow endometrial tissue thickening and prevent new endometrial tissue formation. Hormone therapy does not provide a permanent solution for endometriosis. Symptoms return after stopping treatment.
Hormone therapy cannot be applied to women who wish to have children. Therefore, surgical treatment is preferred. Surgery is usually done by laparoscopic method. In laparoscopic surgery, a small incision is made through the belly button. From this incision, the location of the cyst is reached with the help of a thin tube-shaped instrument called laparoscope and has a camera at the end, and the cyst tissue is cut and removed.
Dietary and lifestyle changes are also effective in controlling the symptoms of endometriosis. Estrogen secreted in the body is known to thicken the endometrial tissue in the lining of the uterus. So keeping estrogen levels low can help minimize the symptoms of chocolate cysts. It is possible to reduce estrogen levels by exercising regularly, limiting caffeine and alcohol intake, and reducing body fat.