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.

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…

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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…

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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…

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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…

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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…

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Laparoscopic Approach to Rectus Muscle Endometriosis and Inguinal Endometriosis - Ted Lee, MD

Rectus muscle endometriosis and inguinal endometriosis are two rare types of endometriosis. Operation room videos of several patients with different rectus muscle endometriosis and inguinal endometriosis are shared during the presentation of Dr. Lee to clarify the methods of the laparoscopic approach to these diseases. More than seventeen percent of abdominal wall endometriosis involves rectus muscles. The main symptom is cyclic abdominal pain with or without palpable mass on rectus muscles and this pain is worsening with activities that engage…

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Further Evidence that endometriosis is related to tubal or ovarian cancer - Togas Tulandi, MD

Most authors suggest an association of endometriosis mainly with clear cell, low-grade serous, and endometrioid ovarian cancer.  But in two large cohort studies, no correlation between them is reported (Olson et al. 2002 and Tseng et al. 2019) Dr. Tulandi and his collaborators used the Healthcare Cost and Utilization Project data, which is the largest collection of longitudinal hospital care data in the United States, and checked nearly 77 million patients between 2005-2014 to identify the relation between endometriosis and adnexal cancers.…

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Insoluble Dilemma of Adenomyosis: Diagnosis, Management, and Treatment  - Errico Zupi, MD

The prevalence of adenomyosis has been reported to range from 1% to 70% in different studies. This large range can be explained by the lack of standard diagnostic criteria by imaging modalities or pathological analyses. Sixty-five% of the women with adenomyosis have clinical symptoms of abnormal uterine bleeding and dysmenorrhea. Additionally, there is an increasing diagnosis of adenomyosis among young women who consult infertility clinics. The FIGO group declared adenomyosis as a disease that is responsible for abnormal uterine bleeding in the…

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Fixing holes: prevention and treatment of complications - Jon Einarsson, MD, MPH

Dr. Einarsson shared his operating room video screens during his speech for discussing four major complications (ureter, bladder,  bowel, and vascular) of endometriosis surgery and the ways to repair them. Fixing the ureter damage: Endometriotic nodules may settle on the tract of ureters, and their removal may cause ureteral damage. The best way to approach this is to cut them from their healthy surface and restore end-to-end anastomosis. Separation of the ureter surface very carefully and passing a stent while constructing…

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Limits of endometrioma surgery in infertility patients - Liselotte Mettler, MD, PhD

The removal of endometrioma may affect ovarian reserve because healthy follicles near endometrioma could also be excised during this procedure. Another concern about the ovarian reserve is that it may be already low before the surgery. Anti Mullerian Hormone (AMH) is an indicator of ovarian reserve, and it always surges down after excision of endometrioma.  If the patient wishes to get pregnant, the gynecologist is concerned not only with the number of healthy follicles but also with the quality of…

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Endometriosis and the sexual relations of the couples

From the viewpoint of endometriotic women, the pain during the penetration is not the only complaint. They also have growing depression and anxiety leading to difficulties with their social and sexual relationship, work, and study. The emotional impact of sub-infertility, the uncertainty of future related repeated surgeries, and the long duration of treatment all aggravate their psychological disturbance. The need to investigate the psychological impact of endometriosis on women was highlighted in the 2013 ESHRE meeting.  Published studies on this…

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Endometriosis and chronic opioid use

The members of the American College of Obstetricians and Gynecologists have declared that gynecologists prescribe opioids after laparoscopic hysterectomy, or for relieving endometriosis pain, although guidelines are not available for when or how to use opioids for the treatment of endometriosis-associated pain, and the data on the potential negative consequences of opioid use in the general population is rising. To identify the potential risk factors for opioid use and long-term addiction, Dr. Lamvu et al., from Orlando Veterans Affairs Medical Center,…

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Comparison of diagnostic accuracy of imaging modalities for the deep infiltrating endometriosis

The treatment of deeply infiltrated endometriosis (DIE) is usually personalized and the potential success for the available therapeutical options is dependent on early and accurate diagnosis. Laparoscopy is the gold standard for the diagnosis of DIE. Other non-invasive diagnostic methods including physical examination and imaging techniques such as Transvaginal ultrasound (TVUS), transrectal ultrasound (TRUS), and magnetic resonance imaging (MRI) have never been assessed and compared for the diagnostic accuracy for the diagnosis of DIE. Zhang et al., from the Department of…

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Patients' opinion about surgical treatment of endometriosis

Delayed diagnosis and management of endometriosis and chronic pelvic pain is a major problem in gynecologic practice. Alternatively, providers may feel reluctant to perform surgery although they are aware of treatment options and surgical timing. One possible reason for this delay could be the postoperative regret of the patient if symptom relief is not achieved. To relieve the gynecologist in this regard, Misal et al., from the Department of Gynecology, Mayo Clinic, Arizona, USA calculated the postoperative contentment of patients by…

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Indocyanine green in endometriosis surgery

Recently, indocyanine green is well studied and used safely in real-time perfusion to organs or tissues, after taking into consideration its binding capacity to the plasma proteins. The usefulness and the effectiveness of near-infrared camera guided indocyanine green is proved with its common use in colorectal surgery in case of assessing the perfusion of the bowel and visualizing the transecting line. Using indocyanine green to evaluate the peritoneal endometriosis lesions is in its infancy and no current clear indications to use for…

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The peculiarity of adolescent endometriosis

Recent studies showed the prevalence of endometriosis in adolescents with chronic cyclic or acyclic pelvic pain is about 60-70%. Moreover, all stages of endometriosis, including deeply infiltrating endometriosis can be found in this population. Gubbels et al. from the Department of Obstetrics and Gynecology, University of Rochester Medical Center, NY, USA, penned a literature review of adolescent endometriosis to indicate the importance of early diagnosis. This paper recently published in the "Obstetrical and Gynecological Survey". In this comprehensive review, the…

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Endometriosis-related obstetrical complications and their outcome

Borisova et al. from the Department of Gynecology and Obstetrics of Peoples' Friendship University, Moskow, Russia, and her colleagues from the Center of Perinatal and Reproductive Medicine of University Perugia, Italy, recently published a review of the literature data about obstetrical outcomes of pregnant women with a history of endometriosis in the "Journal of Maternal-Fetal & Neonatal Medicine".  The aim of the study is to call attention to the importance of adverse obstetrical outcomes during the pregnancy follow-up of the…

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Predictors of voiding dysfunction after surgery for deep endometriosis

While surgery for deep endometriosis provides relief and improves the quality of life in symptomatic patients for whom medical therapy has limited effect, it may also create postoperative lower urinary tract dysfunction. Moreover, postoperative voiding dysfunction could affect the quality of life as many as 20-30% of patients. If clinicians have a useful nomogram to predict the aforementioned dysfunctions preoperatively, they could better inform their patients about these postoperative risks. Vesale and Roman et al. from the Department of Obstetrics…

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Deep Endometriosis or Recto-uterine Obliteration Without Endometrioma

The diagnostic help of ultrasound is increasing by its ability to diagnose deep infiltrating and rectouterine pouch obliteration in patients who are suffering from chronic pelvic pain. Clinicians are used to evaluating the rectal and parametrial areas of the endometriotic women by transvaginal ultrasound cautiously when they primarily diagnose ovarian endometrioma. This habit could be changed if the notification can be made that there could be rectal pouch obliteration and deep invasion of endometriosis even the patient has normal ovaries.…

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Benefits of Nerve-Sparing Hysterectomy

The retroperitoneal spread of endometriosis or cancer may involve pelvic autonomic nerves situated on the lateral aspects of uterosacral ligaments, vesicouterine ligaments, and medial aspects of parametria. During the conventional open hysterectomy operations, nerve-sparing excision is very difficult, simply because pelvic autonomic nerves are thin and difficult to see to the naked eye. On the contrary, during the laparoscopic hysterectomy, high definition endoscopic camera eases to perform nerve-sparing. Magrina et al. from the Department of Medical and Surgical Gynecology, Mayo Clinic, Phoenix, USA,…

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