Gynecological Diseases & Women’s Health in Ankara
Gynecological Diseases is a broad term that includes inflammatory diseases concerning female reproductive organs, fibroids (myomas), various cysts, as well as infertility, vaginismus, and sexual dysfunctions.
Timely treatment of gynecological diseases increases the quality of life and prevents serious problems that may be encountered in the future. Regular check-ups are vital for early diagnosis.
Endometrial Hyperplasia (Thickening of the Uterine Lining)
In every woman of reproductive age, the inner lining of the uterus (Endometrium) reaches a certain thickness throughout the menstrual cycle. With the process we call menstruation, this tissue formed inside the uterus is shed, providing new tissue formation for the next cycle.
Endometrial Hyperplasia is the condition where this tissue inside the uterus fails to shed and accumulates due to various hormonal reasons. It is commonly referred to as “thickening of the uterine wall.” It is a significant condition because it has the potential to turn into uterine cancer (Endometrial Cancer) in later years.
Causes:
Ovarian cysts and tumors secreting hormones.
Polycystic Ovary Syndrome (PCOS).
Menstrual irregularities in the post-menarche (after first period) or pre-menopausal period.
Use of medicines containing only estrogen (without progesterone).
Symptoms & Diagnosis Patients mostly apply with complaints such as irregular and excessive menstrual bleeding or spotting that lasts for days before and after menstruation. Sometimes, it can be detected during routine gynecological examinations and check-ups without any complaints. Since post-menopausal women do not menstruate, diagnosis can be delayed in this group; therefore, annual gynecological examinations are of great importance.
When thickening of the uterine wall is detected, a Biopsy must be performed from inside the uterus. General or local anesthesia can be applied for the procedure. Today, when very thin plastic cannulas (Pipelle) are used for biopsy, it has become an extremely easy and short procedure that can be performed in outpatient clinic conditions. The biopsy material must be sent for pathological examination.
Treatment Cases of endometrial hyperplasia where cancer cells are not detected in the pathology result can be treated with a 3-month medication cure (Progesterone therapy). At the end of the treatment, full recovery is confirmed by performing a control biopsy. According to the pathology result, applying a Hormonal IUD (Mirena) is also beneficial for some patients after treatment. In cases with risk factors or a high probability of turning into cancer, a Hysterectomy (surgical removal of the uterus) is required.
Polycystic Ovary Syndrome (PCOS)
This disease, which we have heard frequently in recent years, causes confusion in many people and even leads to misdiagnoses because it has a very wide range of symptoms and findings. Although its incidence in society is up to 10%, the severe Polycystic Ovary Syndrome picture is much less common.
Symptoms & Diagnosis Patients mostly apply with complaints of menstrual irregularity, hirsutism (excessive hair growth), acne, and weight gain.
Ultrasound Findings: Increased follicle (egg) number in the ovaries and the settlement of these follicles on the edge of the ovary to form a “string of pearls” appearance is one of the typical diagnostic criteria.
Hormonal Profile: Detecting an LH/FSH ratio of 2 times or more and an increase in Androgens (male hormones) are also among the findings.
Metabolic Signs: Insulin resistance and an increase in blood lipids can be seen, especially in obese patients. Slight prolactin elevation is also among possible findings.
Causes of Irregularity & Infertility The reason for menstrual irregularity, especially delayed periods in patients with Polycystic Ovary Syndrome, is delayed ovulation. Therefore, classic ovulation day predictions are not valid for these patients. While ovulation is delayed by only 10 days in some patients, this process can extend up to 6 months in others.
This is the most important reason for infertility seen in nearly 20% of patients with PCOS. Also, since the inside of the uterus is exposed to the estrogen hormone for a long time (unopposed estrogen), the probability of seeing Endometrial Hyperplasia and even uterine cancer in unmonitored cases relatively increases.
Due to increased insulin resistance and blood lipids, especially in obese patients, the probability of seeing metabolic diseases such as Diabetes Mellitus, Hypertension, and Hypercholesterolemia in advanced ages also increases.
Treatment of PCOS Although there are some theories, PCOS is a disease whose cause is not known for certain. Therefore, its treatment is planned according to the symptoms.
Weight Loss: In obese patients, reducing the Body Mass Index (BMI) should be the primary goal. In some patients, just losing weight can eliminate all symptoms.
Medical Treatment: Anti-androgens or cyclic treatments (Birth control pills) should be planned for acne and hirsutism complaints.
Fertility: Treatment options should be arranged considering whether patients with menstrual irregularity want children or not.
With good follow-up and treatment, the negative effects of Polycystic Ovary Syndrome can be minimized, offering the patient an optimal life option.