Our clinical practices that enable us perform all up-to-date and evidence-based diagnoses and treatments and our studies on endometriosis make our center regarded among pioneering clinics of the world in this field.
Endometriosis may occur at various stages of women’s life and it is manifested by various problems; the condition has no curative treatment until menopause. Patients are evaluated from a holistic perspective in our endometriosis center and next, we aim to inform and educate them on endometriosis in order to allow them make informed choices among available therapeutic options for their problems, if any. Our center offers services by a team that involves numerous disciplines due to the very nature of endometriosis. Our team members include gynecologists and obstetricians who are experienced in endometriosis along with experienced urologists, general surgeons, anesthesiologists and physiatrists who may contribute to the treatment.
Our endometriosis center provides patients with ethical and principle-oriented healthcare services for almost the entire spectrum of complaints caused by the disease. Our major goal is to restore the impaired quality of life in women who are diagnosed with this condition. For this purpose, our team primarily uses the most advanced diagnostic tools and technical equipment that are available in its infrastructure in order to diagnose the condition and determine its clinical pictures. Our team is distinctive, as all complaints of our patients are taken into consideration carefully and we have a broad experience.
What are signs and symptoms of endometriosis? What do patients with this condition feel?
Endometriosis may be the underlying cause of numerous complaints that do not resemble each other, such as abdominal and pelvic pain that is not related with a menstrual cycle, infertility (inability and difficulty to conceive), painful intercourse, intestinal complaints associated with constipation or diarrhea, bladder pain, voiding problems, low back and hip pain, numbed skin, weakness of muscles in legs or feet, distension, severe fatigue, weakness and respiratory problems during menstrual cycles. Although the condition is same, it is manifested by different complaints in different patients. Considering the spectrum of complaints, the most common one is ‘pain’ that is also mentioned in broad definition of the condition.
Severe menstrual pain does not have to be the only manifestation; endometriosis may be a period-independent condition that is manifested by chronic and persistent pain and it may even occur in women who do not menstruate.
Although endometriosis is simply defined as “presence of a part of interior lining of the womb (endometrium) in any other organ or tissue” and “onset of bleeding in the involved tissue”, the tissue that leads to endometriosis is similar to, but not identical, endometrium and it causes pain, inflammation, chocolate cysts (endometrioma), adhesions, fibrosis and dysfunction in relevant organs. In this disease, certain complex changes may also be observed in immune and hormone systems of the body.
Although endometriosis is more prevalent in women at reproductive age, it is possible to diagnose the condition in menorrheic and amenorrheic women, patients who had undergone hysterectomy, postmenopausal women and even adolescents who have not menstruated yet. The condition is especially common in young girls; it may be mostly skipped and ignored or it is diagnosed late. Seventy percent of women with pelvic pain at younger ages are diagnosed with endometriosis in subsequent years of their lives.
Endometriosis is commonly manifested by following signs and symptoms:
- Severe menstrual pain
- Severe and long-standing abdominal pain that is not related to the menstrual cycle
- Painful intercourse
- Pain caused by use of tampon or inability to use tampon
- Painful bowel movements, painful voiding, blood in feces or urine
- Infertility, miscarriage, preterm delivery
- Allergy and associating immunological diseases
- Low back and leg pain (endometriosis that involves the sciatic nerve)
- Difficulty breathing and breathing-induced pain during menstrual cycle (endometriosis that involves the diaphragmatic muscle).
- Chronic fatigue, menstrual irregularities
- Anxiety and depression
It should be emphasized that not all these symptoms are noted in patients with endometriosis, while two women with endometriosis may have signs and symptoms that do not resemble each other.
The disease usually occurs at young ages and involves the pelvic organs. These are the tissue lying between the colon and the vagina, peritoneum, bladder, intestines, ovaries and Fallopian tubes. Besides pelvic organs and tissues, it may involve diaphragm, digestive system, urinary tracts, lungs, muscle layer and nerves.
For diagnosis, many imaging modalities (transvaginal and transabdominal ultrasound, MRI, tomography) can be used. Here, we may express that our team is particularly specialized in ultrasonographic diagnosis of endometriosis. There is no blood test that allows final diagnosis of endometriosis without any surgery. Imaging and blood tests are rather used to plan the surgery and evaluate the progress.
The disease is classified in 4 stages – minimal, mild, moderate and severe – by American Society of Reproductive Medicine. However, these stages may not comply with signs and symptoms of the disease and severity of symptoms in most cases. There may be no or very minimal symptom observed in a patient with advanced-stage disease, while a patient with early-stage disease may suffer from severe signs and symptoms.
After the condition is diagnosed, all up-to-date and evidence-based treatments are used. Our center has a clinical council that can discuss cases within scope of evidence-based medicine for difficult cases that are referred to our clinic, such as patients with endometriosis that could not be diagnosed in third party facilities and women with documented endometriosis, who could not have benefit from treatment and have, therefore, undergone one or more than one surgery.
As is the case with many women who are struggling endometriosis, incorrect or under-diagnosis and subsequent under-treatment and –surgery may lead to suffering that may persists for many years. Moreover, many patients develop a misperception or they are not guided properly in this period, resulting in the opinion that the only solution is removal of all reproductive organs (uterus and ovaries).
Most patients require patient-oriented, personalized treatment that involves medical treatment, such as medications, lifestyle modifications and rehabilitation, along with complex and multidisciplinary surgery. Considering this necessity, our center adopts versatile treatment approach in order to improve quality of life.
Surgical management of endometriosis is based on a major principle; all existing endometriosis foci are removed, while voiding, defecation and digestive, reproductive and sexual functions are preserved. This is also a requisite that determines the quality of the surgical procedure. Experienced and skilled surgeons of our center perform minimally invasive procedures, such as laparoscopic and robotic surgery, in operating theaters equipped with state-of-the-art devices and thus, it is possible to gain the targeted outcomes in surgical management of the condition.
Treatment of this disease requires the ability to perform advanced laparoscopic surgery; our surgical team is well educated and experienced in this surgical modality and they not only serve our patients, but they also contribute to education of new colleagues and improvement of diagnosis and treatment, as they share their knowledge and experience in national and international scientific meetings.
Similarly, considering reproductive problems of women with endometriosis, our assisted reproductive treatment center offers personalized treatments for women with endometrosis and adenomyosis through oocyte cryopreservation and in vitro fertilization. Our reproductive medicine team has a respected position both in Turkey and at international scale due to their studies conducted on endometriosis.
Our unit, as a reference center, continues its efforts without conceding ethical and scientific values.
In summary, our experienced team will accompany you lifelong – ranging from adolescence to menopause - for the management of your complaints and solution of all endometriosis-related problems.