Management of Endometriomas

Ludovico Muzii, MD Chiara Di Tucci, MD; Mara Di Feliciantonio, MD; Giulia Galati, MD; Ludovica Verrelli, MD; Violante Di Donato, MD; Claudia Marchetti, MD; Pierluigi Benedetti Panici, MD


Semin Reprod Med. 2017;35(1):25-30. 

In This Article

Abstract and Introduction


Ovarian endometriomas affect 17 to 44% of women with endometriosis, and are often associated with pelvic pain and infertility. Treatment options include expectant management, medical and/or surgical treatment, and in vitro fertilization and embryo transfer (IVF-ET). The choice of treatment depends mostly on the associated symptoms. In most cases, surgery is the preferred choice, since endometriomas do not respond to medical treatment, which may only treat associated pain. In case of infertility, IVF-ET may be a suitable alternative to surgery, particularly when there is no associated pain. According to the best available scientific evidence, laparoscopic excision of the endometrioma wall should be considered the procedure of choice. Concerns have been raised as to the possibility that surgical excision may damage the ovarian reserve, but recent evidences demonstrate that part of the damage may be due to the presence of the endometrioma itself. Indication to surgical treatment should balance the possible risks of damaging the ovarian reserve with the advantages of surgery in terms of satisfactory pain relief rates and pregnancy rates, and of obtaining tissue specimen for ruling out the rare cases of unexpected ovarian malignancy. A score system to guide the clinician in the decision to perform or withhold surgery is presented.


Endometriosis is defined as the presence of endometrial-like tissue outside the uterus. Ovarian endometrioma is a form of pelvic endometriosis, presenting as a chocolate fluid-containing cyst, located inside the ovary. Ovarian endometriomas are present in 17 to 44% of patients with endometriosis, and may be associated with pelvic pain and infertility.[1–3]

The choice of treatment among the available options in case of ovarian endometriomas mostly depends on patient-associated symptoms, age, and desire of fertility. In case of asymptomatic endometriomas, with typical ultrasound features, expectant management is a suitable option. When, however, pain and/or infertility are present, expectant management may not be the best option, since results in terms of pain relief and spontaneous pregnancies are not satisfactory with this approach.[2–4] Moreover, the patient herself may not be compliant to expectant management, when complaining of associated symptoms. Therefore, in most cases of ovarian endometriomas, either a medical or surgical treatment, or in vitro fertilization and embryo transfer (IVF-ET) in case of associated infertility, is warranted.

In this article, we will overview the recent literature on the different management options in case of ovarian endometriomas, with the aim of delivering evidence-based suggestions to guide the clinician in selecting the best approach to the ovarian endometrioma in the different clinical scenarios.