Obstetrics and Gynecology are two distinct medical specialities that generally deal with the female human body.

Obstetrics is concerned with caring for women and their unborn children during pregnancy and childbirth. It is also concerned with the pre-natal health of the fetus and, finally, the post-natal care of the mother.

Gynaecology deals with the functions and diseases specific to women and girls, especially those affecting the reproductive system. This would include the organs of the uterus, cervix, ovaries, and vagina.

The American Medical Centre has opened the first Endometriosis Centre in Cyprus, led by obstetrician and gynaecologist Dr. Stavroulis Andreas.

EndoMarch has succeeded in raising awareness that Cyprus deserves. Many women are suffering, have delayed diagnosis and have multiple incomplete surgeries. They have neither accurate guidance nor monitored information and education to enable them to have an informed choice for their treatment, says a spokesman for the centre.

What is Endometriosis?

The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual pain that’s far worse than usual. They also tend to report that the pain has increased over time.

Common signs and symptoms of endometriosis may include:

-Painful periods (dysmenorrhea). Pelvic pain and cramping may begin before and extend several days into your period, and you may have lower back and abdominal pain.

-Pain with intercourse. Pain during or after sex is joint with endometriosis.

-Pain with bowel movements or urination. You’re most likely to experience these symptoms during your period.

-Excessive bleeding. You may experience occasional heavy periods (menorrhagia) or bleeding between periods (menometrorrhagia).

-Infertility. Endometriosis is first diagnosed in some women who are seeking infertility treatment.

Other symptoms. You may also experience fatigue, diarrhoea, constipation, bloating or nausea, especially during menstrual periods.

The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have extensive pain, while others with advanced endometriosis may have little or no discomfort.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), which causes bouts of diarrhoea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis. (Source: Mayo Clinic.)

The new Endometriosis Centre consists of a dynamic multidisciplinary team providing high-quality and evidence-based care that aims to assess and treat women with all grades of endometriosis ranging from mild disease to the most severe form involving the bowel, bladder and ureters, says the spokesman.

The team includes a specialist nurse, pain specialist, bowel surgeon, urologist, gastroenterologist and a psychologist. The team is permanently on the island to look after patients throughout the years, before and after their treatment.

Dr. Stavroulis Andreas is an accredited Advanced Laparoscopic Surgeon, Researcher, Lecturer and Trainer for Endoscopic and Endometriosis surgery. He trained in London and worked for 5 years at University College London Hospital, the UK's biggest Laparoscopic and Endometriosis Center. He has worked in Cyprus since October 2014 and operated in hospitals in Nicosia and Limassol for mild and complicated endometriosis cases. He has developed his team to form the Endometriosis Centre Cyprus, now housed in the American Medical Centre in Nicosia.

The centre’s mission is to provide state-of-the-art, high-quality, evidence-based and patient-centred treatment for managing all grades of endometriosis.

What It Is and How It Is Treated

Pelvic organ prolapse is the downward displacement of one or more pelvic organs, such as the uterus, bladder, or bowel, through the vaginal canal toward the external genital area.

It occurs when the muscles and connective tissues of the pelvic floor weaken and can no longer adequately support these organs.

This may lead to:

· A sensation of heaviness or pelvic pressure

· The feeling that “something is descending”

· Urinary or bowel difficulties

· Urinary incontinence

· Discomfort during sexual intercourse

· Visible protrusion of tissue in the vaginal area

It is a common condition, particularly after menopause or following multiple vaginal deliveries.

Risk Factors

Common contributing factors include:

· Multiple or difficult vaginal deliveries

· Chronic constipation

· Heavy physical labour

· Chronic cough

· Obesity

· Reduced oestrogen levels after menopause

Individualised Management

Treatment is tailored according to the severity of the prolapse, the patient’s age, general health, and whether future pregnancy is desired.

Management options range from conservative measures to advanced minimally invasive surgical techniques, aiming to restore pelvic support, relieve symptoms, and improve quality of life.

Treatment Options

Vaginal Pessary

A vaginal pessary is a removable device placed in the vagina during an outpatient visit to provide internal support without surgery.

This option is suitable for women who are not candidates for surgery due to medical conditions or advanced age.

The pessary requires replacement approximately every six months and ongoing follow-up. As a foreign body, it may increase the risk of vaginal infections.

Vaginal Hysterectomy

Vaginal hysterectomy is the oldest surgical method for the management of prolapse, in which the uterus is removed through the vagina.

Depending on the case, the procedure may include:

· Anterior repair (if the bladder is also prolapsing – cystocele)

· Posterior repair (if the rectum is also prolapsing – rectocele)

The surgery may be performed under regional (spinal) or general anaesthesia and typically lasts between 1 and 2.5 hours. Hospital stay is usually 2–3 days.

The procedure involves limited surgical trauma and relatively quick recovery; however, recurrence rates within ten years range from approximately 10–20%.

For this reason, it is generally avoided in younger women and in cases where the uterus is significantly enlarged due to multiple or large fibroids.

Laparoscopic / Robotic Sacrocolpopexy

A modern, minimally invasive technique performed through small abdominal incisions.

The procedure involves a laparoscopic or robotic hysterectomy combined with sacrocolpopexy: the placement of a specialised mesh that supports the vaginal vault or cervix by attaching it to the sacrum. It is regarded as the gold standard method today. The comparison is made with previously used techniques, such as vaginal hysterectomy. Performed under general anaesthesia, it lasts approximately three hours, with a hospital stay typically of one day, small incisions, and rapid recovery.

Recurrence rates are approximately 3.7% over ten years for the laparoscopic approach and even lower for the robotic approach.

It is particularly suitable for younger women, women with enlarged uteri, and patients experiencing recurrence after previous vaginal hysterectomy (vault prolapse).

EnPlace® System

The EnPlace® system is a newer, minimally invasive device used to treat pelvic organ prolapse.

The device is placed vaginally and supports the vaginal apex (in case of prolapse after vaginal hysterectomy) by anchoring it to the sacrospinous ligaments, or supports the left and right lateral vaginal fornices.

Key features include: performed under general or regional (spinal) anaesthesia, duration of approximately 30 minutes, hospital stay of a few hours, same-day discharge, no abdominal incisions, and rapid recovery.

Additional repair of cystocele or rectocele may be performed during the same operation if necessary.

The reported recurrence rate is approximately 6%. Early clinical outcomes have demonstrated favourable results and high patient satisfaction. Dr. Andri Kakkoura, after specialised training, applies this method in Cyprus at the American Medical Center.

This approach is primarily considered for postmenopausal women who wish to avoid more extensive surgery and may be appropriate in cases requiring a shorter, less invasive procedure or rapid return to daily activities.

Choosing the Appropriate Treatment

There is no single solution suitable for all women. The appropriate treatment is determined following detailed clinical evaluation and discussion of each patient’s individual needs and expectations.

Early medical assessment allows selection of the most appropriate and safe therapeutic approach.