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What is endometriosis (chocolate cyst)?

What is endometriosis (chocolate cyst)?Endometriosis is a disease that develops as a result of the growth of the endometrial layer lining the inside of the uterus in another region outside the uterus and is often painful.

Endometriosis most often occurs 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, the awareness rate is very low. Although the disease can affect women of any age group, 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. But there are some theories that have been developed for the reason:
* Genetic factors: The disease tends to be transmitted within the family and affects some ethnic groups more than others. If a person has someone with endometriosis in their family, the risk of developing the disease in this person is higher than in the normal population.
* Having menstruation in the opposite direction: With menstrual bleeding, the endometrial tissue lining the uterus is excreted from the body through the vagina. If there is a backward bleeding, the endometrial tissue flows from the fallopian tubes into the abdominal cavity, settles in the organs there and causes endometriosis.
* Problems in the body's natural defense against disease and infection due to a problem with the immune system can be a factor in the development of endometriosis.
• The spread of endometrial cells through the bloodstream or lymphatic system to various parts of the body and 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 condition 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 menstrual periods are painful in most women, there is much more severe pain in those with endometriosis. The severity of the pain may increase over time. Common symptoms and complaints in endometriosis may include:
* Painful menstrual periods (Dysmenorrhea). Pelvic pain and cramps usually begin before menstruation and continue for several days during the cycle process. There may also be pain in the lower back and abdomen.
* Pain during intercourse. In endometriosis, pain appears during or after intercourse.
• Pain during major ablutions or urination. More often, there may be complaints of pain during defecation or urination, which become pronounced during menstrual periods.
* Excessive bleeding. From time to time, excessive bleeding during menstrual periods or abnormal bleeding between periods may occur.
•Infertility. Endometriosis is often diagnosed for the first time in those who seek medical help due to infertility.
* Other signs and symptoms. Especially during menstrual periods, symptoms such as increased fatigue, diarrhea, constipation, bloating, nausea may occur.
The severity of pain is not a reliable indicator of the degree of endometriosis. In mild endometriosis, there may be severe pain, and 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, which is accompanied by diarrhea, constipation and abdominal cramps. Irritable bowel syndrome can accompany endometriosis, making diagnosis difficult.
Despite the intense discomfort, many women do not realize the disease until they try to get pregnant. Since the disease tends to worsen gradually over time, about 30 - 40% of women with endometriosis experience infertility problems. Because there is no way for the blood flowing from the misplaced endometrial tissue into the abdominal cavity to leave the body.

How is endometriosis (chocolate cyst) diagnosed?
To diagnose endometriosis and other conditions that can cause pelvic pain, the doctor asks the patient about their complaints and problems with their medical history. Tests to check for physical clues of endometriosis include:
* Pelvic examination. With pelvic, that is, gynecological examination, abnormalities in the reproductive organs and cystic structures due to endometriosis can be detected.
•Ultrasonography. In ultrasound, high-frequency sound waves are used to image the internal organs of the body. To capture the images, a device called a transducer is inserted into the abdomen or vagina (transvaginal ultrasound). Both ultrasound examinations can be performed so that the reproductive organs can be viewed optimally. It may not be possible to diagnose endometriosis with a standard ultrasound. If cysts associated with endometriosis have formed in the patient, they can be detected by USG.
* Magnetic resonance imaging (MRI). MRI is an examination that uses a magnetic field and radio waves to obtain detailed images of organs and tissues. MRI helps to make a diagnosis and plan surgery. It gives detailed information about the locations and sizes of endometrial tissues located outside the uterus.
• Laparoscopy. Laparoscopy is performed under general anesthesia by entering the abdomen through a small incision opened near the navel.  The procedure is performed with the help of a thin tube with a lighted camera at the end, called a laparoscope. With laparoscopy, in which endometrial tissues located outside the uterus are searched, information about the location, scope and size of endometrial implants can be obtained. If deemed necessary, a tissue sample (biopsy) can be taken for further tests. By removing foci of endometriosis during laparoscopy, the disease can be completely cured. Thus, the diagnosis and treatment are completed with only one operation.

How is endometriosis (chocolate cyst) treated?
Endometriosis treatment can be done with medications or surgery. Sometimes both medications and surgical treatment may be required. Drugs are tried first in the treatment. When success is not achieved with medications, surgical treatment options are evaluated.
To relieve pain and cramps that occur during menstrual periods, nonsteroidal anti-inflammatory drugs are prescribed. Hormone therapy can be started along with painkillers for women who do not have a pregnancy plan. Hormone supplementation is effective in reducing or eliminating endometriosis pain. The fact that the hormones produced in the body during the menstrual cycle first rise and then fall, leads to thickening, disintegration and bleeding of pathological endometrial tissues. Hormone supplementation can slow down endometrial tissue thickening and prevent the formation of new endometrial tissue. Hormone therapy does not provide a permanent solution for endometriosis. After stopping treatment, the symptoms come back.
Hormone therapy cannot be used in women who want children. Therefore, surgical treatment is preferable. The surgical procedure is usually performed by the laparoscopic method. In laparoscopic surgery, a small incision is made through the navel. Through this incision, a thin tube-shaped instrument called a laparoscope with a camera at the end is used to reach the location of the cyst and the cyst tissue is cut and removed.
Nutritional and lifestyle changes are also effective in controlling the symptoms of endometriosis. It is known that estrogen secreted in the body thickens the endometrial tissue on the inner surface of the uterus. If so, keeping estrogen levels low can help minimize the symptoms of a chocolate cyst. By exercising regularly, limiting caffeine and alcohol intake, and reducing body fat, it is possible to achieve a decrease in estrogen levels.

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