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Endometriosis
Endometriosis is an estrogen-dependent inflammatory disease when the lining of the uterus (endometrium) is outside of the uterine cavity.
It is most often found on the lining of small pelvis and ovaries, but it also occurs on the intestines, urinary tract, diaphragm, in the abdominal cavity and in the chest cavity.
Endometriosis can be from a few square millimeters on the lining of the small pelvis to ovarian cysts (endometriomas) and massive scar tissue and adhesions.
During menstrual bleeding, bleeding occurs in places where endometriosis is present, which leads to pain and a chronic inflammatory reaction with the formation of scar tissue and adhesions.
- painful periods (dysmenorrhea);
- pain during sexual intercourse (dyspareunia);
- heavy menstruation;
- pains in the lower part of the stomach (from weak pains to chronic severe pains);
- infertility;
- nausea and vomiting;
- pain when urinating;
- chronic fatigue.
- Endometriosis occurs in about 10% of women of reproductive age.
- About 30-40% of women with infertility have endometriosis and
- about 70% of women with chronic pelvic pain suffer from endometriosis.
- the onset of menstrual bleeding in earlier years;
- short interval between menstrual bleedings;
- heavy menstrual bleeding;
- malformations of genital organs;
- low body mass index (BMI).
- women who have not given birth have an increased risk of endometriosis.
How is endometriosis diagnosed?
- conversation with the patient (anamnesis);
- gynecological examination;
- vaginal ultrasound examination;
- magnetic resonance imaging;
- laparoscopy with biopsy.
Treatment of endometriosis in Gyn-Fertility Clinic Milenković
Endometriosis is treated hormonally and surgically.
In addition, symptomatic therapy against pain (most often from the NSAID group) is administered.
Hormone therapy
Hormone therapy aims to block or reduce menstrual bleeding.
- contraceptive pills in continuous mode so that there is no menstrual bleeding;
- hormonal coil that also contains progesterone (and reduces or does not have menstrual bleeding at all);
- synthetic progesterone tablets or injections (no menstrual bleeding)
- of gonadotropic-releasing hormone (GnRH analogue)-no menstrual bleeding.
Surgical treatment of endometriosis in Gyn-Fertility Clinic Milenković
Surgical treatment aims to reduce pain and improve the chance of spontaneous or pregnancy after insemination and in vitro fertilization (IVF).
Laparoscopy is the method of choice in the surgical treatment of endometriosis.
It can be diagnostic with taking a tissue sample (biopsy) or operative when cysts on the ovaries, adhesions and scar tissue, ovary or uterus are removed (hysterectomy).
- The patient has a detailed conversation with the gynecologist before the final decision on the operation and fills out a detailed questionnaire about her health condition.
- Laparoscopic surgery is performed under general anesthesia. It is necessary to do a blood type and blood count, and then an examination by an anesthesiologist.
- The patient comes to the hospital on the day of the operation, possibly in the evening before the planned day of the operation and takes a shower with an antiseptic shampoo that she gets at Milenković Clinic.
- It is not allowed to take food and water 8 hours before the operation.
- The patient receives general anesthesia in the operating room.
- After placing the catheter in the urinary bladder and antiseptic preparation of the operative field, a 10-15 mm incision is made on the skin in the area of the navel.
- Carbon dioxide gas is injected into the abdominal cavity, which expands the space inside the stomach in order to obtain a better view and room for work.
A camera is inserted through the incision on the navel, and then, under the control of the camera, two or three more 5 mm skin incisions are made, through which laparoscopic surgical instruments are inserted. - The organs in the small pelvis and abdominal cavity are examined in detail.
- If changes are seen on the mucous membrane that correspond to endometriosis, a biopsy is taken and sent for histopathological examination. / The uterus is removed using a hysterectomy technique.
- At the end of the intervention, the gas is "ejected" from the abdominal cavity and the instruments are removed.
- Incisions on the skin are sutured with a suture that does not need to be removed.
- The patient goes to the patient room, where she first receives pain-relieving drugs;
- The catheter is removed from the urinary bladder no later than 24 hours after the operation, depending on which operation was performed;
- 2-3 hours after the operation, the patient first gets to drink the liquid, and then a light meal.
- It is desirable for the patient to start standing up and walking as soon as possible after the operation;
- The patient is most often discharged from the hospital on the day after the operation;
- After leaving the hospital, pain relief therapy is advised as follows: Paracetamol tablets 500 mg 2 tablets up to 4 times a day in combination with Brufen tablets 400-600 mg up to 3 times a day.
- It is advised to take time off from the work for up to 7-10 days, depending on how the patient feels;
- Showering is allowed on the same day after the operation, only it necessary to change the protective patch which is placed at the skin incision;
- Showering in the bathtub and swimming are not allowed ten days after the operation until the skin wound has healed;
- Physical training and sexual intercourses can usually be started 7-10 days after the operation, that is, when the patient herself feels that she is able to do it;
- The patient can try to get pregnant as early as in the next menstrual cycle after the operation (if the uterus has not been removed).
- Complications after laparoscopic surgery are very rare. In case of high fever or stomach pain, call +381 69 50 22222 or contact as at info@drmilenkovic.com
Treatment of infertility caused by endometriosis
- Intrauterine insemination;
- in vitro fertilization (IVF);
- laparoscopic surgery.
Expert advice: frequently asked questions
Answered by: Milan Milenković. MD, PhD
When is endometriosis surgery necessary?
Endometriosis is operated upon when the patient has pain that does not respond to drug therapy or it is estimated that surgical therapy would have a better effect. Also, endometriosis is operated in certain cases of infertility as well.
How long does the recovery take after endometriosis surgery?
The patient is most often discharged from the hospital on the day after laparoscopic surgery and can return to her usual activities 7-10 days after the intervention.
What are the chances of pregnancy after endometriosis surgery?
Surgery for minimal endometriosis on the mucous membrane of the small pelvis increases the chance of pregnancy, but it is hard to say in what percentage. Surgical treatment of ovarian endometriosis can often reduce the chance of pregnancy, so an individual assessment is required whether to operate or perform IVF.
How long after endometriosis surgery can you plan pregnancy?
Pregnancy can be planned a month or two after the operation. The best chances for a spontaneous pregnancy are in the first six months after the surgery.
How does endometriosis affect the success of IVF treatment?
The success of IVF treatment is the same in women who have endometriosis compared to women who do IVF for some other reason.
Is endometriosis surgery necessary before IVF treatment?
Endometriosis surgery is not necessary before IVF. Any ovarian endometriosis surgery reduces ovarian function and requires individual assessment.
Should egg cells be frozen in women with endometriosis?
Egg cells should be frozen if endometriosis affects the ovaries and reduces the ovarian reserve, and the woman does not plan to become pregnant in the near future. The assessment is individual.
Is the tumor marker Ca 125 elevated in women with endometriosis?
The tumor marker Ca 125 is often elevated in women who have endometriosis, especially when the endometriosis is on the mucous membrane of the abdominal cavity.
Does endometriosis complicate pregnancy?
Endometriosis generally remains unchanged or decreases during pregnancy. Complications caused by endometriosis are very rare in pregnancy.
