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Review of the management of ovarian endometriosis: paradigm shift towards conservative approaches

Psaroudakis, Dimitrios; Hirsch, Martin; Davis, Colin

Current Opinion in Obstetrics & Gynecology:
doi: 10.1097/GCO.0000000000000078
MINIMALLY INVASIVE GYNECOLOGIC PROCEDURES: Edited by Colin Davis
Abstract

Purpose of review: To describe the current consensus regarding the modern management of ovarian endometriosis and summarize the recent evidence that led to a shift in the management recommendations.

Recent findings: The vast majority of the recent studies demonstrate an adverse effect of surgery on ovarian reserve markers, whereas convincing evidence of a benefit of surgery on fertility outcomes is lacking. Current research is focussing on identifying the optimal surgical technique that affords minimal injury to ovarian function. New medical treatment options in the form of aromatase inhibitors are emerging, whereas the evidence for a role of ultrasound-guided drainage and sclerotherapy is scarce and unconvincing.

Summary: Consensus from Europe and the USA is for a conservative approach to the treatment of ovarian endometriosis, with early recourse to assisted reproductive technology for subfertility. Surgery is currently only being advised for severe pain or difficult access to growing follicles and only after careful counselling regarding the potential adverse effect on ovarian reserve. Research has still not identified the optimal technique for treating ovarian endometriosis. Laparoscopic ovarian cystectomy not only offers the lowest risk of recurrence and the highest chance of spontaneous pregnancy rate, but also risks significant injury to ovarian function. Medical treatment offers temporary symptom relief but does not improve the fertility outcomes, and the role of ultrasound-guided drainage remains to be established.

Author Information

Centre for Reproductive Medicine, St Bartholomew's Hospital, London, UK

Correspondence to Dr Dimitrios Psaroudakis, Centre for Reproductive Medicine, 1st Floor, Kenton & Lucas Wing, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK. Tel: +44 203 465 5050; e-mail: dimitrios.psaroudakis@bartshealth.nhs.uk

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins