Leaflet Details
| Title | Treatment Options for Ovarian Endometriomas |
| Department | Gynaecology |
| Author(s) | Dr Adamczyk |
| Review Date | January 2022 |
| Next Review | January 2025 |
| Download | A4 Handout PDF |
| Accessibility Options | Click on the Recite Me button to show our accessibility resources |
Patient Information
Who is this information for?
This information is for you if you wish to know more about endometriomas. It may also be helpful if you are the partner or relative of someone with endometriosis.
What are ovaries?
Ovaries are a woman’s reproductive organs that make female hormones and release an egg from a follicle (a small fluid-filled sac) each month. The follicle is usually about 2–3cm when measured across (diameter) but sometimes can be larger.
What is an ovarian cyst?
An ovarian cyst is a larger fluid-filled sac that develops on or in an ovary. A cyst can vary in size from a few centimetres to the size of a large melon. Ovarian cysts may be thin-walled and only contain fluid (known as a simple cyst) or they may be more complex, containing thick fluid, blood or solid areas.
What are endometriomas?
People with endometriosis can develop ovarian cysts containing endometriosis tissue; these are called endometriomas. Endometriomas are usually filled with old blood that resembles chocolate syrup; thus, they are sometimes called "chocolate cysts". They are benign (not cancerous) but can cause pelvic pain and sometimes affect ovarian function and fertility.
What is “ovarian reserve”?
Ovarian reserve refers to the number and quality of eggs which determines a woman’s fertility potential. It can be assessed through a blood test to measure two important hormones: follicle stimulating hormone (FSH) and anti-Mullerian hormone (AMH) or by an ultrasound scan that counts the number of growing follicles within each ovary (antral follicle count).
What are the challenges in the treatment of endometriomas?
Treatment options for endometriomas vary from patient to patient. Currently there are a number of options available, and your clinicians will help you choose an appropriate treatment according to your specific needs and circumstances. The choice depends on various factors such as your age, pain symptoms or wish to become pregnant. Surgically removing ovarian cysts can inadvertently remove some healthy ovarian tissue and reduce a woman’s ovarian reserve. This is more likely if a woman has existing diminished ovarian reserve or is older. In our service, we adopt an individualised approach taking into account your unique factors to help you choose the best possible treatment.
What are the treatment options?
Observation and Monitoring
Small endometriomas that are not causing symptoms don't have to be treated. Instead, we can use the wait and watch approach.
Medical
Similarly to the endometrium (the womb lining), endometriosis can respond to fluctuations in hormones called progesterone and oestrogen. For patients who are not actively trying to conceive, hormonal forms of birth control can decrease natural hormone function, slow down cyst growth, and manage pain.
Surgical
Excision (cystectomy) of endometriomas remains the most common surgical approach with the lowest recurrence rate. However, it can reduce your ovarian reserve (the number of eggs your ovaries contain).
Ablation (burning of the cyst) carries a higher recurrence rate than excision, with a similar ovarian reserve reduction.
Drainage and washout has the highest recurrence rate however the lowest ovarian reserve reduction rates.
Sclerotherapy (when the endometrioma is drained and washed, then temporarily filled with ethanol for 15 min) has a low ovarian reserve reduction rate but a slightly higher recurrence rate than excision.
We have recently introduced the sclerotherapy treatment option in CEMIG; however, this technique has been in use for many years utilising ultrasound to perform the procedure. More recently, laparoscopic sclerotherapy (performed during keyhole surgery) has been used with promising results. It is safe and is thought to have less detrimental effects on the ovarian reserve compared to excision. Studies have shown encouraging results with low recurrence rates and good fertility outcomes.
Oophorectomy (removal of ovary) can be considered as an option in women close to or after menopause and patients with no fertility wishes.
