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.
A literature review about postmenopausal endometriosis.
Typically, endometriosis disease brings relief to women after menopause, but some individuals continue to develop some endometriosis-related issues even after the cessation of menstruation. This enigmatic condition, called postmenopausal endometriosis, needs to be understood, and the disease must be diagnosed carefully. A new explanation for the occurrence of postmenopausal endometriosis is related to the dysregulation of aromatase activity due to genetic and epigenetic changes or genetic polymorphism. The absence of menstrual cycles poses diagnostic challenges and requires a unique approach…
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An often overlooked symptom: Sleep disorders in patients with endometriosis
Recent reports suggested that women with endometriosis have more frequent complaints of poor sleep, reduced quality of life, and higher pain scores when compared with healthy women. Patients experience fatigue and increased pain the day after insomnia. For this reason, knowledge about the severity and frequency of sleep disorders in women with endometriosis is important for gynecologists in clinical practice. Chaichian et al., from the Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran, set up an analytic-cross sectional…
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Retrograde Menstruation Theory Through Müllerian Anomalies
The pathogenesis of endometriosis is still under debate. Sampson also described this condition as "developmentally misplaced endometrial tissue" in 1925. To evaluate the theories of pathogenesis, Vercellini et al. from the Academic Center for Research on Adenomyosis and Endometriosis at the Department of Clinical Sciences of the University of Education, Milan, Italy, set up a literature exploration. To investigate the retrograde menstrual flow theory, the authors selected studies that compare the prevalence of endometriosis in obstructive and non-obstructive Müllarian anomalies.…
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Diagnosis and management of treatment in diaphragmatic endometriosis.
Diaphragmatic endometriosis is a rare extra-pelvic type of deep endometriosis with a prevalence of 0,19% to 4,75. In symptomatic women, the symptoms are characterized by non-specific chest pain, shoulder pain, right upper quadrant abdominal pain, and pneumothorax, whereas 75% of patients have a silent course that makes the diagnosis difficult. The clockwise peritoneal fluid current from the pelvis to the falciform and phrenic-colic ligaments explains why endometriotic lesions are seen 90% asymmetrically on the right side of the diaphragm. A previous spontaneous…
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Improving fertility in peritoneal endometriosis
Endometriosis is the most common gynecologic disease that affects 10-15% of women in their reproductive age. The causal relationship between endometriosis and infertility is not clear yet, but adhesions and anatomical distortions due to the progression of the disease are blamed. Although there are many classification systems for endometriosis, the most used one is the revised ASRM (rASRM) classification, based on visualizing the lesions during the operation. According to this classification system, minimal/mild or stage I/II endometriosis is defined as lesions…
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The need for fertility preservation in women with endometriosis
A variety of pathologies such as adhesions, inflammation, modified pelvic anatomy, and altered ovarian reserve are among the causes of infertility in women with endometriosis. Additionally, these patients experience suboptimal outcomes characterized by reduced pregnancy rates when they undergo assisted reproductive techniques. The molecular level involving dysregulation of steroids, oxidative stress, and angiogenesis within the follicular environment should be responsible for the cause of infertility in this disease. Moreover, removing ovarian endometriomas worsens the ovarian reserve and AMH levels. If the…
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Any link between endometriosis and neonatal uterine bleeding?
A Medline search using the keywords " neonatal uterine bleeding," " pathophysiology," and "premenarche" was made by Dr. Habiba et al. from the Department of Health Sciences, University of Leicester, Leicester, UK. A total of 2264 articles were collected, and the final twenty-one, after the exclusion criteria were used to compose the text recently published in Biomolecules. The authors aimed to focus on the evidence favoring and against the neonatal origin of perimenarchial endometriosis, they discussed the research in the…
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A concerning link between endometriosis and cardiovascular disease.
Endometriosis is a disease characterized by endometrial-like tissues outside the uterus, which causes inflammation, scarring, and adhesion formation. The pathologic process of forming those adhesions releases proinflammatory molecules, cytokines, and growth factors that may have systemic effects. Recent research, for example, mentioned an increased risk of atherosclerotic diseases in women with endometriosis. Unfortunately, early diagnosis and effective treatment of endometriosis remain limited in current practice. Under the leadership of Dr. Olivier Morel from the Division of Cardiovascular Medicine, Strasbourg University…
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Uterine innervation and its impact on endometriosis related pelvic pain.
Advancements in immunochemistry, fluorochromes, computer-associated anatomical dissection, and 3D reconstruction of uterine micro-innervation brought substantial progress in pelvic neuroanatomy. The complex uterine innervation and its interactions with uterine parts and layers are yet fully revealed. Austruc et al., from the Faculty of Medicine of Rennes University, France, reviewed the literature on the complexity of uterine innervation to deepen our understanding of female pelvic pain. The authors' final aim was to uncover valuable insights for enhancing pelvic nerve-sparing techniques in endometriosis…
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Key Aspects of Ureterolysis in deep endometriosis surgery
Deep endometriosis surgery needs talented surgeons to preserve and protect vital structures during the excision of endometriotic lesions. The technique for ureterolysis is essential to mitigate the risk of ureteral injuries and improve patient outcomes. Dr. Chatroux and Dr. Einarsson from the Department of Obstetrics and Gynecology of Harvard Medical School, Boston, USA, summarized the ureteral anatomy, identification, and optimal surgical practice of ureterolysis; and clarified the knowledge gaps about endometriosis surgery involving the ureter. After anatomical description and describing…
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The location of adenomyosis, and recurrent abortion
ESHRE defines repeated pregnancy loss (RPL) as the loss of pregnancies with two or more weeks of gestation. Adenomyosis is the presence of ectopic endometrium, in the myometrium. High-resolution transvaginal ultrasound and sonographic criteria can help to diagnose the disease clinically. However, no consensus has been reached on the classification of adenomyosis. The most likely reason why adenomyosis causes pregnancy complications is its location in the sub-endometrial layer of the myometrium. This affects the uterine functions, especially uterine peristalsis, which…
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Ultrasonographic findings and the clinical symptoms of pelvic endometriosis
Imaging techniques achieve the clinical diagnosis of endometriosis, which affects 10-15% of all women of reproductive age. Suspected patients with clinical history and symptoms need a systemic examination of the uterus, ovaries, adnexa, and peritoneal covering the rectouterine, retrocervical, and sigmoid regions. The efficacy of ultrasonographic examination has been shown in many studies. Transrectal and transvaginal ultrasonography are helpful and reliable tools for diagnosing endometriosis and mapping the nodules before laparoscopic surgery. Mostafavi et al., from the Department of Radiology…
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Visual representation of endometriosis pain
Endometriosis is accompanied by severe chronic pelvic pain that impacts quality of life, relationships, and work conditions. Studies aiming to improve pain are frequently encountered in the literature. Nonetheless, pain research is complex due to its subjective nature, and cannot be visualized. Various studies have focused on language tools such as metaphorical language to externalize the painful experience of women with endometriosis. Visual representation of pain means externalizing painful experiences not only captured by verbal accounts but also by color,…
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Women's willingness to donate menstrual blood for endometriosis research
The menstrual blood is 50-100 ml/per cycle, with 80% lost during the first three days. On the heaviest bleeding day, 2 to 8 ml may be collected from a cup worn for four hours. This fluid could be investigated by collecting viable immune and endometrial cells. The menstrual immune cells are similar to the circular immune cells in peripheral blood, with fewer T lymphocytes and more natural killer cells. The delay in diagnosing endometriosis is estimated to be 8 years.…
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Postoperative pain-related quality of life for patiens with different types of endometriosis surgery.
Endometriosis surgery usually improves chronic pelvic pain and the quality of life in women suffering from that disease. Response to surgery depends on several factors, however, in younger ages, recurrence of both pain and endometriosis lesions are reported. Most research on the outcomes of surgeries was conducted in retrospective studies. There is a lack of prospective study design to evaluate the surgical outcomes in the literature. Lee et al. from the Department of Obstetrics and Gynecology of British Columbia Women's…
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Current practice in robotic surgery for deep-infiltrating endometriosis
Today, surgical excision of endometriotic lesions is the only cytoreductive procedure for managing endometriosis. Hormonal treatment may partly relieve the symptoms, but it suppresses rather than cytoreduction of the disease. Minimally invasive surgery is usually the most preferred method due to reduced blood loss, postoperative pain, and hospitalization. Laparoscopic surgery is recommended in advanced and complex cases but sometimes may result in tissue alterations provoked by adhesions. Compared to 3D robotic surgery, laparoscopic surgery may have some technical limitations such…
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Early use of hormonal contraceptives and the probability of endometriosis diagnosis later in life
Hormonal contraceptives are the first-line medical treatment of endometriosis. If an adolescent has chronic pelvic pain and is an "unresponder" to hormonal therapy, the likelihood of having an "endometriosis diagnosis" is higher. This sign should warn clinicians about endometriosis diagnosis to refer the adolescent to a tertiary endometriosis clinic. Obern et al., from the Department of Children's Health, Uppsala University, Sweden, aimed to evaluate whether the early need for hormonal contraceptives could be a warning sign for endometriosis in adolescents.…
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Early diagnosis of deep infiltrating endometriosis in adolescence
Dysmenorrhea is widely observed in adolescence, and endometriosis is one of its causes. However, endometriosis diagnosis is usually made after 25 years of age. It is clear that early diagnosis and management of this progressive disease is essential and will have a good impact both on the quality of life and fertility. Moreover, patients who undergo surgery in advanced stages of the disease have more intra and postoperative complications. Martire et al. from the Gynecology Unit of the Department of…
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Cervical angle, retroflex uterus and abnormal placental position in women with endometriosis
Pregnancy complications such as miscarriage, preterm delivery, placenta previa, small for gestational age, and early abruption of the amniotic sac are more common in the pregnancies of endometriotic women. These complications could arise due to the inflammatory and adhesive characteristics of endometriosis disease resulting in retroflection. Dr. Higeta et al. from the Department of Obstetrics and Gynecology of Gunma University Graduate School of Medicine, Japan, aimed to evaluate the effect of endometriosis on perinatal complications by comparing pregnancies with and…
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Fertility outcomes after discoid excision for colorectal endometriosis.
Colorectal endometriosis is one of the most severe forms of deep endometriosis, composing 85% of all bowel lesions. Radical treatment is segmental resection of the bowels, which can cause postoperative severe complications such as rectovaginal fistula and voiding dysfunctions that negatively affect the quality of life. Surgeons are used to perform rectal shaving and discoid resection approaches besides this radical technique. Rectal shaving is usually indicated in serosal or superficial muscular involvement of endometriosis, with a higher risk of recurrence as…
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