Treatment of ovarian endometrial cystsin thecontext of recurrence and fertility

Izabela Nowak-Psiorz, Sylwester Ciećwież, Sylwester M Ciećwież, Agnieszka Brodowska, Andrzej Starczewski
Advances in clinical and experimental medicine : official organ Wroclaw Medical University · 2019 · vol. 28(3) , pp. 407–413 · doi:10.17219/acem/90767 · PMID:30659784 · W2909346531
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This paper reviews surgical and pharmacologic treatments for ovarian endometriomas, emphasizing fertility preservation, recurrence prevention, and management based on cyst size, patient age, and childbearing desires.

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Abstract

An approach to ovarian endometrial cysts has changed considerably during recent years, especially in regard to treatment of recurrent endometriosis, fertility sparing and infertility management. Surgical treatment is the primary therapeutic option. The most efficient types of treatment are radical procedures involving adhesiolysis, removal of the cyst along with its capsule and any remaining endometriotic foci. However, small asymptomatic cysts should not be treated surgically, especially in patients older than 35 years. Surgical treatment can be considered in infertile women and those who failed to get pregnant despite 1-1.5 years of trials, as well as in cases in which in vitro fertilization is not an option. Also large cysts, with more than 4 cm in diameter, should be treated surgically due to the risk of their rupture or torsion. The most efficient preventive measure for recurrent ovarian endometriosis is unilateral oophorectomy with sparing the contralateral ovary. Such a procedure should be considered in women who are no longer interested in childbearing or present with another endometriotic cyst in the same ovary. The role of pharmacotherapy is fairly limited; it should be considered in patients in whom diffuse endometriosis is associated with pain. Therapeutic agents from the following groups can be used: estrogen-progestin preparation, gestagens, including progesteronereleasing intrauterine systems and gonadotropin-releasing hormone agonists. Women with infertility should get pregnant as soon as possible, and in patients who failed to get pregnant and/or are older than 35 years, in vitro fertilization should be the treatment of choice.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Ovarian Cysts Ovariectomy Endometriosis Endometriosis Endometriosis Endometrium Female Humans Infertility, Female Laparoscopy Neoplasm Recurrence, Local Ovarian Cysts Ovarian Cysts Ovarian Cysts Pregnancy

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Cited by (14)

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License: CC0 · commercial use OK