Endometriosis: Modern Diagnostics Techniques and Treatment at Goldenes Kreuz Private Hospital
Prof. Fritz Nagele
Medical Director and Head of the Endometriosis Treatment Center at the Goldenes Kreuz Private Hospital, Vienna
Expertise: Gynecology and Obstetrics
Author of more than 150 scientific publications and active lecturer in Austria and abroad. He is a member of numerous local and foreign professional communities.
He has performed more than 1,500 diagnostic and laparoscopic surgical procedures: fallopian tubes and ovaries surgeries, myomectomy and laparoscopic surgeries for treatment of endometriosis, surgical and diagnostic hysteroscopy, polyps removal procedure, correction of congenital abnormalities and others.
The symptoms of endometriosis are:
- severe menstrual pain
- pain during sexual intercourse
- defecation or urination pain
- cycle-independent chronic lower abdominal pain
- longer menstrual period accompanied by pain
What tests should be done to diagnose the disease?
The problem is that endometriosis is difficult to diagnose. On average, it takes seven years from the development of symptoms to the establishment of the correct diagnosis. A precise diagnosis can be made only on the basis of the histological examination of tissue samples. Imaging diagnostics by means of ultrasound and MRI, are insufficient. Endometriosis is estimated to affect approximately one in ten women of reproductive age. The laparoscopic intervention allows not only to extract tissue samples for the diagnostics, but also to remove pathological tissue at once.
Possible treatments and prognosis?
The purpose of endometriosis treatment, on the one hand, is to reduce pain, and on the other hand, to preserve fertility if the woman plans to get pregnant.
When the ovaries are affected by endometriosis, usually the cysts are expressed in ultrasound images. They always have a negative impact on fertility. These cysts have to be removed in a way that the ovary does not lose its function, which is determined by the hormonal test before the surgery. This means that a properly performed surgery will not lead to premature menopause.
Since endometriosis is fueled by hormones produced in the ovaries, the most effective treatment is hormonal suppression of the ovarian function. In this connection, the age of the patient is crucial for hormone treatment: for example, a 25-year-old patient can receive hormone therapy for a longer time to avoid the recurrence of disease, because she has sufficient time to have a baby.
For women with a wish for a child aged 35 or older, this is more problematic. After a laparoscopic biopsy and histological confirmation of the diagnosis, in vitro fertilization has to be initiated as soon as possible. For hormone therapy we use hormones from simple common birth control pills to GnRH analogues.
What are the possible complications?
Endometriosis is a chronic disease and in some cases can take an aggressive course. Moreover, in case of the ingrowth into adjacent organs (bladder, rectum) it can contribute to the development of malignant diseases of these organs. In severe chronic cases, treatment should be supervised by a multidisciplinary team of experts including urologists and proctologists at a special endometriosis center.
Goldenes Kreuz was the first private clinic in Austria with a certified Endometriosis Treatment Center. A multidisciplinary team of experts offers patients qualified assistance in treatment of this disease.
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