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.

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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Endometriosis and the possible mechanisms of pain.

The most common clinical symptoms of endometriosis are chronic pelvic pain and infertility. It is often not enough to treat pain symptoms with hormonal therapy or a surgical approach. Moreover, the stage of endometriosis has weakly associated with the amount, size, location, and degree of pelvic pain.  In this review, Fan et al. from the Department of Obstetrics and Gynecology of Tongi Medical College, Huazhong University, Wuhan, China, explained the possible pathways of pain in endometriosis with literature-based evidence. Based on…

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A prediction model to identify endometriosis during routine ultrasound .

. Ureterolysis is an advanced surgical technique that involves dissection of the ureter from pelvic brim to the ureteric tunnel to avoid injury or freeing the ureter from endometriotic lesions. This manipulation usually requieres advanced surgical training and skill. In the absence of preoperative prediction sites with deeply invaded endometriosis, the improper hands not only can cause inadequate cytoreduction but also cause destruction of the ureters. Therefore, preoperative transvaginal ultrasonography that predicts deep endometriosis and possible ureterolysis is essential. .…

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Parametrial endometriosis and postoperative voiding dysfunction.

Parametrium constitutes a complex connective tissue containing blood vessels, the ureter, and the inferior hypogastric plexus, that extends from the lateral surface of the cervix and vagina to the lateral pelvic wall. Parametrial endometriosis may involve the vessels, nerves, and ureters in this compartment. Surgical removal of this space is not only difficult but also necessitates longer operating time and has intraoperative morbidity. Moreover, damage to the sympathetic and parasympathetic fibers will result in novel neurogenic postoperative pelvic organ dysfunctions.…

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Pelvic pain characteristics in young girls with endometriosis.

The occurrence of severe and frequent pelvic pain in young women is a piece of evidence that endometriosis begins and develops at an early age. Two-thirds of women with endometriosis who were diagnosed in their adulthood reported the onset of symptoms in their adolescence. However, the lack of basic knowledge about the physiopathology of pelvic pain and its relation to endometriosis causes complexity in planning individualized treatment. Dr. Sasamato et al. from the Department of Obstet and Reproductive Biology of…

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Endometriosis Prediction by "Machine Learning"

To develop a predictive model for endometriosis and to re-assess the contribution of known risk factors, Blass et al. from the Hebrew University of Jerusalem, Jerusalem, Israel used the data of the UK biobank by machine learning-based models. They compared and statistically evaluated the personal data of 5924 women with the diagnosis of endometriosis to 71,088 control samples. The UK biobank covers 500.000 participants collected from 23 medical centers across the UK. After retrospectively analyzing over 1000 variables including personal information…

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To Remove the Ovary(ies) or Not During Hysterectomy for Endometriosis

Some surgeons prefer empiric bilateral salpingo-oophorectomy during the hysterectomy of women with endometriosis based on the knowledge that endometriosis is stimulated by endogenous estrogens, as leaving the ovaries in situ may increase the possibility of endometriosis recurrence and pelvic pain. However, the cause of pelvic pain is multifactorial and complex to deal with.  A rather low reoperation rate was reported in hysterectomy with bilateral oophorectomy compared to the operation with preserved ovaries. On the other hand, after oophorectomy,  premature surgical…

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Endometriosis and environmental factors

The estrogen-dependent nature of endometriosis has generally led to search endocrine-based causes. Especially, polychlorinated biphenyls, dioxins, and Dietilstilbesterol are the most studied chemicals in the literature. Interesting data that needs confirmation in the future also suggest a link with night work, red meat consumption, and sun exposure.  Restoring a link between endometriosis development and these various lifestyle factors or chemicals seems complicated due to the average 7 years delay between the beginning of symptoms and diagnosis of the disease. Coiplet…

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The Oocyte Quality in Ovarian Endometriosis

Endometrioma is the ovarian involvement of endometriosis affecting up to 44% of women diagnosed with the disease. Owing to the anatomical locus, ovarian endometriosis may impair folliculogenesis and oocyte competence, differing from other forms of endometriosis.  When investigating the relationship between endometrioma and pregnancy outcomes it would be helpful to consider the clinical settings of assisted reproductive techniques which need to measure oocyte quality and development. In the need to assess the effect of endometrioma on oocyte sufficiency, numerous aspects of…

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Validity of Magnetic Resonance Imaging for Deep Pelvic Endometriosis.

Video laparoscopy has become a valuable tool for diagnosing and managing endometriosis in recent years. In cases associated with deep infiltrating endometriosis, the need for a non-invasive diagnostic method before laparoscopic evaluation paves the way for using MRI.  The use of MRI becomes important to precise the location and spread of the disease.  Manti et al. together with the radiology and the pathology departments of Magnea Grazia University, Catanzaro, Italy, intended to evaluate the diagnostic accuracy of MRI for surgical…

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Does the timing of endometriosis diagnosis affect optimal infertility treatment?

Based on a retrospective population-linked data study in "Human Reproduction", the ESHRE journal club featured a detailed discussion with 50 participants, patients’ representatives, and experts (Paola Vigano´, Mathew Leonardi, Thomas D’Hooghe, Louise Hull), together with the authors of the original article, mainly concerning the relevance of diagnosis timeliness, and the reliability of linking national medical records. Dr. Sofia Makieva, from Zurich University, Swiss, and her colleagues penned this report as a summary of the above discussion and published it in the June…

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Evaluation of retrocervical and parametrial deep endometriosis by detailed ultrasonography

The accuracy of ultrasonographic diagnosis of deep endometriosis in the retrocervical and parametrial areas may be poor due to the variable morphology of endometriotic lesions, the complex structure of the posterior parametrial compartment, and the difference in examiners' experience level. The absence of common terminology between sonographers and surgeons and the weak correlation between anatomical landmarks also may be causative factors. The paper entitled "Ultrasound Evaluation of Retrocervical and Parametrial Deep Endometriosis on the Basis of Surgical Anatomical Landmarks" by Giovanni et…

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Fertility assessment and surgical approach in endometriotic patients.

The prevalence of endometriosis is around 50-70% in women with pelvic pain, and it has been reported as 50% in patients with infertility. Severe adhesive disease associated with advanced endometriosis is a cause of fertility impairment. The relationship between endometriosis and infertility could be due to distorted pelvic anatomy, cycle irregularity, impairment of follicular growth, lower oocyte and embryo quality, altered peritoneal function, and luteal phase dysfunction. The possibility of coexistence with other disorders such as adenomyosis and fibroids also…

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Postoperative outcomes of deep intestinal endometriosis surgery.

Invasion of endometriotic lesions to the bowels' mucosal and/or muscular levels is called intestinal deep endometriosis. These lesions are most frequently found in the rectosigmoid colon, followed by the rectum, ileum,  appendix, and caecum. The optimal surgical approach to intestinal deep endometriosis is still debated due to weighing risks to benefits. Therefore, the choice of radical surgery as segmental resection and conservative surgery as shaving or full-thickness wall excision is controversial. Improving the quality of postoperative life and decreasing recurrence should…

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The accuracy of transvaginal ultrasound and magnetic resonance imaging for deep urinary tract endometrisis.

The prevalence of urinary tract endometriosis is 19-53% in patients within deep infiltrating endometriosis cases. The bladder and ureteral are the most common sites of the involvement. While preparing a radical surgery for a patient with deep endometriosis, the diagnosis of urinary tract endometriosis is important because the involvement of the bladder or ureters could be clinically asymptomatic.  Transvaginal ultrasonography (TVS) was the most preferred method until the discovery of Magnetic resonance imaging (MRI), which is known to improve the diagnostic accuracy…

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Chronic pelvic pain and endometriosis

Patients may have an average of 7 clinical visits before being diagnosed with endometriosis. Understanding chronic pain conditions including endometriosis-associated pain, and developing chronic pelvic pain benefits the management of the patients. The role of central sensitization, comorbid conditions, and biophysical factors become important in the pain experience and treatment outcomes. In this literature review, Green et al. from the Department of Obstetrics and Gynecology at Mayo Clinic, Rochester, Minnesota, the USA, aimed to identify chronic pain conditions and to…

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Early menarche increases the risk of endometriosis.

Early menarche is the first menstrual bleeding occurring before 12 years of age. The timing of normal puberty in girls varies between nations due to genetic, socioeconomic, and environmental factors. Notably, the age of menarche decreased significantly in teenagers born after 2000 with the improvement in the socio-economic conditions in some populations. Lu et al. from Shenzhen Baoan Women's and Children Hospital, Jinan University, Guangdong, China aimed to update the knowledge about the association between early menarche and endometriosis risk.…

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