Evidence Based Management of Endometrioma

Endometriomas are commonly seen in women of reproductive age who may wish to preserve their ovarian function and/or fertility.
•There is insufficient evidence to suggest that surgical treatment of endometrioma is better than medical treatment with respect to the long-term relief of symptoms and quality of life.

Treatment of symptomatic women should be individualized according to
•the woman’s age and her desire for fertility,
•previous surgery,
•long-term effects of medical therapy and
•the patient’s preference.

Drainage and sclerotherapy of endometrioma, possibly followed by postoperative ovarian suppression for 3 months, may be valid for women with a history of previous multiple surgery or those with frozen pelvis who wish to preserve their ovaries.Laparoscopic excision of ovarian endometrioma prior to IVF does not offer any additional benefit over expectant management in terms of ovarian response to gonadotrophin stimulation or pregnancy outcome.Surgical treatment can be justified for women with concomitant pelvic pain not responding to medical treatment, when the cyst is larger than 4 cm or when malignancy cannot be reliably excluded.