From the Guidelines
Endometrioma management should prioritize a multidisciplinary approach, considering the patient's symptoms, fertility goals, and overall quality of life, with laparoscopic surgical excision being the recommended treatment for larger cysts or those causing severe symptoms, as supported by the most recent evidence 1.
Diagnosis and Treatment
The diagnosis of endometrioma is challenging due to variable presenting symptoms and nonspecific physical examination findings 1. However, expanded protocol transvaginal ultrasound (TVUS) studies have been developed to identify and "map" deep endometriosis (DE), and expert consensus groups advise using an MRI protocol tailored for detection of DE 1.
Management Options
Treatment options for endometrioma include hormonal medications like combined oral contraceptives, progestins, or GnRH agonists for mild symptoms, and laparoscopic surgical excision for larger cysts (>4-5 cm), those causing severe symptoms, or when fertility is desired 1.
Surgical Approach
During surgery, the entire cyst wall should be removed to reduce recurrence risk, which is approximately 10-20% within five years 1.
Fertility Considerations
Endometriomas may impact fertility by damaging ovarian tissue and reducing ovarian reserve, so timely intervention is important 1.
Follow-up and Pain Management
Patients should be monitored regularly with ultrasound if the cyst is managed conservatively, and pain management may include NSAIDs for breakthrough pain 1.
Long-term Management
The condition often recurs and may require long-term management strategies, including continuous hormonal therapy to suppress menstruation in some cases 1.
Recent Guidelines
The most recent guidelines from the American College of Radiology support the use of imaging before surgery to inform patient decision making, surgical planning, and management 1.
Key Considerations
In managing endometrioma, it is essential to consider the patient's individual goals, symptoms, and fertility desires, and to prioritize a multidisciplinary approach to optimize outcomes and quality of life 1.
From the Research
Definition and Prevalence of Endometrioma
- Endometrioma is a type of endometriosis where tissue similar to the lining of the uterus grows outside the uterus, often in the ovaries [(2,3,4,5)].
- It is estimated to affect 17 to 44% of women with endometriosis 5.
Symptoms of Endometrioma
- Common symptoms include pelvic pain, dysmenorrhea, and dyspareunia [(2,3,5)].
- Infertility is also a common issue associated with endometriomas 5.
Treatment Options for Endometrioma
- Treatment options include expectant management, medical treatment, surgical treatment, and in vitro fertilization and embryo transfer (IVF-ET) [(3,4,5)].
- Medical treatment may include oral contraceptives, progestins, and gonadotropin-releasing hormone (GnRH) agonists [(2,3,6)].
- Surgical treatment, such as laparoscopic excision of the endometrioma wall, may be considered in some cases [(3,4,5)].
Effectiveness of Treatment Options
- Medical treatment has been shown to be effective in reducing symptoms and improving quality of life [(2,3,6)].
- Surgical treatment can provide satisfactory pain relief rates and pregnancy rates, but may also damage the ovarian reserve 5.
- The choice of treatment depends on the associated symptoms and individual patient needs [(3,4,5)].