Large bilateral ovarian endometriomas. Treatment strategies in the reproductive period

A.I. Davydov, М.Б. Хамошина, A.I. Ishchenko, М. G. Lebedeva, R. Chilova
In: Voprosy ginekologii, akušerstva i perinatologii · 2025 · vol. 24(1) , pp. 147–154 · doi:10.20953/1726-1678-2025-1-147-154 · W4408795212
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Ethanol sclerotherapy followed by continuous hormonal therapy effectively treated large bilateral ovarian endometriomas in a young patient, preserving ovarian function and avoiding surgery.

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This paper reports a rare clinical case of a 22-year-old, previously non-pregnant patient with first-diagnosed large bilateral ovarian endometriomas up to 110 mm in diameter. Ethanol sclerotherapy was used as an initial step, followed by continuous hormonal anti-recurrence therapy with a combined oral contraceptive containing 30 mcg ethinylestradiol and 2 mg dienogest; after 52 days ultrasound showed marked size reduction, leading the team to avoid laparoscopic cystectomy and repeat sclerosing, and after a further 122 days cavity structures were eliminated with fibrosis at the endometrioma sites. A key limitation is that the report is a single-case study. This paper is centrally about endometriosis — it describes treatment strategy for large bilateral ovarian endometriomas using ethanol sclerotherapy and dienogest-containing COC in a reproductive-period patient.

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Abstract

This article presents a rare clinical case of the first-diagnosed large bilateral ovarian endometriomas (up to 110 mm in diameter) in a 22-year-old previously non-pregnant patient. Ethanol sclerotherapy of endometriomas followed by hormonal and stabilization therapy to prevent recurrence with combined oral contraceptive (COC) containing 30 mcg ethinylestradiol (EE) and 2 mg dienogest (DG) (continuous regimen) was chosen as the first (preliminary) stage of treatment. After 52 days, a control pelvic ultrasound revealed a significant reduction in the size of ovarian endometriomas; therefore, it was decided to refrain from laparoscopic cystectomy and to perform repeat sclerosing. After another 122 days, complete elimination of cavity structures with fibrosis formation at the endometrioma site was noted. The patient is under observation, hormonal therapy is continued in the contraception mode. The discussion section covers the treatment of patients with ovarian endometriomas, the role of ethanol sclerosing, and the rationale for COC use as hormonal anti-recurrence therapy. Conclusion. Ethanol sclerotherapy is an exceptional method for the treatment of young patients with large bilateral ovarian endometriomas, but also the only way to preserve ovarian function and provide conditions for further organ-preserving interventions. Key words: large bilateral ovarian endometriomas, sclerotherapy, choice of hormonal therapy, COC, dienogest, Siluette®
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Large bilateral ovarian endometriomas. Treatment strategies in the reproductive period Aleksandr I. Davydov / Marina B. Khamoshina / Anatoliy I. Ishchenko / Marina G. Lebedeva / Raisa A. Chilova / This article presents a rare clinical case of the first-diagnosed large bilateral ovarian endometriomas (up to 110 mm in diameter) in a 22-year-old previously non-pregnant patient. Ethanol sclerotherapy of endometriomas followed by hormonal and stabilization therapy to prevent recurrence with combined oral contraceptive (COC) containing 30 mcg ethinylestradiol (EE) and 2 mg dienogest (DG) (continuous regimen) was chosen as the first (preliminary) stage of treatment. After 52 days, a control pelvic ultrasound revealed a significant reduction in the size of ovarian endometriomas; therefore, it was decided to refrain from laparoscopic cystectomy and to perform repeat sclerosing. After another 122 days, complete elimination of cavity structures with fibrosis formation at the endometrioma site was noted. The patient is under observation, hormonal therapy is continued in the contraception mode. The discussion section covers the treatment of patients with ovarian endometriomas, the role of ethanol sclerosing, and the rationale for COC use as hormonal anti-recurrence therapy. Conclusion. Ethanol sclerotherapy is an exceptional method for the treatment of young patients with large bilateral ovarian endometriomas, but also the only way to preserve ovarian function and provide conditions for further organ-preserving interventions. Key words: large bilateral ovarian endometriomas, sclerotherapy, choice of hormonal therapy, COC, dienogest, Siluette® For citation: Davydov A.I., Khamoshina M.B., Ishchenko A.I., Lebedeva M.G., Chilova R.A. Large bilateral ovarian endometriomas. Treatment strategies in the reproductive period. Vopr. ginekol. akus. perinatol. (Gynecology, Obstetrics and Perinatology). 2025; 24(1): 147–154. (In Russian). DOI: 10.20953/1726-1678-2025-1-147-154

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