Treatment of ovarian endometriosis: Number 1 – 2026

Key points• Endometriosis is a common benign disease that can compromise women's quality of life and their fertility.• Ovarian endometrioma is a form of the disease that can compromise women's fertility and cause pain and discomfort.• Fertility preservation is a key point to consider in the care of women with endometriosis, especially those with ovarian endometriomas.• The etiopathogenesis of the disease and the development of ovarian endometrioma are not yet fully understood.• Several mechanisms are responsible for infertility in women with endometriosis, including increased production of cytokines and chemokines, an altered hormonal environment, increased oxidative stress, and impaired tubal and sperm function.Furthermore, endometriomas can interfere with folliculogenesis. Recommendations• Surgical treatment of endometriomas, when indicated, should preferably be performed with drainage and excision of the pseudocapsule.• Alternative techniques that better preserve ovarian reserve, such as drainage and sclerotherapy or alcohol ablation, may be performed selected cases, provided that this is agreed upon with the patient.• Fertility preservation should be an important point to consider in the care of women with endometriosis, especially those with ovarian endometriomas.• Women with unoperated bilateral endometriomas and those who have previously had unilateral endometriomas removed and require surgery for a contralateral recurrence should be advised about fertility preservation and available strategies, including cryopreservation of embryos and oocytes.• As age is the most important prognostic factor, all patients should be aware of the effect of age on their fertility plans.• Women should be individually advised about the risks, benefits, and costs involved in disease treatment, including medical and surgical treatment and assisted reproduction.• Care by a multidisciplinary team with expertise in endometriosis is fundamental to achieving better results.