Management of ovarian endometriomata

Abstract

Ovarian endometrioma is the most frequent endometriotic lesion, affecting about 55% of patients suffering of endometriosis. It is a marker of severity of the disease, associated with deep endometriotic lesions independently of its size. Its compromise is usually multifocal. Though commonly diagnosed in women of reproductive age, it can develop in adolescent girls and even before menarche. Treatment of the ovarian endometrioma is either medical or surgical. Medical treatment, which aims to relieve pain, is mostly used as an adjuvant following surgery in order to decrease recurrence. Surgical treatment plays a major role, despite its effects on the ovarian reserve; rates of pain relief and spontaneous pregnancy favor this approach. Four conservative surgical techniques can be used, all of them feasible by laparoscopy: pseudo capsule excision (cystectomy), ablation, the two-stage technique and the combined technique. Besides chosen technique, surgery quality and the sensible use of energy during the procedure affect the outcome. In cases of ovarian endometrioma, the best approach is individualized treatment considering the patient’s needs and associated factors.