Diagnoses and Treatment Options
Endometriosis, Minimally Invasive Treatment for Fibroid Removal and Pessary Therapy: Diagnosis and Treatment Options for Gynaecological Conditions
Diagnoses and Treatment Options
EndometriosisMenorrhagiaOvarian CystsUterine FibroidsUrinary IncontinencePelvic Organ ProlapsePain ManagementBreast ConditionsMinimally Invasive SurgeryGynaecological symptoms can have many different causes. Careful diagnostics form the foundation of every treatment decision. Our shared goal is not only to name your symptoms, but to understand them in context and, based on this, develop a treatment plan that is right for you.
Treatment follows a stepwise approach: from conservative measures and minimally invasive procedures through to surgical interventions. Which treatment concept is suitable for you depends not only on medical possibilities, but also on your life circumstances and personal wishes.
Let us find this out together.
Endometriosis is a chronic and often painful condition. Tissue similar to the lining of the womb may grow, for example, within the muscular wall of the uterus, on the ovaries, within the abdomen or involving the bladder or bowel.
These so-called endometriosis lesions respond to hormonal changes during the menstrual cycle in a similar way to the normal womb lining. This can lead to inflammation, irritation and adhesions.
Typical symptoms include severe period pain, pain during sexual intercourse, chronic pelvic pain and difficulties conceiving.
The first step is a personal consultation about your symptoms and how they have developed over time. The aim of my detailed counselling is always to improve your quality of life and to find a treatment approach that fits your life. This is followed by a gynaecological examination and targeted imaging diagnostics. Depending on the findings, further investigations may be helpful in order to assess the extent of the condition as accurately as possible and create a sound basis for decisionmaking.
Many women experience a long journey before receiving a diagnosis. Early and careful assessment of symptoms is therefore essential for achieving sustainable treatment outcomes in endometriosis.
Conservative Treatment
Pain Management — Targeted Symptom Relief
Anti-inflammatory pain medication often forms the basis of pain management. Depending on your needs, individually tailored medication can be added.
Because chronic pain affects not only the body, but also emotional wellbeing, relationships and professional life, a multimodal approach is often helpful. Collaboration with specialist pain therapists, physiotherapists and psychosocial support services can complement treatment.
Hormonal Treatment for Endometriosis
Endometriosis is hormone-dependent. This means that the lesions grow and respond to cyclical hormonal fluctuations. Hormonal treatment can slow down or suppress the activity of these lesions.
Some patients are initially cautious about hormone therapy because of concerns about side effects or the feeling of interfering with the body’s natural hormonal balance. These concerns are understandable and deserve open, honest counselling.
Together, we will discuss which hormonal treatment options are available for your endometriosis, what advantages and disadvantages they may have, and whether this form of therapy is appropriate for you.
Minimally Invasive Surgery — Targeted Removal of Endometriosis Lesions
If your symptoms are severe, organs are affected or you wish to become pregnant, surgery may be appropriate.
In most cases, I use minimally invasive laparoscopic techniques. Visible endometriosis lesions are carefully removed, adhesions are released and, where possible, normal organ function is restored. The aim is to significantly reduce pain and, if desired, improve the chances of pregnancy.
In cases of deeply infiltrating endometriosis involving the bowel or urinary tract, interdisciplinary surgery may be necessary. Surgery treats existing lesions, but cannot always fully prevent renewed disease activity. For this reason, hormonal follow-up treatment is often recommended.
Keeping Fertility in Mind
Endometriosis can affect fertility. Depending on the findings, different pathways may be considered: from cycle optimisation without hormones and surgical treatment through to assisted reproductive medicine.
The decision is made individually, taking into account all findings, your age and your personal wishes.
Menorrhagia describes unusually prolonged menstrual bleeding lasting seven to ten days despite a regular menstrual cycle. Often, the bleeding is also excessively heavy; this is known as heavy menstrual bleeding or hypermenorrhoea.
Many women experience the bleeding as so intense that it affects daily life, for example through the need to change sanitary products very frequently or because of reduced physical resilience.
What matters most is not the absolute amount of blood loss, but your individual experience and the impact on everyday life. Heavy menstrual bleeding may occur on its own or as part of an underlying gynaecological or hormonal imbalance.
The first step is a personal consultation about your bleeding pattern, the duration and intensity of your periods and any accompanying symptoms. This is followed by a gynaecological examination and an ultrasound scan to assess the uterus and womb lining.
Depending on the findings, further diagnostic steps may be helpful in order to identify the cause of the menorrhagia more precisely.
Conservative Treatment
In many cases, heavy menstrual bleeding can initially be treated conservatively. Depending on the cause, medication may be considered that acts on the womb lining, hormonal regulation or blood clotting.
The aim is to reduce the heaviness of bleeding and stabilise the cycle without unnecessarily interfering with your body’s natural processes.
Surgical Treatment
If conservative measures are not sufficiently effective or structural changes are present, surgical treatment of menorrhagia may be appropriate.
Minimally invasive techniques are used wherever possible, with the aim of treating the cause of the bleeding disorder while preserving the uterus as far as possible.
Uterine fibroids are benign muscular growths of the womb. Depending on their size and location, they can cause different symptoms. Typical symptoms include heavy or prolonged periods, bleeding between periods, a feeling of pressure or heaviness in the lower abdomen, frequent urination or pelvic pain. In some cases, fibroids can also affect fertility or be associated with difficulties conceiving.
An ovarian cyst is also often a benign finding. Whether such a change causes symptoms depends, among other factors, on its size, location and behaviour over time. Some cysts remain unnoticed, while others cause dragging pain or a feeling of pressure in the lower abdomen.
Many patients ask questions such as: “Does a fibroid need to be removed?” or “When should an ovarian cyst be operated on?”
The decision does not depend on the finding alone, but on the combination of symptoms, growth tendency, ultrasound appearance and your individual life situation.
Fibroids and cysts can usually be reliably detected during a gynaecological examination and ultrasound scan.
If additional symptoms such as pain are present, or if inflammation is suspected, for example involving the ovaries, diagnostics are adapted accordingly in order to identify the cause more precisely.
Conservative Treatment
Not every fibroid or cyst requires treatment. Fibroids that do not cause symptoms usually do not need to be removed. Treatment is recommended if there is troublesome or circulation-relevant heavy bleeding, pain or pressure symptoms, organ impairment or difficulties conceiving.
Pain or bleeding disturbances caused by cysts or fibroids can often be positively influenced by medication at an early stage. Treatment may act directly on the fibroid, the womb lining or the blood clotting system.
Minimally Invasive Non-Surgical Procedures
Many patients ask: “When, or from what size, should a fibroid be removed?”
Under certain conditions, modern organ-preserving, non-surgical procedures such as fibroid embolisation or focused ultrasound may be considered. Together, we will discuss whether this form of treatment is suitable for you and what advantages and disadvantages it may have.
Minimally Invasive Surgical Procedures
If fibroids cause significant symptoms or affect fertility, surgical removal may be appropriate. In most cases, I use minimally invasive techniques such as laparoscopy or hysteroscopy. This type of fibroid surgery allows the fibroid to be removed precisely while preserving the uterus.
In certain situations, for example with very large or numerous fibroids and completed family planning, hysterectomy may also be considered. During this operation, the uterus is removed either completely or with preservation of the cervix.
Treatment of ovarian cysts also depends on the findings and symptoms. The question of when a cyst should be operated on cannot be answered in general terms, but is always decided in the individual context.
If surgery becomes necessary, for example because of growth, pain or unclear findings, ovarian cyst surgery is usually performed using minimally invasive techniques, typically as laparoscopic cyst removal.
The decision regarding the most suitable procedure is made individually, taking into account all findings, your age and your personal wishes.
Urinary incontinence describes the involuntary leakage of urine and can have different causes.
Stress Urinary Incontinence
Stress urinary incontinence is common and causes urine leakage when coughing, sneezing, laughing or during physical activity. The cause is usually reduced function of the urethral support mechanism. This form of incontinence is particularly common in women.
Urge Urinary Incontinence
Urge urinary incontinence, also known as urgency incontinence or overactive bladder, is characterised by a sudden, difficult-to-control urge to pass urine. It is often associated with overactivity of the bladder muscle.
Urge incontinence can also occur in connection with bladder prolapse, reduced bladder capacity, previous operations, neurological conditions or hormonal changes, for example during the menopause.
The causes may occur alone or in combination and range from functional changes and hormonal influences to neurological factors or prolapse-related problems.
Mixed Urinary Incontinence
Mixed urinary incontinence means that stress urinary incontinence and urge urinary incontinence occur at the same time. The symptoms can vary considerably from one person to another.
Successful and lasting treatment of urinary incontinence requires careful diagnostics. The first step is always a personal consultation about your symptoms.
Together with a gynaecological examination, specialist ultrasound assessment of the pelvic floor and urine testing, this forms the basis of routine diagnostics.
Urodynamics and Bladder Pressure Testing
In selected cases, further diagnostics may include bladder pressure testing and cystoscopy.
Urodynamics is a specialised functional examination used to assess bladder storage and emptying function, as well as the function of the urethra.
During bladder pressure testing, fine catheters are inserted into the bladder and rectum to measure and compare pressure patterns.
If required, the examination can be supplemented by videourodynamics. This combines functional measurements with imaging in order to better understand complex relationships.
Treatment for mixed urinary incontinence and other forms of incontinence is tailored to the underlying causes of your symptoms and to your individual needs.
Stepwise treatment concepts include conservative measures as well as modern, minimally invasive surgical procedures.
What matters most is this: urinary incontinence is not something you simply have to accept. Together, we will find the best possible solution for you.
Conservative Treatment
Pelvic Floor Training — The Foundation of Treatment
Targeted pelvic floor muscle training is often the first and most important step. Under physiotherapeutic guidance, you learn to consciously perceive, strengthen and use the pelvic floor muscles in everyday life.
Biofeedback techniques can help improve body awareness and increase the effectiveness of treatment. Especially in stress urinary incontinence, pelvic floor training alone can often lead to significant symptom improvement.
Medication
In urge urinary incontinence, medication can help calm the overactive bladder muscle. Modern medications are generally well tolerated and are selected individually, taking into account other medical conditions and potential side effects.
Local treatment, such as vaginal oestrogen therapy, can also provide additional support.
Pessary Therapy
In stress urinary incontinence, an individually fitted vaginal pessary can mechanically support the urethra. Pessary therapy is a non-surgical and flexible treatment option that can be used either permanently or situationally, for example during sport.
Pessary therapy is not only an option for older patients. A support pessary specially adapted to the female pelvic floor can also relieve pressure on the supporting structures after childbirth and reduce the strain on the pelvic floor muscles, helping to improve symptoms of stress urinary incontinence.
Minimally Invasive and Surgical Treatment
If conservative measures are not sufficiently effective, modern surgical procedures are available.
Mid-Urethral Sling Surgery
In stress urinary incontinence, a tension-free tape is often placed beneath the urethra during mid-urethral sling surgery, commonly known as TVT surgery. This incontinence tape stabilises the urethra during physical strain.
Laparoscopic Stabilisation of the Urethra
Alternatively, stabilisation of the urethra can also be performed laparoscopically, particularly if foreign material such as permanent plastic implants or urogynaecological mesh is to be avoided.
In this procedure, the urethra is stabilised by lifting the anterior vaginal wall.
Both procedures are particularly suitable once family planning has been completed.
Injection of a Bulking Agent
If you still wish to have children, injection of a gel-like bulking agent directly into the wall of the urethra may be considered. This increases the tissue volume and helps the urethra close more effectively.
Bladder Treatment with Botox
If an overactive bladder is present, bladder treatment with Botox may be helpful after conservative treatment has been exhausted or after successful treatment of vaginal prolapse.
This involves injecting Botox into the bladder muscle in order to specifically reduce its overactivity.
In selected cases, for example in complex functional disorders, sacral neuromodulation — sometimes described as a bladder pacemaker — may also be considered. An implanted generator sends gentle electrical impulses to nerves in the lower back in order to regulate communication between the brain and pelvic organs.
Stepwise treatment concepts are tailored to the cause of your symptoms and to your individual needs. The aim of my detailed counselling is always to improve your quality of life, restore confidence in everyday life and find a treatment that fits your life.
Pelvic organ prolapse, more specifically uterine, bladder or pelvic floor prolapse, develops when the supporting structures of the pelvic floor weaken. As a result, the uterus, bladder or bowel may move downwards within the pelvis.
The degree of prolapse can vary considerably. Some prolapses remain symptom-free, while others cause functional limitations in daily life.
Successful and lasting treatment of prolapse symptoms requires careful diagnostics. The first step is always a personal consultation about your symptoms.
This is followed by a gynaecological examination and specialist pelvic floor ultrasound. In some cases, further assessment by a specialist in bowel and rectal disorders may be helpful.
Prolapse without symptoms usually does not require treatment. If functional impairment is present, an individualised treatment concept can be developed.
Treatment depends on the severity of the anatomical defect, individual risk factors and your own needs and wishes.
Conservative Treatment
Pelvic Floor Training — The Foundation of Treatment
Targeted pelvic floor training for prolapse, for example uterine prolapse, is often the first and most important step.
As part of pelvic floor physiotherapy, you learn under professional guidance to consciously perceive, strengthen and use the pelvic floor muscles correctly in everyday life.
Biofeedback techniques can also help improve body awareness and increase the effectiveness of pelvic floor training.
Pessary Therapy
For prolapse symptoms of any cause, a specially fitted vaginal pessary can mechanically support the vagina. This treatment is non-surgical, individually adaptable and particularly suitable when surgery is not desired.
Pessary therapy can also be used flexibly: either continuously or situationally, for example during exercise.
Pessary therapy, for example in uterine prolapse, is not only an option for older patients. A support pessary specially adapted to the female pelvic floor can also relieve pressure on the supporting structures after childbirth and reduce strain on the pelvic floor muscles, which may ease prolapse symptoms.
Minimally Invasive and Surgical Treatment: Pelvic Floor Reconstruction With or Without Mesh
If conservative measures do not provide sufficient relief or a lasting solution is desired, modern and very gentle surgical procedures are available today.
There are different surgical methods for prolapse, such as bladder prolapse, with generally low risks.
Prolapse Surgery with Mesh
In most cases, I use minimally invasive laparoscopic techniques. The uterus and/or vagina are restored to their correct anatomical and functional position within the pelvis using a fine, specially developed synthetic mesh.
In more complex cases, the rectum may also be fixed, or other tissues such as the vagina may be tightened or lifted without foreign material.
Prolapse Surgery Using Native Tissue or Combined with Mesh
Alternatively, prolapse can also be operated on through the vagina. In this approach, support is rebuilt and strengthened using the body’s own tissue.
In more advanced prolapse or recurrent prolapse, a fine synthetic mesh may be used additionally for support. This provides long-term stabilisation and enables secure fixation of the uterus or vaginal vault deep within the pelvis.
Stepwise treatment concepts include conservative measures as well as modern, minimally invasive surgical procedures.
What matters most is this: prolapse is not something you simply have to accept. Together, we will find the best possible solution for you.
Conservative treatment concepts are often gentle, well tolerated and can be combined effectively. They therefore form the basis of treatment for many gynaecological symptoms.
Pain may occur as an independent symptom or as part of an underlying condition.
Symptom relief can be achieved through medication, physiotherapy, pelvic floor training, specialist pain therapy, behavioural therapy, heat or cold application, and lifestyle interventions.
Invasive treatment is only rarely required in order to resolve the underlying cause of symptoms. When it is needed, these procedures are usually performed using minimally invasive techniques.
As a Gynaecological Oncologist and Senior Breast Surgeon certified by the German Cancer Society, I have been involved for many years in the diagnosis and treatment of benign and malignant breast conditions.
Although changes in the breast are understandably worrying for many people seeking advice, most breast findings are not cancerous.
Every breast treatment pathway begins with a discussion about your current and previous symptoms, medical history, relevant life circumstances and any family history of cancer.
Based on this information, breast diagnostics follow. These include clinical examination, modern imaging techniques and minimally invasive tissue sampling for histopathological confirmation of any suspicious finding.
Surgical treatment of benign breast findings is only necessary if symptoms are present and can usually be performed as a day-case procedure.
Minimally invasive surgical techniques allow procedures to be carried out through very small access routes, placing as little strain as possible on the tissue. Modern video optics allow the surgical field to be greatly enlarged and displayed with high precision. This advanced technique enables smaller wound areas, reduced blood loss and less postoperative pain.
As a result, patients benefit from faster mobilisation, quicker recovery and minimal scarring. I use minimally invasive techniques across the full range of gynaecological surgery: in vaginal procedures as well as abdominal operations, for benign conditions and in oncological treatment.
A particular focus of my work as a gynaecologist is urogynaecological surgery. This includes surgical procedures for pelvic floor reconstruction and incontinence surgery.
My aim is always to restore pelvic floor function and stability and to achieve lasting improvement in your symptoms, taking your individual situation into account.
My surgical experience and specialisation in the relevant fields are supported by various certifications, including MIC II certification and AGUB II certification in urogynaecology.
As a Senior Breast Surgeon, I also have many years of experience in the surgical treatment of breast conditions.
The foundation of every treatment is careful diagnostics and a differentiated assessment of your symptoms. Based on this, we will develop a stepwise treatment concept together — from conservative measures and minimally invasive procedures through to surgical solutions. What matters is not only the medical finding, but also which solution fits your personal situation, your needs and your life circumstances.
Together, we will find the path that is right for you.
Dr. med. Stefan Ollig
Specialist in Gynaecology and Obstetrics
