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What Are Endometriomas?

Some women with endometriosis develop blood-filled cysts called endometriomas. As with endometriosis, endometriomas affect women who are premenopausal as the condition is hormonally stimulated. These encapsulated sacs can form in one or both ovaries and sometimes make their way into the interior of the ovaries. The cysts are filled with blood and endometriotic tissue. Since the blood is old and dark brown, these lesions are often called "chocolate cysts."

An endometrioma can penetrate the outer wall of the ovary and get inside the organ in a process called invagination. These deep cysts continue to develop inside the ovary, and can impact a woman's fertility and cause severe pain. Although some endometriomas may cause no pain or other symptoms, the cysts can be painful, and can also pose a threat to healthy ovarian tissue and egg follicles and reduce a woman's fertility.

Endometriomas contribute to an overall toxic and inhospitable environment for both eggs and sperm. If large, endometriomas can interfere with egg retrieval from the ovaries if a woman needs to undergo assisted reproductive technology (ART) in order to become pregnant.

Endometriomas must be dealt with carefully as surgeries to remove them can also damage the ovaries and reduce a woman's chance of pregnancy.

Particularly when large, ovarian cysts can be found by palpation during a pelvic exam. But those that are deeply entrenched within the ovary need to be examined with imaging techniques such as transvaginal ultrasound or magnetic resonance imaging.

A definitive diagnosis requires that extracted tissue be examined in the lab under a microscope.

Watch and Wait

If an endometrioma is small and not causing pain, a physician may suggest just regular follow-up every 3 to 6 months for several years to monitor any possible growth. There is a small risk of cancer associated with the presence of endometriomas so regular follow-up is important.

Medical Therapies

Unlike regular endometriosis deposits, endometriomas typically do not respond well to the usual estrogen-reducing therapies such as oral contraceptives and progesterone or agents aimed at gonadotropin-releasing hormone. These medications, however, may be helpful after removal of the endometriomas to prevent recurrence. They can also decrease symptoms related to endometriosis such as pain with menses.

Surgery

If your physician recommends removal of an endometrioma, excision with surgery is the best route. Just draining the cysts with a needle or eroding them with ablation methods such as electrocautery, laser, cryoablation (with cold), or microwaves may leave residue that can lead to recurrence.

Surgery should be done by an expert in minimally invasive gynecologic surgery in order to prevent damage to healthy ovarian tissue during the operation.

Surgery is normally done laparoscopically rather than with a large open incision. In laparoscopic surgery the abdomen is inflated with gas to push away the abdominal walls and allow the surgeon a better view. A thin tube with a tiny video camera to guide the procedure is inserted into a small incision in the abdomen. The surgeon cuts away the lesions and removes them completely in order to lessen the chance that leftover tissue will grow back.

Again, standard medical treatments for endometriosis can help prevent recurrence of endometriomas.

Preserving Fertility

Early diagnosis, careful monitoring, and, if necessary, appropriate surgery are crucial for protecting a woman's fertility. If endometriomas are already threatening the egg supply, healthy ovarian tissue may be extracted for preservation before surgery to remove the cysts. An increasing number of women with endometriomas are asking for this measure to secure their chances of having a family.

A diagnosis of endometrioma does not mean a woman will be infertile, but it may take longer to become pregnant. Some women with larger endometriomas may not be able to conceive spontaneously and will require ART.

Fortunately, there are many specialized ways and dedicated treatment centers to help a woman both control the symptoms from endometriomas and help ensure she has successful pregnancies and the family she wants.

Read previous installments in this series:

What Is Endometriosis?

How Will Your Doctor Diagnose Endometriosis?

What to Know About Endometriosis Treatment

Fertility and Pregnancy in Endometriosis

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this 12-part journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.