Therapeutic Management Strategy of Endometriomas

Background: Endometrioma is a distinct and common pelvic manifestation of endometriosis. Due to its functional impact, it can hinder the lives of many young women aspiring to get pregnant. Establishing a precise and early diagnosis in order to define the optimal therapeutic strategy, while balancing efficacy and safety, represents a challenge.The aim of our study was to enumeratethe various therapeutic methods for managing an endometrioma and their respective indications, and to develop a therapeutic management strategybased on recentrecommendations and our practice conditions. Methods: This was a descriptive retrospective study, conducted at the Department of Gynecology and Obstetrics B of the Tunis Maternity and Neonatology Center for over 5years (January 2017-December 2021). All patients with a confirmed diagnosis of endometrioma through anatomopathological examination were included. Results: One hundred and five women withendometrioma were included.The prevalence of endometrioma among ovarian tumors and genital endometriosis was 23.7% and 46.2%, respectively. The average age of the patients was 35.8± 8,7 years. Chronic pelvic pain was the primary reason for consultation (62%). The diagnosis of endometrioma was preoperatively established throughultrasound in 75 patients (71%). Laparoscopic surgery was the first-line therapeutic decision (88,5%).Intraperitoneal cystectomy was the most performed surgical procedure (57%), followed by fenestration-electrocoagulation(32%) and radical treatment (10,4%). Recurrence was observed in 21 patients. Recurrence management included ultrasound-guided ethanol sclerotherapy (42,8%), expectant management (28,5%), or radical treatment with adnexectomy (9,5%). Among the 18 patients consulting for infertility, five successfully achieved pregnancy. Conclusions: The diagnosis of endometrioma demands a holistic therapeutic approach. Different therapeutic options should be well-definedand customized to each patient. Preserving ovarian function while avoiding debilitating recurrences andlengthy therapeutic journeys is crucial forwomen of reproductive age.