Optimal management of Endometrioma/ Endometriosis
Women with symptomatic endometriosis
often have concomitant ovarian chocolate cysts or endometriomas; which is endometriosis of the ovary. Menstrual cramp, persistent pelvic pain or deep pain during sexual intercourse are frequently encountered. The ovarian blood-filled cysts are confirmed by pelvic ultrasound or magnetic resonance imaging.
When pain is incapacitating or when the cyst reached beyond the threshold size (arbitrarily 6cm); treatment is indicated. First line management is surgical removal of the cyst and excision of all visible endometriotic diseases. Laparoscopic or Robot-Assisted Laparoscopic approaches are the preferred operative approaches.
Laparoscopic excision of endometriosis is effective in reducing endometriosis associated pain, post-operatively improve Quality-of-Life, work performance and sexual experience. Surgery alone, though efficacious, unfortunately has a high five-year recurrence rate of about 40%. Surgery has to be combined with suppressive hormonal treatment to maintain long term disease-free state.
To optimize treatment, two essential criteria stand up. Firstly, the surgery must be performed at the right time
, and executed with clearance of all visible diseases. This requires the surgeon who is committed to seek out the last endometriosis nodule, who has the skills and experience, and who has the appropriate instruments
to achieve the desired outcomes. Secondly, initiating medical therapy before surgery and continuing thereafter will determine the duration of cure. Customizing the type and dose of medication to her needs will ensure compliance.