A holistic approach for endometriosis (in which tissue similar to the uterine lining grows outside the uterus), covering pain management, hormonal therapy, and laparoscopic excision.
Indication
- Severe menstrual pain (dysmenorrhea), chronic pelvic pain, or pain during intercourse (dyspareunia)
- Bowel or urinary tract complaints related to endometriosis (painful defecation or urination)
- Endometriosis identified in cases of infertility or recurrent pregnancy loss
- Endometrioma (chocolate cyst) shown on ultrasound or MRI
- Deep infiltrating endometriosis (DIE) — bowel, bladder, or ureter involvement
- Cases that do not respond to hormonal therapy or cannot continue it due to side effects
- Severe menstrual pain in adolescents that disrupts school or work life
Preparation
- Detailed history, pain mapping, and pelvic examination
- Pelvic (especially transvaginal) ultrasound; pelvic MRI when needed for deep infiltrating lesions
- Clarification of reproductive plans (short- and long-term pregnancy goals)
- Planning treatment options (analgesics, oral contraceptives, dienogest, GnRH analogues, levonorgestrel intrauterine device, surgery) together with informed consent
- If surgery is planned, routine investigations, anesthesia evaluation, and multidisciplinary consultation when needed (urology, general surgery)
How it's performed
- As first-line care, NSAIDs (pain relievers) and hormonal therapies (combined or progestin-only oral contraceptives, dienogest) may be started on the physician's recommendation
- GnRH analogues are used for limited durations, with 'add-back' therapy when needed
- A levonorgestrel intrauterine device is an option to reduce menstrual pain and bleeding
- For endometrioma and deep infiltrating lesions, laparoscopic excision (removal rather than ablation) is preferred; robotic surgery may also be an option in suitable cases
- When the bowel, bladder, or ureter is involved, simultaneous surgery is planned with a multidisciplinary team (urology, general surgery)
- If infertility coexists, assisted reproductive treatments (IVF) may be considered after or instead of surgery
Post-procedure
- Treatment response is regularly assessed with pain scores and imaging
- Side effects of hormonal therapy and adherence are reviewed
- After surgery, return to daily life is usually within 2–6 weeks; analgesics and hormonal maintenance therapy may be planned
- Because the disease tends to recur, long-term follow-up and protective hormonal therapy may be needed
- In patients planning pregnancy, timing and fertility evaluation are pursued in parallel
Risks
- Side effects of hormonal therapies (breakthrough bleeding, weight changes, mood changes, decreased bone density — with long-term GnRH analogues)
- Injury to neighboring organs such as bowel, ureter, or bladder during surgery — rare
- Risk of reduced ovarian reserve in endometrioma surgery
- Recurrence of pain or endometriosis despite treatment
- Risk of infertility and pregnancy loss may not be fully eliminated despite treatment
FAQ
Can endometriosis be definitively cured?
Endometriosis is a chronic condition that tends to recur; promises of a 'definitive cure' are not realistic. The aim is to control pain, preserve fertility, and improve quality of life.
Should drug therapy or surgery be preferred?
The decision depends on symptom severity, extent of disease, pregnancy plans, and response to medical therapy. In many patients, medical and surgical treatments are used together, in alternating phases.
Does pregnancy resolve endometriosis?
During pregnancy, symptoms may temporarily decrease due to hormonal changes, but the disease can become active again after delivery. Pregnancy is not a cure.
Does endometriosis cause cancer?
Endometriosis is usually benign. Although a small increase in risk has been described for certain cancer subtypes associated with some forms of endometriosis, most patients do not develop cancer. Regular follow-up is important.
Related Information
Related Medical Services
Other services in the same specialty or with similar indications you may want to explore.
Gynecologic ultrasound
Obstetrics Services
Gynecologic ultrasound — imaging-based evaluation of the female reproductive organs.
Laparoscopic Gynecologic Surgery
Obstetrics Services
Laparoscopic gynecologic surgery — minimally invasive women's health surgery performed through small incisions under camera guidance.
Infertility Evaluation
Obstetrics Services
Infertility evaluation — investigation of the causes of infertility and the foundation of treatment planning.
Pelvic Floor Rehabilitation
Obstetrics Services
Pelvic floor rehabilitation — an evidence-based muscle training program for urinary incontinence and pelvic organ prolapse.
Ectopic pregnancy treatment
Obstetrics Services
Ectopic pregnancy treatment — medical (methotrexate) and surgical (salpingostomy/salpingectomy) options for a pregnancy implanted outside the uterus.
Hysterectomy
Obstetrics Services
Hysterectomy — surgical removal of the uterus, performed for medical reasons.
Hysterosalpingography
Obstetrics Services
Hysterosalpingography (HSG) — radiological evaluation of the uterus and fallopian tubes.
Ovarian Cyst Surgery
Obstetrics Services
Ovarian cyst surgery (cystectomy) — laparoscopic or open removal of ovarian cysts.