Assoc. Prof. Dr. Küçükyıldız: “Approximately 30-50 percent of women with endometriosis may encounter problems with inability to conceive”

“Approximately 30-50 percent of women with endometriosis may encounter problems with inability to conceive,” said Assoc. Prof. Dr. İrem Alyazıcı Küçükyıldız from Medicana Health Group Gynecology and Obstetrics Department.

Experts point out that endometriosis, known as 'chocolate cyst' in the society and affecting approximately 10 percent of women of reproductive age, is a benign disease. Experts also state that the complaints caused by endometriosis in women can be mild or reach severe levels that completely affect the daily life of the person and impair the quality of life. Stating that endometriosis is a condition in which the cells in the inner wall of the uterus are found outside the uterus, Assoc. Prof. Dr. İrem Alyazıcı Küçükyıldız from the Department of Gynecology and Obstetrics at Medicana International Ankara Hospital gave information about the treatment methods of endometriosis

Can cause severe pain

Stating that endometriosis is an estrogen-dependent, inflammatory and benign disease affecting approximately 10 percent of women of reproductive age, Assoc. Prof. Dr. İrem Alyazıcı Küçükyıldız said, “Since it is a hormone-dependent disease in the pre-menarche and post-menopausal period, endometriosis is a condition that often does not cause complaints and is not detected. Complaints may differ depending on the location of the ectopic endometrial tissue. It often causes painful menstruation, cyclic or non-cyclic pelvic-abdominal pain, constipation, diarrhea or painful urination due to intestinal involvement, pain during sexual intercourse and infertility. Complaints can be mild or severe, affecting the daily life of the person completely and disrupting the quality of life.”

“Inability to conceive can be seen in 30-50 percent of women with endometriosis”

Stating that laparoscopy is the most common surgical method for the diagnosis and treatment of endometriosis, Küçükyıldız said, “However, a good anamnesis and pelvic examination are also necessary for differential diagnosis. Approximately 30-50 percent of women with endometriosis may encounter problems with inability to conceive. There is information that endometriosis may cause disruption of pelvic anatomy with the adhesions it forms, thus mechanically preventing fertilization, and the presence of endometriosis may have negative effects on egg (oocyte) quality.”

Treatment method is determined according to the level of complaint

Underlining that treatment approaches in endometriosis patients are generally determined according to the levels of complaints seen in patients, Küçükyıldız used the following statements:

“If the primary problem is pain, medical treatments (drug therapies) constitute the first-line treatment. For pain complaints that are not very severe, treatment can be started with NSAIDs. In endometriosis, which is thought to be an estrogen-dependent disease, approaches to reduce estrogen hormone or increase progesterone hormone are the most commonly used medical treatment methods in current medicine. Combined oral contraceptives are used in many areas of gynecology and are among the preferred drug groups in endometriosis patients.”

Medical treatment methods can be used

On the other hand, noting that drugs that mimic the effect of progesterone hormone in the body are other frequently used medical treatment methods, Assoc. Prof. Dr. Küçükyıldız emphasized that the use of Levonorgestrel-secreting intrauterine device is also one of the approaches that can be included in the treatment of endometriosis.

Stating that there are also GnRH aganist treatments to suppress the pituitary function in patients who are not frequently preferred in first-line treatment due to their side effects but are resistant to other medical methods, Assoc. Prof. Dr. Küçükyıldız explained that the most important side effects of this treatment method are the negative effects of bone mineral density in its long use, hot flashes, sweating, palpitations that can be seen during perimenopause-menopause.

Child desire is decisive in the treatment method

In cases where the patient has a desire to have children, Assoc. Prof. Dr. Küçükyıldız said that medical methods used for endometriosis are not suitable for this group of patients, “Because these methods prevent ovulation by making hormonal changes. In this group of patients, close follow-up monitoring, assisted reproductive techniques or surgery will be appropriate approaches. Close follow-up monitoring can generally be applied for a short period of time in patients who do not complain of intense pain and in young patients who do not have other reasons that may prevent pregnancy.”

Chocolate cysts may increase the risk of developing ovarian cancer

“Apart from the fertility request, surgical treatments may be necessary in patients who do not get results with medical treatment,” said Assoc. Prof. Dr. İrem Alyazıcı Küçükyıldız and gave the following information about the surgical treatment option:

“Another criterion for choosing surgical treatment is the large size of endometriomas. Chocolate cysts slightly increase the risk of developing ovarian cancer. For this reason, surgery can be planned to rule out the possibility of cancer in people who tend to grow rapidly in follow-ups, whose tumor marker follow-up (CA125) is high and tends to increase gradually. The aim of surgical treatments is to remove all endometriosis tissues if possible and to normalize or improve the pelvic anatomy. However, surgical planning should be done carefully and the possible benefits and harms to the patient should be well planned. It is important to remove the cyst wall to reduce the possibility of cyst recurrence. However, the possibility of affecting the ovarian reserve should not be forgotten in these interventions. In cases where there is a desire to have children and the ovarian reserve may be affected by surgery, assisted reproductive techniques should be considered first.”