Endometriosis: Management of ovarian endometriomas
- Barbara S Levy, MD, FACOG
Barbara S Levy, MD, FACOG
- Vice President for Health Policy
- American College of Obstetricians & Gynecologists
- Robert L Barbieri, MD
Robert L Barbieri, MD
- Editor-in-Chief — Obstetrics, Gynecology and Women's Health
- Section Editor — General Gynecology and Female Reproductive Endocrinology
- Kate Macy Ladd Professor of Obstetrics, Gynecology and Reproductive Biology
- Harvard Medical School
An ovarian endometrioma is a cystic mass arising from ectopic endometrial tissue within the ovary. It contains thick, brown, tar-like fluid, which may be referred to as a "chocolate cyst." Endometriomas are often densely adherent to surrounding structures, such as the peritoneum, fallopian tubes, and bowel. This topic will review management of ovarian endometriomas. Information on adnexal masses and the clinical diagnosis and management of endometriosis is discussed separately. (See "Approach to the patient with an adnexal mass" and "Endometriosis: Pathogenesis, clinical features, and diagnosis".)
The goals of endometrioma treatment are to relieve symptoms (eg, pain or mass), prevent complications related to the adnexal mass (eg, rupture or torsion), exclude malignancy, improve subfertility, and preserve ovarian function.
Relief of symptoms — Endometriomas that cause pain or a mass effect are removed to relieve the patient's symptoms [1-4].
Prevention of cyst complications — Enlarging cysts are removed because they increase the risk for ovarian torsion, cyst rupture, and the possibility of malignancy . Ovarian torsion is a surgical emergency. (See "Ovarian and fallopian tube torsion", section on 'Surgical evaluation'.)
Exclusion of malignancy — Endometriosis of the ovary is associated with a small increased risk of development of or transformation to ovarian cancer; the most common histologies are clear cell and endometrioid [6,7]. For this reason, endometriomas are removed if they have an atypical appearance on imaging studies or other concerning features (eg, enlarging size) . (See "Endometriosis: Pathogenesis, clinical features, and diagnosis", section on 'Link to cancer'.)
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- TREATMENT GOALS
- Relief of symptoms
- Prevention of cyst complications
- Exclusion of malignancy
- Treatment of subfertility
- Preservation of ovarian function
- TREATMENT OPTIONS
- OUR APPROACH
- SURGICAL PROCEDURES
- Conservative surgery (cystectomy)
- Definitive surgery (oophorectomy with or without hysterectomy)
- POSTOPERATIVE MANAGEMENT
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS