Endometriosis Treatment in Istanbul, Turkey

What Is Endometriosis?

Endometriosis is a chronic inflammatory disease characterized by the presence of endometrium-like tissue outside the uterine cavity.

These lesions may respond to hormonal changes during the menstrual cycle and can be associated with inflammation, fibrosis, adhesions and chronic pelvic pain.

Endometriosis commonly affects:

• Ovaries.

• Pelvic peritoneum.

• Uterosacral ligaments.

• Pouch of Douglas.

• Rectovaginal septum.

• Bladder and bowel in selected cases.

The condition may present in different forms and degrees of severity. The extent of visible disease does not always correspond to the intensity of symptoms. Some patients experience significant pain with limited visible disease, while others may have extensive endometriosis with relatively few symptoms.

Common Symptoms of Endometriosis

Symptoms of endometriosis vary between patients. Some women experience severe menstrual pain, while others primarily report chronic pelvic discomfort or fertility problems.

Common symptoms include:

Painful Menstruation (Dysmenorrhea)

Menstrual pain associated with endometriosis may be severe enough to interfere with daily activities, work and quality of life.

Pain may begin before menstruation and continue throughout the menstrual period.

Chronic Pelvic Pain

Persistent or recurrent pelvic pain is a common presentation. The pain may occur during menstruation or at other times of the menstrual cycle.

Deep Pain During Sexual Intercourse (Dyspareunia)

Deep pelvic pain during or after sexual intercourse may occur, particularly when endometriosis involves the uterosacral ligaments, posterior pelvic compartment or rectovaginal region.

Painful Bowel Movements (Dyschezia)

Some patients experience painful bowel movements, especially during menstruation. This may be associated with deep infiltrating endometriosis involving the bowel or surrounding pelvic structures.

Urinary Symptoms

Endometriosis affecting the bladder or urinary tract may cause cyclical urinary discomfort, painful urination or, less commonly, blood in the urine.

Infertility

Endometriosis may be associated with reduced fertility through several mechanisms, including pelvic adhesions, altered pelvic anatomy, ovarian involvement and other reproductive factors.

Not every patient with endometriosis experiences infertility.

Types of Endometriosis

Endometriosis can be classified according to the location and characteristics of the lesions.

Superficial Peritoneal Endometriosis

This form involves superficial endometriotic lesions on the pelvic peritoneum. The lesions may be subtle and difficult to identify through routine imaging.

Ovarian Endometrioma (Chocolate Cyst)

An endometrioma is an ovarian cyst associated with endometriosis. It commonly contains thick, dark, old blood and is often referred to as a chocolate cyst.

Endometriomas may be associated with pelvic pain, adhesions and reduced ovarian reserve.

Treatment decisions should consider cyst characteristics, symptoms, ovarian reserve and reproductive plans. Surgery is not automatically required for every endometrioma.

Deep Infiltrating Endometriosis

Deep infiltrating endometriosis involves lesions extending beneath the peritoneal surface and may affect structures such as:

• Uterosacral ligaments.

• Rectovaginal septum.

• Rectum and sigmoid colon.

• Bladder.

• Ureters.

Patients with suspected deep infiltrating endometriosis may require detailed pelvic imaging and multidisciplinary assessment before treatment planning.

Diagnosis of Endometriosis in Istanbul

An accurate diagnosis begins with a detailed evaluation of symptoms, menstrual history, previous treatments and reproductive goals.

The diagnostic process may include:

1. Gynecological Examination

A pelvic examination may identify tenderness, reduced organ mobility, pelvic nodules or an adnexal mass.

A normal examination does not exclude endometriosis.

2. Transvaginal Ultrasound

Transvaginal ultrasound is an important imaging method for evaluating ovarian endometriomas and selected forms of deep endometriosis.

The examination may assess:

• Ovarian endometriomas.

• Pelvic anatomy.

• Adhesion-related findings.

• Deep endometriotic lesions when visible.

• Other possible causes of pelvic pain.

3. Pelvic MRI

Magnetic resonance imaging may be useful when deep infiltrating endometriosis is suspected or when more detailed anatomical assessment is needed for treatment planning.

4. Diagnostic Laparoscopy

Laparoscopy allows direct visualization of the pelvic cavity and may be used for diagnosis and treatment in selected patients.

However, diagnostic laparoscopy is not required in every patient. Clinical assessment and imaging may be sufficient to establish a working diagnosis and begin appropriate treatment.

A negative ultrasound or MRI does not completely exclude endometriosis, particularly superficial peritoneal disease.

Endometriosis Treatment Options

There is no single treatment suitable for every patient with endometriosis.

The choice of treatment depends on pain severity, lesion location, ovarian involvement, previous treatment response, fertility plans and patient preferences.

The main treatment approaches include medical management, surgical treatment and supportive care.

Medical Treatment of Endometriosis

Medical treatment aims to reduce endometriosis-associated pain and suppress hormonal stimulation of endometriotic lesions.

Depending on the patient’s medical history and reproductive goals, treatment options may include:

• Combined hormonal contraceptives.

• Progestogens.

• Levonorgestrel-releasing intrauterine systems in selected patients.

• GnRH agonists.

• GnRH antagonists.

• Non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief.

The selection of medication requires individual assessment of contraindications, adverse effects and treatment goals.

Hormonal treatment can help control symptoms but does not permanently eliminate endometriosis.

Hormonal suppression is generally not used to improve spontaneous pregnancy rates in patients actively trying to conceive.

Laparoscopic Endometriosis Surgery in Istanbul

Laparoscopic surgery may be considered for patients with persistent symptoms, selected ovarian endometriomas, deep infiltrating disease or other clinically significant findings.

The procedure is performed through small abdominal incisions using a camera and specialized surgical instruments.

Depending on the location and extent of disease, surgical management may involve:

• Excision of endometriotic lesions.

• Treatment of superficial peritoneal endometriosis.

• Adhesiolysis to restore pelvic anatomy when appropriate.

• Ovarian endometrioma surgery in selected cases.

• Management of deep infiltrating endometriosis with appropriate specialist planning.

The objective is to treat clinically significant disease while minimizing unnecessary damage to healthy ovarian and pelvic tissue.

For complex deep endometriosis involving the bowel, bladder or ureters, multidisciplinary surgical planning may be necessary.