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.

Outcomes of chronic pelvic pain of endometriosis after laparoscopic surgery

The prevalence of endometriosis is up to 35-50% among patients with pelvic pain. Among several medical and surgical options to relieve chronic pelvic pain, surgical options are the preferred method but this depends on patients' age, fertility desire, and disease severity as well. In the current literature, the management of pelvic pain focuses on comparing the surgical and medical therapies of pain relief, whereas the reoccurrence rate and reoperation after operative laparoscopy remain unclear. Laguerre et al from the University…

Key Points Lay Summary

Managing Persistent Pelvic Pain in a distinct "pain" clinic

Persistent pelvic pain is an important problem producing physiological stress and productivity loss during the reproductive period of women. A specific pelvic pain clinic named "Mater Health Persistent Pelvic Pain Clinic" was established in 2017 in a part of the emergency department in Mater Hospital, Queensland, Australia. The clinic aimed to reduce the burden of a busy emergency department and to eliminate the need to submit to an emergency department by a multidisciplinary follow-up of patients with persistent pelvic pain. Wilkinson et al.…

Key Points Lay Summary

Factors affecting complications and the recurrence of operated deep infiltrating endometriosis

Deep infiltrating endometriosis is classified as penetrating the endometrial tissues more than 5 mm deep on the peritoneal surface, mainly uterosacral ligament, rectovaginal septum, ovarian fossa, pelvic peritoneum, bowels, ureters, and bladder. Treatment of the disease depends on the need for pain relief, fertility, and to prevent the spread of endometrial foci. The surgical approach is the removal of endometriosis foci, and operation of the advanced stages requires highly skilled surgeons to prevent complications and lower the recurrence rate of…

Key Points Lay Summary

Endometriosis scar disruption may lead to "spontaneous hemorrhage in pregnancy" and can be life-threatening.

Kollikonda et al from Cleveland Clinic Women's Health Institute, Cleveland, Ohio, US penned a case report about their hemoperitoneum experience during labor, which was recently published in the "Journal of Obstetrics and Gyneaecology Canada". The aim is to warn obstetricians about the occurrence of spontaneous hemorrhage in pregnant patients with a history of advanced-stage endometriosis. Apart from the vascular nature of endometriotic adhesions and their low elasticity, repeated surgical resections may also be the predisposing factors of adhesions to become…

Key Points Lay Summary

Evaluation of preoperative risk factors of ureteral endometriosis

Endometriosis affects the urinary tract in 1% to 5.5% of the patients, and among them, bladder involvement is 70-85%, while ureteral involvement alone is 9% to 23%.  Ureteral endometriosis is most commonly unilateral, especially on the left side, usually affecting the distal part. Some patients with ureteral endometriosis don't complain of any related symptoms even though it can cause dysuria, dyspareunia, and chronic pelvic pain. Moreover, there are no standard imaging methods for preoperatively evaluating the presence of ureteral endometriosis.…

Key Points Lay Summary

Postoperative infertility management using Endometriosis Fertility Index in endometriotic women

"Endometriosis Fertility Index '' score, described by the World Endometriosis Society in 2017, is a robust score and assists to predict the spontaneous pregnancy rate of women with endometriosis, within 3 years after their operation. Its calculation is possible by patient characteristics such as age, pregnancy history, the duration of infertility, endometriosis stage, and the functional postoperative score assessed by the surgeon.  The patients with an unfavorable "Endometriosis Fertility Index '' necessitate more assisted reproductive techniques compared to the patients with a favorable "Endometriosis…

Key Points Lay Summary

The association of chronic endometritis, endometriosis and tubal infertility

Holzer et al. from the Department of Gynecologic Endocrinology and Reproductive Medicine of  Medical University of Vienna, Austria, set up apilot prospective cohort study to evaluate the relationship between chronic endometritis, infertility and endometriosis. The results of the study were recently published in the "Journal of Minimally Invasive Gynecology". This project includes 100 women diagnosed with infertility. The authors performed hysteroscopy, laparoscopy and histopathological evaluation for chronic endometritis on every patient to clarify the pathology of the endometrium, myometrium, and fallopian…

Key Points Lay Summary

Improvement of the quality of life after surgery for deep infiltrating endometriosis.

Deeply infiltrating endometriosis is the most severe form among the endometriosis types. The required laparoscopic approach is the appropriate excision of endometriotic foci from pelvis, by consideration of failure and side effects of the medical treatments. The specialist endometriosis centers showed good evidence of the safety and effectiveness of laparoscopic surgery for deep infiltrating endometriosis patients. Improved the quality of life at 6 months after surgery could be achieved and be maintained at 2 years in these specialized endometriosis  centers.…

Key Points Lay Summary

Postoperative long-term estro-progestin therapy for endometrioma

After the removal of ovarian endometriomas, the major concern is the high recurrence rate of symptoms and endometriotic cysts. The estimated recurrence rate of endometriomas is up to 50% at 5 years after surgery. To prevent the recurrence, postoperatively long-term combined or single hormone as progestins are generally advised. Del Forno and colleagues from Bologna University, Italy planned this retrospective cohort study to evaluate the efficacy of hormone therapy on their collection of 18 years of data. The paper is recently…

Key Points Lay Summary

Fertilization rate and pregnancy outcome in IVF cycles of endometriosis.

Endometriosis affects the pelvic cavity, uterus, ovaries and causes impaired fertility as a result. The chronic inflammatory nature of this disease negatively impacts the oocyte quality, maturation, and fertilization. Obviously, fewer oocytes can be harvested in the IVF cycles of endometriotic women when compared to controls. Data in the literature for the fertilization rates of endometriotic women are confusing. Prof. Jansen group from the Department of Gynecology, Leiden University, the Netherlands, studied IVF cycles of infertile endometriotic women to compare…

Key Points Lay Summary

Endometriosis, ART, fertility preservation

This review entitled "The impact of endometriosis on the outcome of assisted reproductive techniques: role of fertility preservation" was written by Necula et al. from Gynecology and Obstetrics Unit, Biel, Switzerland, and recently published in the journal "Hormone, Molecular Biology and Clinical Investigation". Endometriosis is a major cause of infertility. Although different types of endometriosis may require different types of therapy, recent understanding shows that individual treatment for every patient is important. The development of ART techniques facilitates to get conceived, however, the application…

Key Points Lay Summary

Endometriosis and possible cardiovascular outcomes

A retrospective population-based cohort study from the Institute of Applied Health Research, University of Birmingham, Birmingham, the UK, investigated the long-term cardiovascular outcomes of women with endometriosis. The study included 279,759 women in total, 20,1% (>56.000) were patients with surgically confirmed endometriotic patients, and the remaining 79,9% was the control group, matched with the endometriosis group in terms of age, body mass index, and health situation. Although the annual overall incidence of endometriosis remained stable throughout the 20 years of follow-up,…

Key Points Lay Summary

Environmental to occupational exposure, and possible risk factors for endometriosis.

Many objects in daily use are made of plasticizing agents. Studies suggest that chronic exposure to these agents are toxic to reproductive organs and cause metabolic disorders. For example, diethyl phthalate is still in use in cosmetic products.  Caporossi et al. from the Department of Epidemiology and Hygiene, Monte Porzio Catone, Italy, planned to examine the agents that cause the onset of endometriosis, and carried out a literature search for this purpose. Papers published from 1995 to 2020 in PubMed and…

Key Points Lay Summary

Endometriosis and the risk of Systemic lupus Erythematosus: A report from Taiwan

Systemic Lupus Erythematosus (SLE) is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage that affects mostly women, with an M:F ratio of 1:9. Recent evidence has also shown that endometriosis is a disease associated with immune system dysfunction. The association between those two diseases is not clear due to the limited number of cohort studies in the literature. Fan et al., from Taiwan Chung Sang Medical University, used the Taiwan nationwide population-based…

Key Points Lay Summary

The improvement of fertility rate and symptoms of superficial endometriosis following laparoscopic peritoneal stripping

Pain, in the form of diverse entities, including dyspareunia, dysuria, dyschezia, is the main symptom of endometriosis patients. The severity of pain is independent of the extent and the location of the disease, and generally causes a negative impact on the physical, mental, and social wellbeing of the patient. Due to the complex nature of pain and heterogeneity of the underlying disease, the diagnosis, and the differential diagnosis are difficult.  There is no consensus for the treatment of peritoneal endometriosis. It…

Key Points Lay Summary

Antioxidant therapy for the endometriosis pain

Ts the protective defense mechanism of cells, hence the destruction of balance between oxidants and antioxidants in our body is called "redox imbalance".  The major oxidants are reactive oxygen species (ROS) that are involved in multiple cellular processes by physiologically transporting signals. Our body has also an antioxidant defense system that includes a complex network of enzymes and co-enzymes. Additionally, we could intake externally suppliable antioxidants like vitamin E, carotenoids, etc. for further antioxidant needs.   Endometriosis is a chronic inflammatory…

Key Points Lay Summary

Ovarian, breast and endometrial cancer coexisting with endometriosis.

The invasive nature of endometriosis results in calling the disease " benign cancer". The transformation of endometriosis to malignancy is rare, but when compared to the general population, the relative risk of developing ovarian cancer is 4.2 times greater especially in women with long-lasting endometriosis. Based on this important fact, a retrospective, cross-sectional study was planned by a group of researchers from the Department of Obstetrics and Gynecology of Christian Medical School, Vellore, India, to determine the predictive risk factors of…

Key Points Lay Summary

What is the cause of Dienogest-resistance in patients with endometrioma?

Endometriosis may cause infertility in women, leading to adhesions in the pelvis, besides affecting the ovaries. Clinicians concern about the child-bearing desire of their patients when treating them surgically or with hormonal therapy. Dienogest (DNG) is a kind of progestin, and its clinical effect is similar to GnRH antagonists when it is used long-term in endometriosis patients. When compared to patients treated by cyclic oral estrogen-progestin, dienogest was reported to be significantly effective in reducing the size of the endometrioma…

Key Points Lay Summary

High-dose progestin intake and sexual functions in endometriosis patients

Dr. Oppenheimer et al. from the Department of Reproductive Medicine and Fertility Preservation of Antoine Beclere University Hospital, Clamart, France, recently published this bi-center observational prospective study in "Acta Obstetrica et Gynecologica Scandinavica". The study was designed to put forth the effect of high-dose progestin intake on sexual functions and includes 214 women who are sexually active and diagnosed with endometriosis. Every single patient completed the French version of the specific sexual activity questionnaire (SAQ) at the beginning and after…

Key Points Lay Summary

Deep endometriosis treatment options based on the patient's decision

Deep endometriosis, defined as endometriotic lesions penetrating deeper than 5 mm into the peritoneum comprise approximately 20% of all endometriosis cases. This invasive disease causes a significant reduction in the quality of life, social participation, and sexual health of affected women. Conservative therapy and surgical approach could be discussed with the women who faced to cope with the disease. Failure of hormonal therapy, and the side effects such as weight gain, a decrease of libido, mood swings, headache, and the…

Key Points Lay Summary