The inner lining of the uterus, called the endometrium, is secreted through the vagina during menstruation. In endometriosis, parts of the lining develop in places other than the uterus, including the ovaries, fallopian tubes, vagina, peritoneum, or intestine. It is called endometriosis, which can be treated in Turkey.

What is endometriosis or endometriosis?

Most women learn about their diagnosis of endometriosis when they notice pelvic pain or severe menstrual cramps.
Endometriosis can also make it difficult for a woman to get pregnant.
Mild forms of endometriosis are common and may not require treatment.

Who can get endometriosis?

Any woman who has menstrual periods can develop endometriosis.
While endometriosis most often occurs between the ages of 25 and 40, it can also occur in younger women. This condition may also persist after menopause in some women, but such an occurrence is very uncommon.

What causes endometriosis?

The cause of endometriosis is unknown. Some experts believe that pieces of the uterine lining travel through the fallopian tubes and travel into the pelvic cavity (the space inside the pelvis that holds the reproductive organs). Small pieces of tissue may settle on the surfaces of the genitals. During menstruation, tissues bleed, just like the lining of the uterus inside the uterus. Surrounding tissues may become inflamed. Over time, scar tissue and cysts can form.

What are the symptoms of endometriosis in women?

Often, endometriosis has no symptoms. when symptoms appear,

It may include:

Very painful menstrual cramps
painful sex
Difficulty getting pregnant
Abdominal cramps or back pain during menstruation
painful bowel movements

There is no relationship between symptoms and the severity or extent of endometriosis. In other words, patients who are very mildly ill may have very severe symptoms while those who are seriously ill may not have significant symptoms.

Diagnosis of endometriosis and necessary tests

How is endometriosis diagnosed in Turkey?

If you have any of the above symptoms, see your doctor.
You may need to have a surgery called a laparoscopy to confirm the diagnosis.
In this procedure, a small speculum is inserted through a small incision in the abdomen so that the doctor can look for endometrial implants.

Often, a doctor will take a biopsy from these implants to confirm the diagnosis.
Once the diagnosis is clear, he or she will attempt to remove the implants during this surgery.

There are many reasons why a couple may be infertile.
Endometriosis is sometimes found in women who have difficulty conceiving.
In a minority of these women, scar tissue from endometriosis caused blockage of the fallopian tubes.

However, it is not clear in most women why it affects their fertility.

Theories include that endometriosis:

Resulting in eggs that are less likely to be fertilized
Produces natural toxins from sperm.

Endometriosis can be treated medically with medication or surgery.
Sometimes both medicine and surgery are used.
Some women may also benefit from alternative treatments.

Medications range from pain medications (such as paracetamol and nonsteroidal anti-inflammatory drugs) to hormonal treatments that suppress ovulation and menstruation.

Surgery may be used to remove or burn the lining of the uterus.
The most common surgery is laparoscopy (laparoscopy).

If the ovaries contain cysts of endometriosis, it is best to treat them surgically as they are not likely to go away on their own and cannot be treated with medication.

1_ Treatment of endometriosis for pregnancy and increase fertility in Istanbul

Surgery has been shown to improve fertility in women with mild endometriosis.
Surgical treatment of acute endometriosis, especially if there are ovarian cysts, also appears to improve fertility, although this has not been fully demonstrated. As for endometriosis medication, it has not been proven to improve fertility.

Other causes of infertility should be sought and treated (Like a cyst in the ovaries).

2_ Pain treatment

When pain is the main problem, treatment aims to relieve symptoms and relieve pain.

Simple pain relievers (paracetamol, etc.)

Many women will experience some symptom relief with over-the-counter medications such as paracetamol (Panadol) and NSAIDs (Ponstan, Nurofen, Naprogesic, etc.).

Hormonal treatments (birth control pills, etc.)

Hormonal therapies are used to suppress the natural menstrual cycle, which in turn stops or slows down the growth of the uterine lining.
The simplest way to achieve this is with the pill.
Other hormone therapies are also available that have been shown to be effective in reducing the pain associated with endometriosis. Some women will experience side effects with hormonal treatments.

Laparoscopic surgery in Turkey

It may be offered initially to help make a diagnosis.
Some women are offered surgery because they don't want to take the medicine or because the medicines haven't worked.
Endometriosis surgery includes laparoscopy (keyhole surgery), which can be used to diagnose and treat all visible endometriosis.
This is done using a laser or diathermy, which destroys the endometrium by burning it.

Hysterectomy for the treatment of endometriosis

In a small group of women with severe symptoms that cannot be relieved by medical or other surgical treatment, more extensive surgery such as a hysterectomy and removal of the ovaries may be considered.

Intestinal surgery

Endometriosis sometimes affects the intestinal wall.
When this causes serious symptoms, it may be suggested that the affected part of the intestine be removed.
This may require intestinal surgery and is uncommon.

Herbal treatment of endometriosis

There are many treatments available that can complement your medical treatment or be an alternative to medical treatment.
The most popular is traditional Chinese medicine and herbal preparations.
Some women feel better with these symptoms, but there is no scientific evidence to support the effectiveness of Chinese medicines in reducing symptoms or improving fertility.

If you are using complementary therapies, it is wise to discuss their use with your doctor because they may interfere with other prescribed medications.

Choosing not to treat endometriosis.

Mild endometriosis does not always require treatment.
You will usually be given treatment to help relieve symptoms rather than treating the disease itself.

If left untreated, some endometriosis will improve, but most will remain. Some will become more severe without treatment.

For most women with endometriosis, symptoms will stabilize once they enter menopause.
Deciding whether to treat endometriosis is often a matter of balancing the risks of treatment and the impact of endometriosis on your life.

Advantages and disadvantages of different treatments

Do nothing - no cure

Benefits

There are no drug side effects
There are no risks of surgery

negative t

Most symptoms persist
Some symptoms may get worse

Simple pain relief

(paracetamol, ibuprofen)

Benefits

easy to get
Uncommon side effects

cons

Often ineffective
Using ibuprofen has some health risks

Progesterone-like medicines

Benefits

reduced pain
Irregular or irregular menstruation
It stops the growth of the endometrium in most cases
Some of them are contraindications

cons

Possible side effects - weight gain, mood swings, acne, increased hair, cramping, breast tenderness
Symptoms may recur when treatment is stopped
It may not cure the pain
Does not improve fertility
You should not get pregnant while taking this medicine

Menopausal drugs

Benefits

No menstrual cycles
reduced pain
It stops the growth of the endometrium in most cases

cons

Side Effects - Hot flashes and sweating
Osteoporosis if used for more than six months
Symptoms may recur when treatment is stopped
You should not get pregnant while taking this medicine
Not a contraceptive
It may not cure the pain

Combined contraceptive pill

Benefits

Contraception
reduced pain
It can be taken to reduce or stop periods

cons

Side Effects - Nausea and Weight Gain
You should not get pregnant
Low risk of clots in the legs or lungs

Laparoscopic treatment of endometriosis

Benefits

specific diagnosis
Long-term treatment in up to 70 percent of women
No need for long-term medication use

cons

Not all endometriosis can be treated in this way
There are risks associated with the surgery
It may not cure the pain
Recurrent endometriosis in 30% of women

Hysterectomy and endometrial ablation

Benefits

Long-term treatment achieved in more than 90 percent of women
No need to use medicine
No more periods

cons

The risks of surgery are greater than laparoscopy
Eliminates fertility
Some women mourn the loss of a uterus
You may need HRT if your ovaries were removed
It may not cure the pain

Laparoscopic treatment of endometriosis in Turkey

Overview of surgery in Turkey

Laparoscopy is the most common procedure for diagnosing and removing mild to moderate endometriosis.
Instead of using a large incision in the abdomen.
The surgeon inserts a lighted viewing instrument called a laparoscope through a small incision.
If the surgeon needs better access, he or she will make one or two additional small incisions to insert other surgical tools.

If your doctor recommends a laparoscopy, it will be to:

Seeing internal organs to look for signs of endometriosis and other potential problems.
This is the only way that endometriosis can be diagnosed with certainty
. But the diagnosis “no endometriosis” is never certain.
Tumors (implants) can be small or hidden from the surgeon's view.
Removal of any visible endometriotic implants and scar tissue that may be causing pain or infertility.
If an endometriotic cyst is found growing on the ovary (endometriosis), it will likely be removed.

Laparoscopy procedure

It is advised not to eat or drink for at least 8 hours before the laparoscopy.
Laparoscopy is usually done under general anaesthesia, although you can stay awake if you have a local or spinal anaesthetic.
The procedure is performed by a gynecologist or general surgeon.

For laparoscopy, the abdomen is inflated with gas (carbon dioxide or nitrous oxide).
The gas injected with a needle pushes the abdominal wall away from the organs so that the surgeon can see them clearly.
Then the surgeon inserts the laparoscope through a small incision and examines the internal organs.
Additional incisions may be used to insert instruments to move internal organs and structures for better vision. The process usually takes 30 to 45 minutes.

If endometriosis or scar tissue needs to be removed, the surgeon will use one of several techniques, including cutting and removing the tissue (excision) or destroying it with lasers or electric current (electrocautery).

After the operation, the surgeon closes the abdominal incisions with a few stitches.
There is usually little or no scarring.

What to expect after surgery

Laparoscopy is usually done in the hospital. Surgery sometimes requires a one-day hospital stay
. You'll likely be able to return to your normal activities within one week, and possibly longer.

Why is this done

Laparoscopy is used to examine the pelvic organs and remove implants and scar tissue.

This procedure is usually used to examine and treat:

Severe endometriosis and scar tissue thought to interfere with internal organs, such as the intestines or bladder.
If uterine pain persists or if it returns after hormone therapy.
Severe endometriosis pain (some women and their doctors choose to skip drug therapy).
Endometrial cyst on the ovary (endometrioma).
In the event that the endometrium is a possible cause of infertility.
The surgeon usually removes any visible implants and scar tissue. This may improve fertility.

When is a laparoscopy not needed?

Direct viewing of your pelvic organs is the only way to confirm that you have endometriosis. But this is not always required.
Hormone therapy is often prescribed for suspected endometriosis.

Surgery to relieve pain

As with hormone therapy, surgery relieves endometriosis pain in most women.
But it does not guarantee long-term results.

Some studies have shown:

Most women — about 60 to 80 out of 100 — report pain relief in the first months after surgery.
More than 50 women out of 100 who show symptoms return within two years after surgery. This number increases over time.

Some studies suggest that using hormone therapy after surgery can make your pain-free period longer by preventing the growth of new endometriosis or the return of endometriosis.

Infertility surgery

If infertility is your primary concern, your doctor will likely use a laparoscopy to look for and remove signs of endometriosis.

Research has not conclusively demonstrated that removing mild endometriosis improves fertility.
For moderate to severe endometriosis, surgery will improve your chances of getting pregnant.
In some severe cases, a fertility specialist will recommend skipping surgical removal and using IVF.

After your laparoscopy, your next steps depend on how severe your endometriosis is and your age.
If you are over 35, the quality of your eggs declines and the risk of miscarriage increases with each passing year.
In this case, your doctor may recommend infertility treatment, such as fertility drugs, in vitro fertilization or in vitro fertilization.
If you're younger, consider trying to conceive without infertility treatment.

surgery risks

Complications from surgery are rare, but include:

pelvic infection;
Uncontrolled bleeding that results in the need for a larger abdominal incision (laparotomy) to stop the bleeding.
Scar tissue (adhesion) forms after surgery.
Damage to the intestines, bladder or ureters (the small tubes that carry urine from the kidneys to the bladder).

What to think about after surgery

The benefits of laparoscopic surgery over open abdominal surgery include less bruising, tissue scarring and smaller incisions, as well as the ability to perform an outpatient procedure or a shorter hospital stay and recovery time.

The skill of the surgeon is critical when using surgery to treat endometriosis that causes infertility.
The use of laparoscopy, lasers, and some surgical procedures require additional training for the surgeon.
Doctors have reported varying pregnancy rates after endometriosis surgery.

in vitro fertilization (IVF), an assisted reproductive technology, is an alternative to surgery to correct infertility caused by endometriosis.

Laparoscopy (keyhole surgery) can be used to diagnose or treat a number of conditions in the abdominal and pelvic area.
The advantage of laparoscopy is that it requires only small incisions.

The added advantage of laparoscopy in endometriosis is that your diagnosis can be confirmed and treatment performed at the same time.
It can also be used to find out where and how much endometriosis is, as well as to make sure there isn't another medical problem causing your symptoms.

If endometriosis can be seen during a laparoscopy, a biopsy is usually taken.
This will confirm the diagnosis.

Your treatment will depend on where and how much your endometriosis is.

Endometriotic patches throughout the pelvis can be removed surgically or by burning (using diathermy or laser).
Usually, endometriosis in the ovaries has formed a cyst called an endometrial cyst (endometrioma).
This will need to be removed.

I showed studies Five years after surgery, up to 93 percent of women will have no evidence of endometriosis returning.

However, not all cases of endometriosis can be treated laparoscopically. Endometriosis sometimes affects other organs such as the intestines or the ureter (the tube running from the kidney to the bladder). If this is the case, you may need more surgery at a later time. Additional surgery will likely involve other specialized surgeons.

Endometriosis laser treatment or diathermy?

Laser and diathermy are tools that a doctor can use to heat tissue.
Both can be used to either burn off the lining of the uterus (resection) or cut it out.
Both methods have advantages and disadvantages. The gynecologist will use the most experienced and comfortable way to use it.

Other risks include:

Symptoms may not improve
Scar formation (adhesion).

In some cases, it may not be possible to remove all of the endometriosis or the endometriosis may return at a later time.

Before surgery, your doctor should discuss the risks with you, so when you provide consent for the procedure, you understand what the risks are. Don't be afraid to ask questions.

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