Treatment after endometrioma recurrence: a narrative review

Dimitrios Rafail Kalaitzopoulos, Dimitrios R Kalaitzopoulos, Maria Themeli Zografou, Zografou M, Maria Zografou, Konstantinos Nirgianakis, Nirgianakis K, Angelos Daniilidis, Aris Daniilidis, Daniilidis A, Krentel H, Harald Krentel, Markus Eberhard, Eberhard M, Nicolas Samartzis, Samartzis N
Minerva obstetrics and gynecology · 2023 · vol. 75(5) , pp. 449–459 · doi:10.23736/s2724-606x.23.05249-1 · PMID:37058320 · W4365479668
review OA: closed CC0 ⤵ 4 in-corpus citations
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This review synthesizes literature on treating recurrent ovarian endometriomas, finding repeated surgery negatively impacts ovarian function while aspiration offers similar pregnancy outcomes to no intervention, and progestins reduce pain and cyst size.

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Abstract

INTRODUCTION: Ovarian endometrioma is a common subtype of endometriosis with a prevalence between 17 and 44%. The reported average recurrence of endometrioma after surgical management is 21.5% after 2 years and 40-50% after 5 years. The aim of this narrative review was to summarize the existing literature focusing on treatment options after endometrioma recurrence in order to provide an evidence-based approach for the clinical practice. EVIDENCE ACQUISITION: Three electronic databases (MEDLINE, EMBASE and Cochrane) were searched until September 2022 for eligible studies. EVIDENCE SYNTHESIS: The available studies showed that repeated surgery has a negative impact on ovarian function, without improving the fertility outcomes. Transvaginal aspiration as an alternative option for surgery has a high rate of recurrence, which varies from 8.20 to 43.5% depending on the technique used and on the study population. Pregnancy related outcomes were similar between transvaginal aspiration groups and no intervention groups in patients with endometrioma recurrence. Regarding medical treatments, only four studies were found, showing that progestins reduce the pain and the diameter of the ovarian cyst. CONCLUSIONS: Recurrent endometrioma is a challenging condition which could be encountered during the care of women with endometriosis. The decision about the treatment-strategy has to be individualized considering family planning status, age, ovarian reserve and transvaginal ultrasound findings. Well-designed randomized clinical trials are needed to export safer conclusions about the most appropriate treatment in each specific condition after endometrioma recurrence.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

Citation neighborhood

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. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (52)

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License: CC0 · commercial use OK