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.
Converting Enzian into AAGL2021: A Step Toward Unified Staging
The revised American Society of Reproductive Medicine (rASRM) is the most widely used classification for endometriosis. This classification is easy to use but has some limitations, especially in describing deep endometriotic lesions and pain severity. On the other hand, the Enzian classification can code peritoneal, ovarian, deep endometriosis, and adenomyosis. This latter classification consists of letter and number coding rather than staging. In 2021, the American Association of Gynecologic Endoscopists introduced another staging classification named AAGL2021. To investigate the surgery-based…
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Physical Activity Boosts Self-Perception in Young Women with Endometriosis
Endometriosis affects millions of women worldwide, causing chronic pelvic pain, infertility, and significant disruptions to daily life. Beyond the physical pain, this condition can severely impact a woman’s self-esteem and body image. Since body perception is closely tied to physical appearance and abilities, engaging in physical activities can be a powerful way to boost self-image and overall well-being. A recent study by Coquinos et al. from the Sports Health Science Institute at Paris University explored how physical activity affects body…
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Linking Endometriosis to Age-Related Macular Degeneration
The macula, the central region of the retina, is crucial for sharp central vision and the color perception. Age-related macular degeneration (AMD) primarily affects this area and progresses through different stages, ranging from early to advanced forms. AMD has two main types: dry AMD and wet AMD. In the wet form, inflammation and abnormal blood vessel growth, or angiogenesis, play a key role in causing significant vision loss. These irregular blood vessels beneath the retina can leak fluid, leading to…
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Diaphragma central tendon and catamenial pneumothorax
Endometriosis typically involves ectopic endometrial tissue in pelvic organs, such as the bladder, ovaries, and uterine ligaments, leading to symptoms like dysmenorrhea, dyspareunia, and dyschezia. A rare form occurs in the diaphragm, causing catamenial pneumothorax. Management often includes hormone therapy or ovarian suppression, with surgery beneficial, especially for women desiring pregnancy. Inoue et al., from Kishiwada Tokushukai Hospital, Japan, reported the management of a case of a young unmarried woman with catamenial pneumothorax (a condition where lung collapse is associated…
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Impact of Menstrual Cycle on Cognitive Function in Midlife Women
Dementia, which affects women at more than 1.7 times the rate of men, continues to be a growing health concern, with potential links to hormonal changes. Estrogen, known for its neuroprotective effects, influences cognitive functions such as verbal memory, fluency, and fine motor skills. Disruptions in the hypothalamic-pituitary-ovarian axis and hormone imbalances can reduce estrogen levels, potentially contributing to cognitive decline. A recent retrospective study by Soria-Contreras et al. from Harvard T.H. Chan School of Public Health examined the relationship…
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Impact of appropriate surgery on endometriosis-related infertility
Endometriosis surgery by removing all visible lesions and repairing damaged tisue is important to build normal pelvic anatomy. It is still difficult to predict postoperative pregnancy rates among women with endometriosis who suffer from infertility. This retrospective study, conducted by Tahmasbi Rad et al. from the Department of Obstetrics and Gynecology at the University of Frankfurt, evaluated factors influencing postoperative pregnancy rates in women with endometriosis. The study followed 102 women who underwent laparoscopic surgery at a tertiary clinic between 2007…
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The current management of endometriosis-related infertility.
Endometriosis is a chronic disease affecting women of reproductive age, often presenting with pelvic pain such as dyspareunia, dyschezia, and dysuria, or inertility, and significantly impacting quality of life. Management should be individualized based on symptoms, reproductive goals, age, and patient preference. The choice between surgery and ART depends on clinical factors, with first-line IVF generally recommended for asymptomatic deep endometriosis cases.Colombi et al., from the University of Siena, reviewed endometriosis-related infertility, focusing on surgical roles by analyzing 1,035…
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Impact of Nerve Preservation During Parametrectomy on Urinary Retention in Deep Endometriosis Surgery
Deep infiltrating endometriosis (DIE) is the most advanced form of the disease, characterized by lesions penetrating deeper than 5 mm. Surgical treatment requires a meticulous approach to minimize functional complications. Deep lesions involving the parametrium, uterosacral ligaments, and anterior rectal wall may affect the inferior hypogastric nerve fibers, leading to a high incidence of postoperative voiding dysfunction. These fibers are anatomically located medially to the internal iliac arteries and caudally where the uterine artery crosses the ureter. Thus, preserving the…
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Pre-Diagnosis Hospital Utilization Patterns in Women With Endometriosis
Endometriosis is commonly associated with symptoms such as painful periods, chronic pelvic pain, and infertility. Diagnosing the condition is challenging due to symptom overlap with other gynecologic and gastrointestinal disorders, as well as the need for advanced imaging or laparoscopic techniques. Many women report a prolonged diagnostic process involving repeated visits to multiple clinics. Although previous studies have shown that women with endometriosis utilize healthcare services more frequently, little is known about their hospital contacts prior to diagnosis. To address…
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Excisional vs Ablative Surgery for Ovarian Endometriomas: Fertility and Recurrence Rates
Endometriomas are typically treated surgically with either cystectomy or ablation and drainage. Laparoscopic surgery offers benefits such as shorter hospital stays, quicker recovery, and reduced healthcare costs. Many women undergo endometrioma surgery prior to fertility treatments or to enhance their chances of natural conception. A 2008 review found better outcomes with cystectomy for endometrioma management. Kalra et al. from the Department of Obstetrics and Gynecology, Perth, Australia, aimed to update the evidence comparing excisional surgery with ablation for pain relief…
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Imaging findings in postmenopausal endometriosis
Most women diagnosed with endometriosis during their reproductive years become asymptomatic in postmenopausal period, but lesions remain biologically active despite lower estrogen levels. The pathophysiology of postmenopausal endometriosis remains unclear, though lesions appear less active and extensive. The risk of malignancy is higher in older women, especially those on estrogen-only therapy. Treatment often involves surgery or estrogen-blocking agents. MRI is the preferred method for detecting malignancy in postmenopausal endometriosis. Dr. Chamie and colleagues from São Paulo, Brazil, in their Radiographics…
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Non-invasive MRI Based Detection of Uterosacral Deep Infiltrating Endometriosis
Deep infiltrating endometriosis (DIE) frequently affects the uterosacral ligaments, with a prevalence of around 70% in affected patients. However, there is no consensus on the imaging anatomy of the uterosacral ligaments (USLs). Currently, the assessment of USL endometriosis is subjective, lacking a standardized MRI classification, which can lead to variations in diagnostic accuracy and reporting. To address this, the development of a standardized MRI classification system could enhance reporting consistency and improve communication between radiologists and clinicians, promoting further research and…
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Endometriosis in Adolescents: Diagnosis, Treatment, and Challenges
Endometriosis is a condition that affects not only adult women but also adolescents, regardless of their race, ethnicity, or socioeconomic status. It can cause significant pain, including dysmenorrhea and pelvic pain. Research has shown that up to 20% of transgender adolescents with these symptoms also have laparoscopically confirmed endometriosis. Dr. Jessica Y. Shim from Boston Children’s Hospital has written a comprehensive review in Obstetric Gynecology Clinics of North America, to summarize what is currently known about adolescent endometriosis, focusing on how…
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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…
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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…
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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…
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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…
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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…
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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…
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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…
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