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Endometriosis Center
Endometriosis Center

Endometriosis is the external location of the layer covering the inside of the uterus; it is normally shed with menstruation. The locations it is most frequently encountered are, first and foremost; the ovaries, then the bladder, intestines and peritoneum. As it forms cysts of chocolate viscosity in the ovaries, it is often called a chocolate cyst.

Chocolate cysts or endometriosis causes intense adhesions in the ovaries, tubes and intestines, later leading to severe menstrual pain, pain during sexual intercourse, chronic and persistent pelvic pain and decreased egg quality by decreasing the egg reserves which itself leads to infertility.

Endometriosis feeds off of one of the female hormones, estrogen; as such, the hormonal medications used in treatment of the pain are geared towards suppressing estrogen production of the ovaries. As first step, in addition to painkillers, oral contraceptives are used, and if a favorable response is not obtained, more effective hormonal treatments which also carry more side effects such as; medications containing progesterone, GnRh analogues and aromatase inhibitors are used.

Patients who, despite all these hormonal treatments, experience persistent pain, recurrent IVF failures, or those who have chocolate cysts are recommended to under go laparoscopic surgery to have the chocolate cysts and other foci removed.

The extent of the surgery to be performed varies from patient to patient. While removing the cyst appropriately from the ovary, it is very important for the ovarian reserves to not use energy during hemostasis.  If the laparoscopic surgery of endometriosis is carried out by experienced and specialized teams, the success rate increases.

Deep endometriosis is the most severe form of endometriosis and is characterized by the formation of nodules that cause severe pain in the deep connective tissue behind the uterus and in the intestines. In the recent years, the variations in this matter have increased.

The laparoscopic treatment of deep endometriosis is carried out by reaching these nodules and laparoscopically removing them. However, due to the deep location of these nodules in the intestines or urinary tracts, these procedures are quite complicated and are strongly recommended to be carried out by gynecologic laparoscopic surgeons who are specialized in the subject. The surgery may be joined by general surgeons and/or urologists depending on the location of the nodule.

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