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.

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…

Key Points Lay Summary

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…

Key Points Lay Summary

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…

Key Points Lay Summary

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…

Key Points Lay Summary

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.…

Key Points Lay Summary

The relation between body mass index and endometriosis

The studies have emphasized a link between low BMI values and endometriosis, however, this conclusion may be questionable when the estrogen dependence of the disease is concerned. Excess adipose tissue may produce higher circulating estrogen that may result in an increased inflammatory response as well as estrogen-dependent conditions.  The evaluation of BMI changes in young women with or without endometriosis for a certain period of time could be helpful to clarify the issue. Rowlands et al. from the School of…

Key Points Lay Summary

The consequence of COVID-19 pandemic on endometriosis patients

The relevant policies and restrictions concerning Covid-19 have prevented patients from accessing medical care. Similarly, standard care for endometriosis patients has also been negatively impacted by postponed or canceled appointments and suspended surgeries across the countries. Women trying to cope with pain, subfertility, frustration about disease recurrence, and uncertainty during this period were exposed to a risk of negative physiological effects, and deterioration in their quality of life.  Ashkenazi et al. from Pomeranian Medical University, Poland, aimed to explore the effect…

Key Points Lay Summary

Comparison of imaging techniques for estimating the depth of bowel wall infiltration by endometriosis.

The surgical removal of deep endometriosis is the cornerstone of the management. However, the decision for the varying surgical approach types ranging from conservative management (shaving) to segmental or discoid resection depends on the depth of infiltration within the bowel wall, which should be assessed by appropriate preoperative imaging workup. In other words, preoperative workup influences the course of surgery, the need for a multidisciplinary surgical team, and the postoperative course of the disease. However, there is currently no strict recommendation on the surgical technique…

Key Points Lay Summary

Social media and endometriosis management

Endometriosis has a negative impact on social life, work, daily activities, personal relationship, and overall quality of life. A study from Australia recently published in the Australian New Zeland Journal of Obstetrics and Gynaecology reports that social media helps these patients to share their personal troubles and engage with other users.  To better understand the role of social media as a self-management tool for patients who were diagnosed with endometriosis, van den Haspel and colleagues from Royal Women's Hospital, Melbourne,…

Key Points Lay Summary

The incidence of ovarian cancer after histologically diagnosed endometriosis.

Ovarian cancer has the highest mortality rate among gynecologic cancers. Furthermore, these patients are generally diagnosed in advanced stage due to their non-symptomatic nature. Therefore, preventative strategies have enormous importance for the management of ovarian cancer.  Dr. Hermens and colleagues from the Department of Obstetrics and Gynecology of Catharina Hospital, Eindhoven, the Netherlands, aimed to assess the incidence of ovarian cancer in women with histologically proven endometriosis in a retrospective national cohort study. The authors compared two histologically proven endometriosis cohorts,…

Key Points Lay Summary

Distribution of tubal endometriosis

The incidence of tubal endometriosis was previously reported in a percentage of 4 to 11, but recent studies gave a prevalence up to 42.5 % which indicates the actual incidence of this disease is underestimated.  Some studies in recent literature suggested that endometrioma as well as left deeply infiltrating endometriosis are more likely to occur on the left side, compared to the right. According to Sampson's theory, the explanation for this left-side involvement is related to the presence of the…

Key Points Lay Summary

Endometriosis diagnosis and management based on the best available evidence from published literature

ESHRE, "European Society of Human Reproduction and Embryology" published a Guideline for the diagnosis and treatment of endometriosis in 2005 and then revised it in 2013. Based on new research and development there was a need to renew the last version of the ESHRE Guideline.  A core guideline development group was formed that included former members of the ESHRE guideline group and a subgroup of European experts who evaluate data coming from two patient representatives and five patient organizations. This group…

Key Points Lay Summary

Prevalence of endometriosis and adenomyosis by transvaginal ultrasound.

Women who present dyspareunia, dysmenorrhea, dysuria, dyschezia, chronic abdominal, and pelvic pain, and infertility would benefit from the early investigation. If the correct diagnosis of endometriosis and/or adenomyosis can be made in advance, early treatment will improve the quality of life in these patients. Transvaginal ultrasound is considered an accurate method for the diagnosis of endometriosis and adenomyosis as a first-line diagnostic method apart from its cost-effective nature. This retrospective cross-sectional study by Orlov et al. from the Department of…

Key Points Lay Summary

Planning surgery for recto-sigmoid endometriosis with 3D virtual models.

Efforts to reduce the high complication rate of rectosigmoid surgery in deeply infiltrated endometriosis are of great interest to gynecologists. 3D printing, currently used in various surgical specialties to support surgical planning and guide intraoperative procedures may be a way out. Borghese and colleagues from the Department of Medical and Surgical Sciences of the University of Bologne, Italy came up with the idea of using 3D models based on preoperative MRI segments of patients with recto-sigmoid endometriosis and comparing them…

Key Points Lay Summary

A French National Study Concerning The "Recovery Protocol" After Deep Infiltrating Endometriosis Surgery.

In recent years especially for complex surgeries, enhanced recovery after surgery (ERAS) programs have been implemented in several surgical specialties. This is based on a multimodal and multidisciplinary approach centered on the patient’s perioperative situation designed to improve patient management and reduce the hospital stay. In France, ERAS program guidelines for surgical procedures were published in 2016 by the French National Health Agency.  Deep infiltrating endometriosis (DIE) is a serious form of the disease, surgery for DIE can be complex and surgery may…

Key Points Lay Summary

A novel scoring tool to standardize surgical complexity for gynecologists.

The field of gynecologic surgery needs a more comprehensive, objective, and reproducible method for assessing and communicating surgical complexity than the current approach. Actually, there is no formal image-based system that allows surgeons to categorize and communicate the complexity of endoscopic hysterectomies. The aim of this study is to develop a system specifically for endoscopic hysterectomy through the creation of a novel scoring tool based on a review of surgical images.  Misal et al from the Department of Gynecology, Mayo…

Key Points Lay Summary

Algorithm for pain management in endometriosis

One of the debilitating symptoms of endometriosis is pain. Mostly due to delayed diagnosis and the high recurrence rate, even after the surgical and hormonal therapy pain control may not be sufficient causing the patient to suffer for decades.  Endometriosis-associated pain is caused by peripheral and central sensitization. Peripheral pain is due to the lesions themselves, and from the related nerve fibers.  This type of pain can be treated hormonally and surgically, as well as using analgesics. However, the continuous pain…

Key Points Lay Summary

Diaphragmatic endometriosis

Diaphragmatic endometriosis is a rare clinical condition that may show signs and symptoms like chest pain, right upper quadrant abdominal pain, shoulder pain, pleuritic pain, hemothorax, pneumothorax, hemoptysis, and thoracic endometriosis syndrome while the major part of the patients is asymptomatic (70%). The clinical diagnosis of this form of endometriosis is difficult due to the low sensitivity of imaging techniques and the lack of symptoms in most of the patients.  To reveal the feasibility, safety, and effectiveness of the minimally…

Key Points Lay Summary

Nerve-sparing technique for deep infiltrating endometriosis and its impacts on pelvic organ and sexual functions.

Deep infiltrating endometriosis and involvement of parametrium cause severe pelvic pain and dysfunction of some pelvic organs resulting in a reduction in women's quality of life. Although surgery for DIE aims to relieve pelvic pain, entering into the posterior parametrial spaces may also result in accidental pelvic nerve injury. Particularly for cases with posterior parametrial involvement, nerve-sparing excision surgery has recently been added to laparoscopic surgery in tertiary clinics, however, only a few cohort studies investigated the functional outcomes. Ianieri…

Key Points Lay Summary

A comparison of endometriosis Classifications: rASRM, EFI or Enzian?

None of the endometriosis classifications provide a clinically valuable system since the very first description of the disease in 1860. One unique terminology to describe the localization and the extension of the disease is needed, which should be the same for surgeons and imaging experts. A common language is essential due to the multidisciplinary aspect of the disease that involves radiologists, sonographers, gynecologists, and experts in gynecological, colorectal, and urological surgery.  One of the major classifications for endometriosis is rASRM …

Key Points Lay Summary