The secret enemy of women: Deep endometriosis

The secret enemy of women: Deep endometriosis

Professor Mete Güngör

Professor of Gynecology, Obstetrics and Gynecologic Oncology Mete Güngör warns that the women suffering from severe menstrual pain and painful intercourse should necessarily visit a doctor in order to prevent the damages that can be potentially caused by deep endometriosis.

Endometriosis implies growth of the endometrium – the interior lining of the uterine wall – anywhere other than the womb. It is divided into two groups; superficial and deep. The endometrial tissues growing on the peritoneum, the outer surface of the ovaries and the fallopian tubes are referred to as “superficial endometriosis”. 

“Deep endometriosis” is defined as endometriosis lesions that have penetrated into the peritoneum more than 5 mm, have also involved intestinal and bladder wall, formed painful nodules, invaded the nerves and led to adhesions, resulting in impaired anatomy of the organs in the region.

It may cause irreversible damage in organs!

The most significant sign of endometriosis is the severe pain that usually occurs during the period and sexual intercourse, it is felt in the abdomen or the groin and impairs the quality of life. The pain may be independent from the menstrual cycle, if it progresses into a chronic form in time. Deep endometriosis accounts for 10-20% of all endometriosis cases and it may lead to severe damage in the involved organs along with the severe pain; therefore, it may be necessary to remove a part of those organs surgically.

Colon: It may cause severe pain during defecation, constipation and gas complaints secondary to obstruction in colon.

Urinary bladder and ureters: It may cause hematuria (blood in urine) and dysuria (painful voiding associated with feeling of burn). Moreover, it may lead to kidney failure by obstructing the ureters.

Ovaries and fallopian tubes: When the ovaries and the fallopian tubes are involved, these organs become totally dysfunctional, resulting in infertility.

Nerves: It may, sometimes, lead to extremely severe pain and dysfunction, when the nerves located in pelvic region are involved.

Surgery is a must in deep endometriosis

Emphasizing that treatment of the endometriosis varies depending on the severity of the disease, symptoms and future pregnancy plan of the patient, Professor of Gynecology, Obstetrics and Gynecologic Oncology Mete Güngör says “Endometriosis can be managed with medication treatment, surgery or both modalities. However, the patient should be operated on to eliminate adhesions of organs, obstructions and damages, even if medication treatment may alleviate the pain in endometriosis”.

It may be as difficult as cancer surgery

Highlighting that the surgical management of deep endometriosis may, sometimes, be as challenging and complex as the cancer surgery, Professor Mete Güngör adds “Therefore, when surgical treatment is decided, it is very crucial that the surgery is performed with closed techniques by the surgeons, who are experienced in management of this condition, in order to protect the fertility and hormonal functions and reduce the possibility of recurrence”.

Laparoscopic or Robotic-assisted surgeries increase the success

Deep endometriosis may cause adhesions between pelvic organs, such as womb, ovaries, colon, urinary bladder and ureters, and obstruction of the digestive and urinary tracts. In the surgery, it is necessary to ensure patency of these organs without any damage, remove the irreversibly obstructed segments of the digestive or urinary tract and to anastomose them end-to-end. Meanwhile, the nerves should not be injured in order to maintain functions of the organs and the ovaries should be protected; finally, it is necessary to restore this body part such that a potential future pregnancy can be achieved. Professor Mete Güngör specifies that these surgeries should, therefore, be performed with minimally invasive techniques, namely laparoscopic or robotic-assisted surgery, in order to see the anatomy more closely and clearly and adds that those techniques will increase success rates of the surgeries and offer major advantages, such as quicker recovery, milder pain, less bleeding and ability to resume daily life earlier.”

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