Related Experiment Video
Updated: Mar 15, 2026
Surgical Techniques to Optimize Ovarian Reserve during Laparoscopic Cystectomy for Ovarian Endometrioma
Published on: January 22, 2022
Pharmacologic treatment of the ovarian endometrioma
Giuseppe Benagiano1, Sun-Wei Guo2, Paola Bianchi3
1a Department of Gynaecology, Obstetrics and Urology , Sapienza University of Rome , Rome , Italy.
Introduction:
Treatment of ovarian endometriomas is commonly achieved through laparoscopic surgery and this can be effective in eliminating the disease, although a majority of recent trials documented an adverse effect of surgery on ovarian reserve markers. With the advancement in imaging techniques, ovarian endometriomas are increasingly diagnosed at an earlier stage when the endometrioma may be smaller, less fibrotic and more responsive to medical treatment, making an evaluation of medical options critically important.
Areas Covered:
The review focuses on currently utilized pharmacologic therapies for endometrioma (oral contraceptives, the levonorgestrel-releasing IUS, the hormone-releasing subdermal implant, Implanon); experimental and future treatments are also mentioned (GnRH antagonists, progesterone receptor modulators, antioestrogens, newer subdermal implants and intracystic administration of pharmacologic agents). Finally, the usefulness of post-operative adjuvant medical treatments is discussed Expert opinion: Today, reliable, non-invasive diagnostic procedures of an ovarian endometrioma are available and should be utilized to identify its presence and type of pathology. In a young patient, classic medical therapies such as oral contraceptives and synthetic progestins should be tried first to alleviate symptoms. Only when these regimens fail, should a minimally invasive surgery be envisaged. Following endoscopic surgery, adjuvant medical treatment may reduce recurrence of both symptoms and the lesion.
Insights
Medical treatments for ovarian endometriomas are increasingly important, especially for early-stage disease. While surgery can be effective, medical options like oral contraceptives and progestins offer alternatives, potentially preserving ovarian reserve.
Area of Science:
- Gynecology
- Reproductive Medicine
- Pharmacology
Background:
- Laparoscopic surgery is a common treatment for ovarian endometriomas but can negatively impact ovarian reserve.
- Advancements in imaging allow earlier diagnosis of ovarian endometriomas, enabling evaluation of less invasive medical treatments.
- Early-stage endometriomas may be smaller and more responsive to medical interventions.
Purpose of the Study:
- To review current and emerging pharmacologic therapies for ovarian endometriomas.
- To discuss the role of medical treatments in managing endometriomas, including post-operative adjuvant therapy.
- To provide expert opinion on diagnostic procedures and treatment strategies for ovarian endometriomas.
Main Methods:
- Review of currently utilized pharmacologic therapies (oral contraceptives, levonorgestrel-releasing IUS, hormone-releasing subdermal implant).
- Discussion of experimental and future treatments (GnRH antagonists, progesterone receptor modulators, antioestrogens, newer implants, intracystic agents).
- Evaluation of the usefulness of post-operative adjuvant medical treatments.
Main Results:
- Non-invasive diagnostic procedures for ovarian endometriomas are available and should be used.
- For young patients, initial treatment should focus on medical therapies like oral contraceptives and synthetic progestins.
- Minimally invasive surgery should be considered only when medical regimens fail.
Conclusions:
- Medical management is a crucial consideration for ovarian endometriomas, particularly in early stages.
- Adjuvant medical treatment following surgery may help reduce symptom and lesion recurrence.
- A stepwise approach prioritizing medical therapy before surgery is recommended for young patients.
Related Concept Videos
02:07Oogenesis
01:30Hormonal Control of the Ovarian Cycle
Before puberty, the hypothalamus releases GnRH in a low frequency, low amplitude pulsatile manner. This along with the immature hypothalamic-pituitary-gonadal axis activity, results in low estrogen levels and the absence of a fully functional ovarian cycle. At puberty, GnRH secretion increases in both frequency and...
01:22Hormonal Regulation of the Menstrual Cycle
At puberty, GnRH begins a pulsatile release pattern, which triggers the anterior pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The frequency and amplitude of GnRH pulses vary across the menstrual cycle, with faster pulses favoring LH release and slower pulses favoring FSH...
01:27Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists
01:27Ovarian Cycle