This section presents the main gynecological conditions that frequently require surgical management. First and foremost is infertility as a key topic in modern gynecology. Because infertility is closely linked with endometriosis, this disease is discussed in detail in the following section.
Uterine pathologies represent another major focus: uterine fibroids (leiomyomas) as well as endometrial polyps and endometrial hyperplasia — diagnoses frequently made during ultrasound examinations and treated surgically.
Furthermore, the spectrum of pelvic organ prolapse and urinary incontinence with modern surgical treatment options is explained.
A special focus is placed on emergency gynecology: ovarian apoplexy (rupture) and ectopic pregnancy (tubal pregnancy). These acute conditions require prompt medical attention.
Gynecological Conditions & Treatment Options
Female Infertility
An increasing number of couples face difficulty conceiving. In about 50–60% of cases, male factors play a role, which can be quickly ruled out via semen analysis (spermiogram). Female factors are more complex and multifaceted.
One of the most frequent causes is the tubal factor (blockage or dysfunction of the fallopian tubes). If pregnancy does not occur after one year of regular intercourse, tubal patency should be evaluated.
Endometriosis
Endometriosis is a common gynecological condition in which endometrial-like tissue grows outside the uterine cavity, forming inflammatory lesions. According to ESHRE, endometriosis affects 2–10% of women of reproductive age and up to 50% of infertile women.
Endometriosis is benign but chronic. The primary symptoms include cyclic pelvic pain and infertility.
When tissue grows into the uterine muscle wall, it is called adenomyosis. Ovarian endometriomas ("chocolate cysts") reduce healthy ovarian tissue and egg reserve. Testing anti-Müllerian hormone (AMH) levels helps assess ovarian reserve.
Today, modern medical and surgical treatment methods are combined to achieve optimal pain relief and support fertility goals.
Uterine Fibroids (Leiomyomas)
Uterine fibroids affect approximately 20–40% of women over 30 years of age and represent the most common benign tumors of the female reproductive tract.
In most cases, small asymptomatic fibroids require only periodic ultrasound monitoring (every 6–12 months). However, 10–12% of cases require active treatment.
Medication cannot completely cure fibroids; surgical treatment is recommended for symptomatic patients. Main indications for surgery include: fibroid diameter > 6 cm, submucosal location (distorting the uterine cavity), or heavy uterine bleeding.
Laparoscopy or vNOTES is the preferred method for fibroid removal. Submucous fibroids are removed via hysteroscopy, while hysterectomy is reserved for severe cases where uterine preservation is not requested.
Uterine Cavity Pathologies
Common pathological changes inside the uterine cavity include: endometrial polyps, endometrial hyperplasia, submucous fibroids, adenomyosis, and intrauterine adhesions (synechiae).
Endometrial hyperplasia refers to abnormal proliferation of the uterine lining.
According to WHO classification, hyperplastic processes include glandular hyperplasia, polyps, and atypical changes with increased oncological risk.
Endometrial polyps can occur both alongside hyperplasia or within normal endometrial tissue.
Hysteroscopy remains the gold standard for accurate diagnosis and gentle resection of intrauterine lesions.
Pelvic Organ Prolapse & Urinary Incontinence
Pelvic organ prolapse (descent or prolapse of the vaginal walls and uterus) is among the most frequent conditions in older women. It represents the third most common reason for elective gynecological surgery. Almost every second woman over 50 shows some degree of prolapse.
Prolapse can also occur after previous hysterectomy.
Genital prolapse is frequently accompanied by urinary dysfunction. Stress urinary incontinence or urgency affects up to 30% of women under 55 and up to 75% over age 70.
Emergency Gynecology (Acute Conditions)
Ovarian Apoplexy (Ovarian Rupture)
Ovarian apoplexy is a sudden rupture of ovarian tissue (often a corpus luteum cyst in the second half of the cycle), accompanied by intra-abdominal bleeding. Severe bleeding requires immediate laparoscopic surgery.
The objective is rapid hemostasis and removal of blood clots while maximum preservation of ovarian tissue and function is prioritized.
Ectopic Pregnancy (Tubal Pregnancy)
In an ectopic pregnancy, the fertilized egg implants outside the uterine cavity — most commonly in the fallopian tube. Ectopic pregnancy occurs in approximately 1 out of 100 pregnancies. Risk factors include pelvic inflammatory disease and pelvic adhesions.
Ectopic pregnancy can be asymptomatic in early weeks. Diagnosis is confirmed via ultrasound and blood tests.
With a positive pregnancy test, seek immediate medical care if you experience:
• scanty dark brown bleeding or spotting;
• unilateral pelvic pain or sharp cramping;
• nausea, weakness, or dizziness.
Suspected ectopic pregnancy requires emergency hospitalization. Surgical management is performed laparoscopically, preserving the fallopian tube whenever medically possible.