Endometriomas
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Evidence-based guidance on ovarian endometriomas (chocolate cysts): recognition, imaging, treatment options, fertility considerations, pain management, and recovery to help you navigate care decisions.
Overview
Endometriomas (“chocolate cysts”) are ovarian cysts caused by endometriosis. They can drive period and pelvic pain, dyspareunia, and fertility challenges, or be found incidentally. Diagnosis is usually made with transvaginal ultrasound based on a classic “ground‑glass” appearance; MRI is helpful when features are atypical or to plan surgery. Because they arise from endometriosis rather than the uterine muscle, they differ from adenomyosis and are managed with ovarian and fertility preservation in mind. Learn how imaging results, symptoms, and goals shape next steps, with links to Ultrasound and MRI for deeper context.
Care focuses on easing pain, protecting ovarian reserve, and aligning with pregnancy plans. Options include watchful waiting with hormonal suppression, pain strategies, and surgery when cysts are large, symptomatic, suspicious, or complicate egg retrieval. Cystectomy generally lowers recurrence more than drainage/ablation but may impact ovarian reserve, so decisions weigh age, AMH/AFc, cyst size, prior surgery, and fertility timelines. Explore operative considerations in Excision Surgery and Surgery, fertility pathways in Fertility & Reproductive Health and IVF & ART, and symptom tools in Pain Relief.
How are endometriomas diagnosed, and do I need MRI or surgery to confirm?
Most are diagnosed by transvaginal ultrasound using characteristic features, often without the need for surgery to confirm. MRI is added when ultrasound is inconclusive, to rule out look‑alikes, or to map coexisting deep disease before an operation; see Ultrasound and MRI for details. Surgery is pursued for treatment, not just to “prove” the diagnosis, unless imaging raises concern for another process.
Will an endometrioma affect fertility or my ovarian reserve?
Endometriomas can inflame the ovary and surrounding tissue, sometimes lowering response to stimulation and complicating ovulation or egg retrieval. The cyst itself and repeated surgery can both impact reserve, so plans balance cyst size and symptoms with age, AMH/AFc, and reproductive goals. A tailored approach may combine medical suppression, careful surgical technique, or proceeding directly to assisted reproduction; see Fertility & Reproductive Health.
Should I have an endometrioma removed before trying to conceive or doing IVF?
Removal may help when cysts are large (commonly discussed around 4 cm or more), painful, suspicious on imaging, or likely to block access to follicles during retrieval. However, surgery can reduce ovarian reserve, so many people proceed with IVF while monitoring a smaller, typical‑appearing cyst. Decisions are individualized with your fertility specialist; learn more in IVF & ART and Excision Surgery.
Can medications shrink or treat an endometrioma?
Hormonal therapies such as combined pills, progestins, or GnRH‑based options can reduce bleeding into the cyst, ease pain, and sometimes modestly shrink size, but they do not remove the cyst wall. They are useful for symptom control, postoperative suppression to lower recurrence, or when delaying surgery for fertility planning. Adjunctive strategies for comfort are outlined in Pain Relief and At-Home Remedies.
What are the risks of leaving an endometrioma in place, and how is it monitored?
Potential risks include growth with worsening pain, rare rupture or torsion, and a small increased lifetime risk of certain ovarian cancers; the absolute risk remains low, especially with typical imaging features. Monitoring usually involves periodic ultrasound (often every 6–12 months) and reassessment if symptoms change or the cyst develops solid or vascular areas. Rapid growth, new concerning features, or difficulty accessing follicles are reasons to revisit surgical options in Surgery.
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