Version July 2025
NSAID: nonsteroidal anti-inflammatory drug.
* An endometrioma generally appears as an avascular, thick-walled cystic mass that contains material with a homogenous low-level echo pattern (ie, ground-glass appearance). Cysts may be uni- or multilocular. Septations, if present, should be smooth and without solid elements. Definitive diagnosis of endometrioma requires histologic confirmation of a surgical specimen.
¶ Imaging findings suggestive of malignancy include increasing cyst size and complexity as well as presence of mural nodules. Clinical factors that independently increase the risk of malignancy include genes associated with ovarian cancer (eg, BRCA), family history of ovarian or peritoneal cancer, and patient age over 50 years.
Δ Cystectomy (removal of endometrioma only) is preferred for most patients without concern for malignancy as it minimizes the impact on ovarian function and preserves fertility. However, recurrent endometrioma may develop.
◊ Oophorectomy (removal of ovary) is mainly reserved for individuals with concern for malignancy or who desire definitive surgical treatment. Oophorectomy may be combined with other procedures (eg, fallopian tube removal) but results in loss of ovarian hormonal and reproductive function.
§ Initial treatment for endometriosis-related pain typically includes a hormonal contraceptive plus an NSAID. Hormonal contraceptives include estrogen-progestin methods (oral pill, transdermal patch, or vaginal ring) or progestin-only methods (oral pill, injectable, implant, or intrauterine device). Selection is based on patient preferences and availability. Patients who are unable to take NSAIDs use the contraceptive only. Additional treatment options are available. Further discussion of treatments and selection for patients with endometriosis-related pain is available in related UpToDate content.