Non-surgical management of ovarian endometrioma

INTRODUCTION: An ovarian endometrioma is a cystic lesion arising from atopic endometrial tissueinside the ovary. Management options include surgical removal (cystectomy) and observation withserial ultrasonography. Whereas medical treatment is an effective option for pelvic pain induced byendometriosis, it has no advantages over observation for treatment of endometriomas. We evaluatenon- surgical management of ovarian endometrioma compared to surgery in selected groups ofpatients.Observation: Observation protect ovarian reserves and avoids surgical risk. The risks of observationcontain lack of histologic diagnosis, failure to eliminate malignancy, and possible for disease progress.Women with symptomatic or growing endometriomas are manage surgically. For women with smalland asymptomatic cysts (<5 CM) that have the ultrasound characteristics of an endometrioma, werecommend observation rather than excision. For endometriomas that are being observed, a typicalmanagement plan contains physical examination and imaging every 6 months for 1 to 2 years, followedby yearly examination and ultrasound if the adnexal mass has remained unaffected in dimension andclinical features. But, increasing cyst volume or complexity on a scan must prompt closer follow-up (3rather than 6 or 12 months). Two consecutive scans demonstrating increased cyst volume, change indifficulty of the cyst, or progress of symptoms should prompt surgical intervention.Medication: The treatment goals for endometriomas: pain relief, avoiding rupture or torsion, excludingmalignancy, and preventing symptomatic or expanding endometriomas. Medical therapy is not a choicefor first-line treatment because it does not resolve endometriomas or treat their symptoms. CurrentMedical treatment includes Ovarian suppressive agents as Hormonal (Oral contraceptive, Progestins,SPRM/SERM, GnRh analogues and Androgenic agents and aromatase inhibitor and non-hormonal(Immunomodulators, Antiangiogenic factors).Sclerotherapy: Cyst sclerotherapy has also been tried as a less aggressive another to cystectomy.However, the endometrioma recurrence rate after sclerotherapy is about 63 percent, without animprovement in clinical outcomes. Sclerotherapy involves of injecting a sclerosing agent (ethanol,tetracycline, or methotrexate) into the cyst opening and is thought to disturb the cyst epithelial lining,which results in inflammation, fibrosis, and, finally, elimination of the cyst.Conclusion: For women with small and asymptomatic cysts (<5 CM) that have the ultrasoundcharacteristics of an endometrioma, we recommend observation rather than surgery. There are nobenefits about another medication which used in endometriosis. Also, there is no benefits ofsclerotherapy other than observation alone. For endometriomas that are being observed, a typicalmanagement plan contains physical examination and imaging every 6 months for 1 to 2 years, followed by yearly examination and ultrasound.