Ulas Bozdogan, MD, FACOG

Endometriosis & Fibroids Specialist located in Hackensack, NJ and New York City, NY

Dr. Bozdogan has performed over 3,000 minimally-invasive laparoscopic and Da Vinci robotic surgery during his esteemed career serving his patients suffering from pelvic disorders id endometriosis, fibroid, chronic pain, etc. His participation in national ans international medical conferences throughout every year attests to his commitment to life-long learning and incorporation state-of-the-art technology and procedures into his work.

Is endometriosis malignant?

No. But it can harm you by causing severe pain or by interfering with your pelvic or intestinal organs. While not malignant, it is invasive, digging into your normal tissues.

How did you get endometriosis?

No one can say for sure. Because it is so similar to the inner lining of your uterus, many feel it is backwards leakage from your uterus during your period. That is, instead of flowing out through your vagina, it is squeezed through your tubes to drip onto your ovaries and other pelvic structures. Others have theorized its cells are carried through the bloodstream to lodge distantly (e.g., lungs, nose, brain, etc.); others say it is faulty migration of this tissue during your development as an embryo, leaving “nests” of it along the route toward your developing uterus.

What kinds of problems will endometriosis cause you?

The two main effects of endometriosis are caused by inflammatory reactions to it.

• PELVIC PAIN: endometriosis releases inflammatory substances that are directly painful, especially during certain times of your cycle, during which it is hormonal reactive but has nowhere to escape (like normal menstrual tissue).
• SCARRING: endometriosis, with its inflammatory reaction, provokes your body to wall it off away from the rest of the body. This is done by other things migrating and attaching over it, like bowel and bowel fat.

Thus, it is a two-phase assault on your quality of life:

1. Directly painful in and of itself.
2. Indirectly painful by causing adhesion (things meant to be free-floating to get stuck down in a mass of scarring).

From these effects come other problems.

What other problems come from endometriosis?

• PAINFUL PERIODS: besides the usual cramping and monthly discomfort of your period, the pain IS INCREASED by the addition of other sites creating pain due to the hormonal sensitivity of this abnormal tissue.
• PAINFUL SEX: the mechanical action of intercourse can directly jostle the painful sites or stretch bowel stuck down to them.
• ABNORMAL CYCLES: endometriosis can interfere with ovulation and your ovary’s contribution to your menstrual cycle, causing irregular periods.
• INFERTILITY: fertilization is a complex process that involves both the correct biochemistry and an intact and normally functioning anatomy. Besides directly inhibiting conception due to the inflammatory substances it produces, the scarring that ensues can cause mechanical blockage that can either interfere with sperm meeting egg or the successful passage of a fertilized egg en route to your uterus for implantation.
• INTERFERENCE WITH BOWEL: direct inflammation can alter its function and result in diarrhea or other motility issues. Scarring can cause bowel to get hung up in unnatural twists and kinks, and when these are stretched during the passage of feces, colicky pain is the result. Worse, partial or complete obstruction can create a surgical emergency. The pain from bowel involvement won’t be just during your “period,” but all the time.
• RECTAL PROBLEMS: rectal involvement can interfere with normal evacuation of the bowels, causing chronic pain, painful sex, and painful bowel movements.
• INTERFERENCE WITH BLADDER: endo on the bladder interferes with its normal filling and emptying operation, actions which can provoke the pain from the inflammation involved.
• PSYCHOLOGICAL PROBLEMS: both infertility and chronic pain can each impact your quality of life, causing depression and hopelessness. Put the two together, and the sum may be more than the mere addition of the parts: this can translate into relationship problems and even separation or divorce. The psychological problems are often ignored because of the more immediate medical problems; however, they are extremely serious and must be addressed along with the other approaches to treating endometriosis. As an endometriosis specialist at NJ Enodmetriosis, Dr. Bozdogan “gets it,” and always incorporates a sensitivity to this aspect along with the gynecology involved.

What are “chocolate cysts”?

Endometriosis that is inside your ovary can make “chocolate cysts,” which is old bloody tissue that collects and enlarges your ovary; as described above, such cysts can interfere with ovulation and your ovary’s contribution to your menstrual cycle. They also make your ovary heavier, which can inflame the sensitive nerves its suspensory structure.

What is a “frozen pelvis”?

As described above, rectal involvement can cause what is called a “frozen pelvis,” which means your rectum and its spaces are matted down with your uterus and pelvic floor as one solid mass, interfering with evacuation of the bowels and causing chronic pain, painful sex, extremely painful bowel movements, constipation, and possibly even fecal impactions or obstruction.

How is endometriosis diagnosed?

There is not test that can declare you to have endometriosis. It is an assumed diagnosis, based on pelvic pain in any woman, which can include painful periods, painful bowel movements, or painful sex. Any pain that interferes with these activities of daily living, as well as interferes with your social life, should not be ignored. An endometriosis specialist like Dr. Bozdogan of NJ Endometriosis can evaluate you with a keen awareness for this possibility, because delayed diagnosis only makes treatment, infertility, and pain worse.

Unfortunately, endometriosis is what is called a “surgical diagnosis.” That is, although it can be suspected, it can only be confirmed by surgically identifying it inside your body. Thankfully, minimally invasive laparoscopic surgery with da Vinci robotic approaches, like what Dr. Bozdogan at NJ Endometriosis uses, can go a long way to relieve your fears of undergoing surgery, due to its small, cosmetic incisions, quick recovery (same-day surgery), and minimum discomfort.

How is endometriosis treated?

Again, the best way is to actually remove it, which means surgery. Some will try to treat it hormonal by putting you into a temporary menopausal state to “starve” this tissue, but who wants menopause? Especially if she’s trying to get pregnant? The surgical approach to eliminate your endometriosis is the same as the one to diagnose it.

Why can’t it be treated in the same surgery as the one that makes the diagnosis? Wouldn’t it make sense to do both in the same procedure?

While this may seem obvious and common sense, there are those who separate out the procedure into two: one for diagnosis and one for treatment. When treating (removing) it can be added to the diagnostic procedure, it’s the same procedure (minimally invasive and robotic), so it has the same recovery time and cosmetic considerations as just a diagnostic procedure. Dr. Bozdogan at NJ Endometriosis prefers diagnosis + treatment simultaneously so that you can get on with your life without any more delays.

Conclusion

Endometriosis is an invasive, painful disease that is cruel in that it not only causes pain that disrupts your daily activities and your life in general, but can also prevent pregnancy, which is devastating to those with hopes and dreams of a life with a family.

Today’s surgical approaches to endometriosis are no longer “your mother’s” remedies from years ago.  A personalized approach can be offered, via the expertise of a skilled and experienced surgeon like Dr. Ulas Bozdogan of NJ Endometriosis. Quality of life and fertility depend on the expertise of the doctor you choose!