Current status of management of endometriomas

It is well documented that there is no successful medical treatment for ovarian endometriomas. Transvaginal aspiration is associated with a very high recurrence rate. The use of sclerosing agents as tetracycline and ethanol may reduce the recurrence rate, however, aspiration may possibly result in infection or adhesions.

Surgical treatment of endometriomas is the appropriate approach in the management of associated pain. Laparoscopic surgery proved to be superior to laparotomy in the treatment of endometriomas as it showed less postoperative pain, less blood loss and shorter hospital stay. It is believed that coagulation and ablation of the superficial endometrium lining of the cyst wall is an effective line of treatment as it causes the minimal possible damage to the ovarian tissue. Ovarian cystectomy is considered to be more effective treatment and is associated with lower incidence of recurrence rate. However, there is no available randomized studies to compare both modalities concerning infertility treatment. Assisted reproduction in the form of ovarian stimulation and intrauterine insemination could be tried if the tubes are patent, and IVF is considered as the first line of treatment in extensive adhesions or after failure of surgical treatment.