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Management of Endometriomas

Rehmer, Jenna M., MD*; Flyckt, Rebecca L., MD; Goodman, Linnea R., MD; Falcone, Tommaso, MD§

Obstetrical & Gynecological Survey: April 2019 - Volume 74 - Issue 4 - p 232–240
doi: 10.1097/OGX.0000000000000660

Importance Endometriomas are a unique and complex representation of the classic phenotypes of endometriosis. Associated symptoms, high recurrence rate, and multimodal approach represent ongoing challenges in the management of this chronic disease.

Objective To review current literature regarding medical and surgical management of endometriomas.

Evidence Acquisition An extensive literature search including PubMed and Cochrane Library was performed. Review was performed using the following key words: “endometrioma,” “cystectomy,” “chronic pain,” “infertility,” “IVF,” “menopause,” “recurrence.” All pertinent articles were assessed. The references of those articles were then reviewed, and additional publications were evaluated. Eligibility of the studies was first assessed on titles and abstracts. Full articles were then reviewed for all selected studies, and decision for final inclusion was made at that time.

Conclusions and Relevance Cystectomy of ovarian endometriomas has been the first-line treatment for management for many years because it provides improved pain relief, reduces recurrence rates, and was thought to be favorable in in vitro fertilization. However, a growing body of evidence is demonstrating benefit, or at least no harm, in expectant management for asymptomatic patients with small, stable endometriomas. Medical management is often very effective and appropriate first line. When surgical intervention is appropriate, careful ovarian cyst excision with goal of ovarian tissue preservation and treatment of additional endometriosis by a trained surgeon can provide the patient the best long-term outcome and preservation of ovarian tissue and function.

Target Audience Physicians from family medicine, obstetrics and gynecology, and reproductive endocrinology and infertility.

Learning Objectives Following completion of this CME activity, physicians should be better able to accurately diagnose endometriomas; select appropriate medical management; determine when surgical intervention is warranted; and identify the importance of ovarian tissue–conserving surgical techniques.

*Reproductive Endocrinology and Infertility Fellow Physician and

Reproductive Endocrinology and Infertility Assistant Professor of Surgery, Obstetrics, Gynecology, and Women's Health Institute, Cleveland Clinic, Cleveland, OH;

Reproductive Endocrinology and Infertility Assistant Professor, UNC Fertility, University of North Carolina Chapel Hill, Chapel Hill, NC; and

§Chief of Staff, Chief Academic Officer, and Medical Director, Cleveland Clinic London, and Professor of Surgery, Obstetrics, Gynecology, and Women’s Health Institute, Cleveland Clinic, Cleveland, OH

All authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this educational activity.

Correspondence requests to: Tommaso Falcone, MD, Reproductive Endocrinology & Infertility, Obstetrics, Gynecology & Women's Health Institute, 9500 Euclid Ave, Desk A81, Cleveland, OH 44195. E-mail:

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