Endometriosis, Endometrioma (Chocolate cyst)
Endometriosis is a condition where the tissue that normally exists inside the womb (uterus) also develops outside. While the tissue inside the uterus is called ‘endometrium’, the condition of this tissue being outside the uterus is called ‘endometriosis’. The tissues where endometriosis is most frequently found are: ovaries, Fallopian tubes, abdominal tissue around the intestine and uterus.
The form of endometriosis that is located in the ovary and forms a cyst is called “endometrioma”. It is also known as “chocolate cyst” because the liquid in the cyst has chocolate color and texture.
Some women with endometriosis have no complaints, while others may experience severe pain and inability to conceive. There are many treatment options for endometriosis. Treatment of endometriosis should be customized according to the characteristics of the patient.
The cause of endometriosis is not known for certain. There are four theories accepted so far. The most common of these is the theory that menstrual blood and some intrauterine tissue with blood flow back into fallopian tubes and intraabdominal cavity. Thus, the intrauterine tissue that is shed into the abdomen will grow there. This is called “retrograde menstruation theory.”
Many mutations have been shown that create genetic predisposition associated with endometriosis. Today, molecular and genetic studies continue quite intensely.
Some women do not develop any symptoms (complaints). The most common symptom is pain in the pelvis (lower abdomen) (especially along with the menstrual period). Painful menstrual cycles may worsen over time in some women.
Pain in women with endometriosis can be seen in the following conditions:
Just before or during the menstrual period.
Between the menstrual periods, more severe during the menstrual period.
During and/or after sexual intercourse.
When urinating or defecating (especially during the menstrual period).
Of course, pelvic pain may also be caused by many other reasons. It may be possible for us to understand the cause of the pain during pelvic exam.
In endometriosis, there may be difficulty in conception in addition to pain. This may be because endometriosis leads to formation of scar tissue that damages the ovaries or fallopian tubes. If you are pregnant, endometriosis will not harm pregnancy. Pregnancy often reduces complaints of endometriosis.
Based on your complaints, your doctor may suspect endometriosis. The only way to definitively diagnose endometriosis in a person is by examining the tissue sample in pathology. This does not always mean that surgery is required. Gynecological exam and ultrasound may lead to a high suspicion of the diagnosis for endometriosis.
In women who have surgery, we classify endometriosis as mild, moderate and severe according to the findings in the operation. While women with mild complaints before surgery may have severe and widespread endometriosis, the opposite is also possible.
There are many treatment options for endometriosis. Common treatment methods include:
Birth control pills
Non-steroidal anti-inflammatory drugs
Other hormone treatments (Progestins, GnRHa)
The best treatment option will be offered based on your age, complaints, examination findings, and potential pregnancy plans in the future. When deciding on surgery or drug treatment, we take into account the fact that the ovarian reserve may decrease slightly after the operation, that the endometriosis/endometrioma is a disease which can recur and that if the surgery is required again, there may be further decrease in the ovarian reserves.
If we have recommended medical treatment (drug therapy), we provide detailed information about their benefits and harm, side effects, how often and how long they will be used.
The surgery option may be recommended if:
Very severe pain, tenderness, especially in the particular area
No response to drug treatment
If the patient cannot conceive and endometriosis is thought to be the cause of this
If there is a possibility of malignant tumor in the chocolate cyst
The purpose of the surgery is to remove endometriosis and scar tissues. Pain complaints will decrease in 80-90% of the patients within a few months following the surgery.
In endometriosis surgeries, we almost always prefer laparoscopy (keyhole surgery).