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Endometriosis: Management of Ovarian endometriomas

Barbara S Levy, MD, FACOG
Robert L Barbieri, MD
Section Editor
Howard T Sharp, MD
Deputy Editor
Kristen Eckler, MD, FACOG


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 [5]. 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) [5]. (See "Endometriosis: Pathogenesis, clinical features, and diagnosis", section on 'Link to cancer'.)


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Literature review current through: Sep 2016. | This topic last updated: Aug 25, 2016.
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