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.
Laparoscopic resection of bladder endometriosis
When we talk about deep-infiltrating endometriosis, one of the most commonly affected organs in the urinary tract is the bladder, with a prevalence of 80%. Bladder endometriosis can be defined as the existence of the endometrial glands and stroma inside the detrusor muscle. In most cases, the bladder mucosa is unaffected, yet the most frequent site of involvement is the dome and base of the bladder. The source of bladder endometriosis can be primary or secondary. The secondary development of…
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Comparison of two surgical approaches for endometriosis.
Endometriosis is one of the causes of infertility in women. But the pathophysiology of infertility caused by endometriosis is not yet clear. Hormonal disorders, abnormal peritoneal function, distorted pelvic anatomy, and multiple cesarean deliveries are among the accused. Dr. Li et al. from the Shijiazhuang People's Hospital, China conducted this study to investigate the effect of two different surgical methods on the subsequent fertility of women with endometriosis. The retrospective study included 226 women with endometriosis who were operated on…
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Endometriosis awarness for the Gastroenterologists.
Women with endometriosis can develop chronic abdominal pain and/or abnormal bowel habits more than eight times compared to women without endometriosis. For this reason, an undiagnosed patient with endometriosis may be referred to a gastroenterologist and remain in a situation where the chance of diagnosis is missed. But the prompt diagnosis of endometriosis is crucial to reduce the economic burden and disease complications, including prolonged pain and infertility while preventing the progression. Dr. Vanessa Yu et al. from the Division of Gastroenterology,…
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The effectiveness of acupuncture in the treatment of dysmenorrrhea
Asymptomatic endometriosis does not adversely affect women's quality of life and mental health. But the quality of life of women with endometriosis who suffer endometriosis-related pelvic pain, dysmenorrhea, dyspareunia, and dysuria declines as they become more susceptible to anxiety and depression. The analgesic effects of acupuncture are closely related to the activity of central transmitters, including endogenous opioid peptides, serotonin, dopamine, and others. When a woman with endometriosis receives acupuncture treatment, the acupoints transmit acupuncture signals from the periphery to…
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The optimal endometrial preparation protocol in FET cycles of women with endometriosis.
Endometriosis can create infertility and may require treatment with assisted reproductive technology (ART) to induce pregnancy. However, the current literature rarely discusses the optimal endometrial preparation protocol in thawed-frozen embryo transfer (FET) cycles for endometriotic patients. Dr.Jin. group from the Reproductive Medicine Center, Huanzong University of Science and Technology, Wuhan, China explored different endometrial preparation regimes on pregnancy and perinatal outcomes in women with endometriosis after FET cycles. They studied three commonly used endometrial preparation protocols in a retrospective cohort research…
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Evaluation of the postoperative disability in women with endometriosis.
Endometriosis is a chronic disease with a prevalence of 4,4% in women of reproductive age. It is also estimated that 23,8 of infertile women have endometriosis. Pelvic pain, dyschezia, dysmenorrhea, and dysuria are the symptoms of this disease that negatively influence daily activities, self-care, physical and mental health, social well-being, and sexual intercourse. Laparoscopy, as a surgical treatment option for endometriosis, has a low-risk and minimally invasive type of surgery performed through small incision areas on the pelvis. However, even…
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Iron and toxic environmental elements in ovarian endometriomas
It is well-known that the growth of endometriotic lesions is estrogen-dependent and supported by inflammatory processes. In addition to oxidative stress, it is believed that several other factors, including chemicals and environmental factors, and genetic predisposition may play a potential role in the pathogenesis of endometriosis. Pascolo et al. from the Institute for Maternal and Child Health, Trieste, İtaly set up a histological and histochemical study regarding the evidence between endometriosis and altered iron metabolism with the truth of frequent…
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Ultrasonographic Presurgical Staging and Classification of Endometriosis
Laparoscopic surgery is the gold standard for diagnosing endometriosis, but a preoperative imaging procedure is strongly recommended. Transvaginal sonography by a skilled examiner is not inferior to MRI diagnostics regarding sensitivity and specificity in predicting the extension of deep endometriosis. Keckstein et al. from the Department of Obstetrics and Gynecology of the Medical University of Ulm, Germany, published a paper presenting recommendations and expert opinions in the field of non-invasive and invasive diagnostics besides the therapy of endometriosis. This paper…
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Imaging techniques for fallopian tubes
The imaging techniques used for suspected fallopian tube pathology are ultrasound, hysterosalpingo-contrast-sonography, hysterosalpingography, computed tomography, and magnetic resonance imaging. Among several benign lesions that involve fallopian tubes, pelvic inflammatory disease, tubo-ovarian abscess, salpingitis isthmica nodosa, hydrosalpinx, tubal endometriosis, isolated fallopian tube torsion, ectopic pregnancy, and benign neoplasms of tuba uterina. On the other hand, primary fallopian tube carcinoma and serous tubal intraepithelial carcinoma are their malign neoplasms. Some pathologies as peritoneal inclusion cysts, lymphocele, and acute appendicitis, mimic fallopian tube diseases.…
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Diagnostic criteria for uterosacral ligament involvement in endometriosis.
Transvaginal ultrasonography is often used to diagnose endometriosis in suspected women due to its high resolution, low cost, and relatively low discomfort. Histologic confirmation of laparoscopically removed specimens is still the gold standard for appropriate diagnosis. The team led by Dr. Mehdizadeh Kashi, from the Department of Obstetrics and Gynecology of Iran University, Tehran, Iran, intended to evaluate the diagnostic accuracy of transvaginal ultrasonography in uterosacral ligament involvement through a cross-sectional study carried out during 2019-2020. The results have recently…
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Adverse pregnancy outcomes and endometriosis.
Inflammation plays a big role in the pathogenesis of endometriosis with the release of inflammatory cytokines, angiogenic imbalance, and oxidative stress. These pathways are also common features of severe maternal morbidity. Severe maternal morbidity is life-threatening, causing cardiac and renal failure, eclampsia, severe hemorrhage, uterine rupture, and assisted ventilation requiring intensive-care conditions. There is an elevated risk of adverse defects, even death. To evaluate the association between endometriosis and the risk of severe maternal morbidity, Dr. Lafleur et al. from…
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Molecular and cellular mechanisms of fibrogenesis in endometriosis
Endometriosis lesions are characterized by endometrium-like cell proliferation, invasion, and oxidative stress associated with inflammation and neoangiogenesis. Fibrosis, which occurs due to these events, causes chronic pelvic pain depending on the location and the severity of endometriosis. For the purpose of explaining the mechanism of fibrosis, Garcia et al., from the University of Florance, Italy, wrote a review to explain the cellular and molecular mechanisms responsible for the development of fibrosis in endometriosis. The biological mechanisms and signaling pathways responsible…
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Ovarian endometriomas, ovarian reserve, oocyte quality and IVF/ICSI outcomes
Surgery and assisted reproductive technology (ART) are the preferred treatments for endometrioma in infertile patients. When ART is considered, surgery may seem to have no advantages, as it may not improve pregnancy outcomes and may carry the risk of decreasing ovarian reserve. Therefore for infertility specialists, ART becomes the first choice for infertile women with ovarian endometrioma. ART could be applied to women whose ovarian reserve is compromised and/or who are over 35 years of age with endometriomas below 40…
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What causes pelvic pain? Androgens or estrogens?
A comparison between women and men reveals that women suffer more pelvic pain. This reality raises the possibility of the pain-relieving effect of testosterone or androgens. It would be a wise solution to investigate how androgens affect pain at different stages of life and, if possible, plan pain treatment accordingly. In this review, Evans et al. from the University of Adelaide, Australia, investigated the relationship between serum levels of 10 steroid hormones and subjective menstrual pain complaints. The research team…
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Obstetric Outcomes of Pre-pregnancy Endometriosis Surgery
Endometriosis may be associated with poor pregnancy outcomes, including placenta praevia, preterm birth, premature prelabour rupture of membranes, obstetric hemorrhage, gestational hypertensive disorders, fetal growth restriction, and perinatal death. Some authors have attempted to demonstrate a causal relationship between endometriosis and obstetric complications. It is unknown whether pre-pregnancy surgery for endometriosis alters the risk of adverse obstetrics outcomes. Moreover, the effect of assisted reproductive technologies and comorbid adenomyosis on obstetric risk should be investigated. Dr. Samantha Mooney et al. from…
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Non-hormonal medication for endometriosis-associated pelvic pain
The thought of benefiting from non-hormonal therapy in endometriosis pain is based on the pathophysiological findings that include angiogenesis, fibrosis, the presence of inflammatory cytokines and immune cells, apoptosis, and stem cell theory. But the effect of this treatment in improving pelvic pain differs among studies. A group of researchers led by Dr. Sangioni from the Division of Gynecology and Obstetrics of the University of Cagliari, Italy, penned this systematic review composed of the evaluation of randomized control trials published over…
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Deep lateral parametrial endometriosis nerve-sparing surgery
Dr. Kanno et al. from the Department of Obstetrics and Gynecology of Kurashiki medical center, Okayama, Japan recently published a deep lateral parametrial endometriosis case report in the journal named Fertility and Sterility. The aim is to demonstrate the technical and anatomical features of nerve-sparing laparoscopic surgery for the parametrium via video. A 38 years old woman with severe chronic pelvic and gluteal pain that persisted for 5 years that was resistant to pharmacotherapies was found to be a right ovarian…
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Web-based resource to improve menstrual health awareness
Many women consider "menstrual pain" a normal part of being female, and do not seek medical help but rather use self-management methods such as heat, rest, and analgesics. They are often unsure which self-management strategies are effective or what the right choice is for analgesics and their doses. Armour et al. from NCIM Health Research Institute, Western Sydney University, Australia aimed to increase health literacy through menstrual education using web-based tools and intended to explore whether access to these resources…
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Exposure to toxic metals and the risk of endometriosis
Mercury, lead, and cadmium are the best-studied heavy metals for several adverse effects on the human reproductive system. Mercury can induce DNA damage, oxidative stress, and mitochondrial dysfunction, and lead exposure is associated with menstrual disorders, preterm birth, and miscarriage. Cadmium exposure can cause breast and endometrial cancer. Environmental pollution in recent years is being worsened by coal burning, mining, and the use of pesticides and organic fertilizers. Although these toxic metals have been shown to have endocrine-disrupting properties, their…
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The management of diaphragmatic endometriosis
Thoracic endometriosis is a rare disease, and it is likely to have been underdiagnosed and underreported. Optimal diagnostic testing and management options are yet to be determined. Imaging for thoracic endometriosis is still in its infancy, and MRI only helps to rule out other pulmonary diseases. Dr. McKee et al.from Mayo Clinic Arizona, Department of Medical and Surgical Gynecology, Arizona, USA, wrote a literature review of thoracic endometriosis to point out that to date, there is no guideline for the optimal…
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