Management of likely endometrioma*

* Definitive diagnosis of endometrioma is based on histologic evaluation of a surgical specimen. Imaging findings suggestive of endometrioma include an avascular, thick-walled cystic mass that contains material with a homogenous low-level echo pattern (ie, ground-glass appearance). Cysts may be uni- or multilocular. Septations, if present, should be smooth and without solid elements.

¶ Imaging findings suggestive of malignancy include increasing cyst size and complexity as well as presence of mural nodules. Clinical factors that independently increase the risk of malignancy include presence of genes associated with ovarian cancer, family history of ovarian or peritoneal cancer, and patient age over 50 years. For additional discussion, refer to related UpToDate content on epithelial carcinoma of the ovary and fallopian tube.

Δ Active surveillance consists of serial imaging, preferably with ultrasound, and physical examination. The frequency of imaging decreases once cyst stability has been established over one to two years of imaging.

◊ Surgical removal of an endometrioma does not improve outcomes for patients undergoing in vitro fertilization. Surgery should not be performed in this patient group unless there are other indications (ie, concern for malignancy or symptoms).

§ Oophorectomy (removal of ovary) is reserved for individuals with concern for malignancy or who desire definitive surgical treatment. It may be done with or without hysterectomy and/or removal of the contralateral ovary and/or fallopian tube. It provides definitive surgical therapy, but results in loss of ovarian hormonal and reproductive function. Additional discussion is presented in UpToDate's content on elective oophorectomy versus ovarian conservation at the time of hysterectomy.