Selma Oransay, MD
Dr. ORANSAY is 35 years experienced clinician in OB/ GYN. She worked in the main national maternity educational hospital of Turkey for 20 years than she moved to İstanbul and worked in private hospitals. Her published articles are mostly on topics of menopause and infertility. She is also experienced as a voluntary OB/GYN doctor in African healthcare program.
Surgery for Deep Endometriosis: Reproductive Outcomes in Infertile Women
Deep endometriosis (DE) is a severe form of endometriosis where endometriotic growths invade deeper tissues such as the pelvic organs, including the bowel, bladder, and sometimes nerves. This type of endometriosis is often linked to infertility, but the exact relationship between the severity of the disease and infertility remains unclear. One of the main treatments for women with DE-related infertility is surgery to remove or reduce the endometriotic tissue. However, the effectiveness of surgery in improving fertility outcomes is still…
Key Points Lay Summary
The long-term cardiovascular risk in women with endometriosis.
Endometriosis, a chronic and systemic condition affecting 10% of women of reproductive age, has far-reaching effects beyond the reproductive system. Recent research highlights its role in triggering systemic inflammation, oxidative stress, and endothelial dysfunction. These processes can disrupt liver metabolism, alter adipose tissue, and lead to an unhealthy lipid profile—factors linked to an increased risk of cardiovascular diseases (CVD), even in young women. To explore this connection, Dr. Havers-Borgersen and collegues from Copenhagen University conducted a large-scale cohort study using…
Key Points Lay Summary
The effect of endometriosis surgery on female sexual functions
Sexual dysfunction is almost twice as prevalent in women with endometriosis compared to those with other benign gynecological conditions. Deep dyspareunia, a hallmark symptom of deeply infiltrating endometriosis, poses a ninefold higher risk in affected women. This symptom profoundly impacts sexual function, particularly desire, orgasm, and satisfaction, leading to a diminished quality of sexual life. While retrospective studies have suggested improvements in dyspareunia after endometriosis surgery, there has been a lack of prospective studies assessing the broader impact of surgery…
Key Points Lay Summary
Diagnostic Delays in Endometriosis: Contributing Factors
While the delay in diagnosing endometriosis is well-documented, the reasons behind this delay and the specific gaps in the healthcare system remain poorly understood. Transvaginal ultrasound and magnetic resonance imaging are useful tools in detecting the condition, but laparoscopic surgery remains the 'gold standard' for a definitive diagnosis. In their recent study published in Health Care for Women International, Fryer et al. from North Shields Council, Harrogate, UK, explored the reasons behind the clinical delay in diagnosing endometriosis. The study…
Key Points Lay Summary
Adenomyosis as a Barrier to Effective Surgery for Dyspareunia in Rectovaginal Endometriosis
Women with endometriosis often experience severe pain during intercourse, known as dyspareunia, which can deeply affect their quality of life and intimate relationships. One form of this condition, rectovaginal septum endometriosis, involves deep, scarred tissue that can cause pain during deep penetration.The efficacy of hormonal and medical treatment is limited in cases of deep-infiltrating endometriosis, surgery is often necessary to remove the affected tissue. However, even after surgery, some continue to struggle with persistent symptoms, including pain. Recent research suggests…
Key Points Lay Summary
Retrograde Menstruation: Insights from Humans and Non-Human Primates
Vigano et al.from the Academic Center for Research on Adenomyosis and Endometriosis of Milan University, Italy, conducted a comprehensive literature review over a span of 23 years to evaluate retrograde menstruation in both humans and non-human primates, focusing on its role in endometriosis. After screening relevant studies, 15 human and two non-human primate studies were included in the review. The studies examined peritoneal fluid as evidence of retrograde menstruation, with human studies revealing varying rates of endometrial cells in the peritoneal…
Key Points Lay Summary
Knowledge synthesis of the "Relevance of Endometriosis Diagnostic Tools"
Spiers et al. from the Department of Obstetrics and Reproductive Medicine at Angers University Hospital in France identified significant diagnostic challenges and the absence of definitive diagnostic tools for endometriosis. In response, they evaluated existing medical literature to enhance diagnostic methodologies, as detailed in their recent publication in the International Journal of Gynecology and Obstetrics. The research team, comprising 30 authors, conducted a thorough literature search using a rapid strategy and specific selection criteria. The review focused on retrospective and…
Key Points Lay Summary
Endometriosis: Investigating Theoretical Causes and Pathogenesis
Understanding the etiology of endometriosis is crucial for preventing its occurrence and minimizing the significant health burdens it imposes on women. As current treatment options are limited and often lead to severe side effects, identifying potential causes can empower women with knowledge and lead to better management strategies In a recent study, Dr. A. Awad Hegazy from the Department of Basic Medical Sciences at Zarqa University, Jordan, delves into the theoretical causes of endometriosis. As a progressive and painful chronic…
Key Points Lay Summary
Laparoscopic port site complications.
Dr. Semm performed the first laparoscopic surgery in September 1980 at the University of Kiel, marking a significant milestone. Following 1985, laparoscopy expanded beyond urogynecology into various medical fields, becoming widely accepted for interventions in multiple anatomical spaces. In recent years, the tools and techniques for laparoscopic procedures have evolved considerably, offering various trocar designs and incision approaches, including larger trocars with multiple access channels. Post-operative complications are rare, occurring in about 0.1% of cases, primarily involving gastrointestinal, genitourinary, and…
Key Points Lay Summary
The prevalence of deep and superficial dyspareunia in women with endometriosis..
Almost half of the women affected by endometriosis experience both superficial and deep dyspareunia. While superficial dyspareunia is less studied, deep dyspareunia is often linked to mechanical pressure on endometriotic lesions or tissue rigidity. To address the sexual difficulties faced by women with endometriosis, pelvic floor physiotherapy, along with medical and surgical therapies, are being utilized. To evaluate the prevalence of deep and superficial dyspareunia in women diagnosed with endometriosis, Forno et al. from the Department of Medical and Surgical…
Key Points Lay Summary
An observational study on predicting endometriosis recurrence risk.
Endometriosis presents in various ways, and improper management can lead to recurrence. Studies show that the recurrence rate can range from 6% to 67%. Factors that may increase this risk include having severe or deep forms of the disease, being younger, and opting for conservative treatment. It’s important to differentiate between suspected recurrence based on symptoms and recurrence confirmed by a histopathological examination after complete surgical removal. To investigate those factors that increase the recurrence risk of endometriosis, Holdsworth-Carson et…
Key Points Lay Summary
Intraoperative Transvaginal Ultrasound-Guided Resection of Bowel Endometriosis
Alec et al. from the Department of Obstetrics and Gynecology at Geneva University Hospitals aimed to show how to manage rectal endometriosis using ultrasound in a narrative video. The main goal of their procedure was to check the rectal wall for any remaining disease after bowel shaving and to decide if more bowel resection was necessary. The study featured two patients diagnosed with severe rectal endometriosis. Both women experienced severe pain during their periods, pain during intercourse, and difficulty with…
Key Points Lay Summary
Bladder Endometriosis: Current Knowledge and Future Directions
About 70-80% of urinary tract endometriosis occurs in the bladder, particularly affecting the base and dome regions. Endometriotic lesions can penetrate the detrusor muscle either partially or completely. Endometriosis affecting the uterovesical fold peritoneum or deep endometriosis that does not involve the bladder muscle, is not classified as "bladder endometriosis." Patients with bladder endometriosis may experience symptoms such as suprapubic pain, urgency, dysuria, frequency, and hematuria. These symptoms can arise spontaneously or as a result of bladder injuries, such as those…
Key Points Lay Summary
Post Surgery Endometrioma Recurrence
Endometrioma is a common form of endometriosis. Endometrioma cystectomy is the preferred treatment, as it is more effective than ablation or laser vaporization in reducing pain and recurrence. While medical treatment can help prevent recurrence after surgery, postoperative hormonal therapy is not always well-tolerated or preferred, possibly due to medical history, side effects, or a desire to conceive. Postoperative hormonal suppression of endometriosis helps alleviate pain, including pelvic pain, dysmenorrhea, and dyspareunia, after 12 months. Additionally, literature indicates that hormonal…
Key Points Lay Summary
Robotic-assisted laparoscopy to manage severe diaphragmatic endometriosis
Diaphragmatic endometriosis is a rare extrapelvic form of endometriosis, with specific symptoms experienced by 30%, such as shoulder, chest, arm, and right upper quadrant pain. An early diagnosis is vital to prevent the disease progressively toward the thoracic cavity, causing catamenial hemothorax and/or pneumothorax. For this reason, when deep endometriosis is strongly suspected, it is worth evaluating the diaphragm intraoperatively using a minimally invasive approach. The published literature does not describe how to approach the diaphragm, which can be done laparoscopically…
Key Points Lay Summary
Performance of the 2021 AAGL endometriosis classification
The most common scoring system is the revised American Society for Reproductive Medicine (rASRM) staging system for endometriosis. However, this classification system was widely criticized for failing to correlate surgical complexity and to show patients' pain scales and fertility indexes. It also has a poor inter-observer agreement. To replace rASRM with an improved system, the American Association of Gynecologic Laparoscopists (AAGL) announced a new endometriosis classification in 2021. The primary objective was to correlate surgical complexity and usability, and the…
Key Points Lay Summary
A new pathogenetic hypothesis of endometriosis
Recent research has focused on perimenopausal women who experienced hematoperitoneum and lower abdominal pain, subsequently developing deep infiltrating endometriosis within a few months of the initial episode. Ultrasonographic evaluations revealed that a bleeding functional ovarian cyst was the primary cause of the hemoperitoneum. The link between spontaneous hematoperitoneum and the subsequent development of deep endometriosis is so strong that it can be reasonably considered causal. Based on this hypothesis, Dr. Vercellini et al. from the Department of Clinical Sciences and…
Key Points Lay Summary
Why we should prefer nerve-sparing surgery in deep endometriosis?
Despite its benign nature, deep endometriosis can mimic malignant processes and infiltrate multiple organs, blood vessels, ligaments, and nerves within the pelvis. When conservative medical management fails, the need for surgical excision of endometriotic lesions arises. The surgeons aim to complete the removal of lesions without harming urinary, bowel, and sexual functions. For this reason, they started using nerve-sparing techniques two decades ago to treat deep endometriosis. This technique involves identifying and preserving anatomic nerve fibers to minimize surgical denervation…
Key Points Lay Summary
Robot-assisted laparoscopy for deep infiltrating endometriosis of bowel
Deep infiltrating endometriosis is characterized by lesions larger than 5 mm that penetrate the peritoneum or invade the muscular layer of adjacent organs, affecting over 20% of women with endometriosis. Bowel involvement occurs in 5-12% of cases and may present with symptoms such as abdominal pain, hematochezia, and dyschezia. Medical treatment includes non-steroidal anti-inflammatory drugs, oral contraceptives, and progestins. Surgical removal of endometriotic lesions typically involves laparoscopic techniques such as discoid excision, rectal shaving, or segmental resections, chosen based on the extent…
Key Points Lay Summary
Superiority of hysterectomy over lesion excision in the treatment of rectovaginal endometriosis
Confirmative treatment of endometriosis includes excision or ablation of visible lesions while conserving the uterus and ovaries. On the contrary, the radical approach involves total hysterectomy and even bilateral oophorectomy to create a hypo-estrogen state, remove adenomyosis if it exists, and lead to amenorrhea. These radical processes carry both a high risk of postoperative complications and subsequent cardiovascular diseases and osteoporosis due to surgical menopause. Despite its potential disadvantages, the radical method aims to relieve the symptoms, remit the disease,…
Key Points Lay Summary