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

Dimitrios Psaroudakis, D Psaroudakis, Psaroudakis D, Martin Hirsch, Colin Davis, Colin J. Davis, Davis C
Current opinion in obstetrics & gynecology · 2014 · vol. 26(4) , pp. 266–274 · doi:10.1097/gco.0000000000000078 · PMID:24978850 · W2333710050
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This review outlines a conservative management approach for ovarian endometriosis, emphasizing assisted reproduction, limited surgery for severe symptoms, and minimal ovarian reserve impact.

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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.

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Condition tags

endometriosis

MeSH descriptors

Aromatase Inhibitors Cystectomy Drainage Endometriosis Infertility Laparoscopy Laparoscopy Ovarian Diseases Aromatase Inhibitors Aromatase Inhibitors Cystectomy Cystectomy Drainage Drainage Endometriosis Endometriosis Endometriosis Endometriosis Evidence-Based Medicine Evidence-Based Medicine

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (87)

Cited by (20)

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