Endometriosis affects approximately 10% of women of reproductive age. The most frequently affected organ is the ovary. Ovarian cysts are diagnosed in about 17% to 44% of women with endometriosis. The roles of currently available pharmacotherapy and surgical interventions for treating endometriosis-associated symptoms in women with endometriotic ovarian cyst are classified and clear. Ideal treatment depends on various factors like age, symptoms, involvement of bilateral ovaries, or the want for children. If the cyst is symptomless, a ‘wait and watch’ approach may also be suggested.
An endometrial ovarian cyst is an abnormal mass arising in the ovary from endometrial tissue. This cyst develops when endometrial tissues from the inside surface of the uterus grow abnormally and attach to the ovaries. Endometrial cysts can be present in the form of classic implants usually located on the surface of one or both ovaries but they can also be found deep within them. The endometriosis ovarian cyst contains thick, brown, tar-like fluid which is more commonly referred to as a “chocolate cyst.” The gradual collection of such un-clotted blood within the sacs starts irritating the surrounding tissues. Endometrial tissues are often found densely adhered to other surrounding structures, such as the peritoneum, fallopian tubes, and bowel as well.
The goals of ideal treatment for endometrial ovarian cyst are to relieve symptoms, prevent complications, exclude malignancy, improve subfertility and preserve ovarian function.
Goals of Treatment for Endometriosis Ovarian Cyst
The clinical management of endometrial ovarian cyst aims to adequately address three major clinical disruptions that are pain, infertility, and malignant transformation. A woman’s age and her reproductive life stage are the variants of symptoms and they are best managed individually.
A single treatment method cannot be applied when managing endometrial ovarian cysts. Best endometrial ovarian cyst treatment follows various treatment methods. Expert opinion believes that women of reproductive age should be treated by fertility specialists. Qualified specialists in the treatment of endometriosis and infertility can provide the ideal treatment for the individual woman, with utmost care. Common treatment methods used by specialists to treat endometrial ovarian cysts are:
It is observed that ovarian endometriotic cyst could be a cause of pelvic pain, but it is rare that endometriotic cyst is the only cause of severe, chronic pain. Extraovarian endometriosis, adhesions, or inflammation resulting from the abnormal tissues may be responsible for the pain. Various medicines have been used to treat endometrial ovarian pain. Not many reports indicate that medical treatment alone effectively alleviates long-term pain in women with symptomatic endometriotic cysts.
Surgery is considered to be the first-line treatment for severe pain in women with endometrial ovarian cyst. Surgical treatment to save bilateral ovaries includes drainage, sclerotherapy, diathermy, laser vaporization, and cystectomy. Ovarian cystectomy is suggested to be a more definitive treatment for an endometriotic cyst. Though many studies have not reported differences among various surgical procedures, randomized trials indicate a lower rate of recurrence of dysmenorrhea, dyspareunia, and chronic pelvic pain in women who underwent cystectomy compared with those who underwent other procedures.
Since the purpose of treatment here is different from pain management, the treatment strategy differs. The treatment method may also vary for patients desiring natural conception and for those undergoing assisted reproductive technology (ART). All medical treatments for endometriosis are hormonal blockage of ovarian function and are contraceptive in their mode of action. Hence, medical treatment is not the choice of treatment for women desiring natural conception. As per reports, there was no improvement in pregnancy rates with medical intervention for endometrial ovarian cysts.
Women with a longstanding history of endometriosis have a greater risk of developing ovarian cancer, suggesting that surgical intervention can reduce the risk of malignant transformation. Women who underwent a hysterectomy for ovarian endometriosis did not show an increased risk of ovarian cancer. This indicates that hysterectomy may have some protective role against ovarian cancer. For elderly women with an endometriotic cyst, it is suggested that the cyst is resected.
Several surgical procedures are used as treatment options for various symptoms derived from ovarian endometriosis. Minimally invasive surgery under laparoscopy is chosen to be the standard modality for the removal of endometrial ovarian cyst, especially in conservative therapy.
Laparoscopy offers the advantage of allowing simultaneous diagnosis and treatment of ovarian cysts in endometriosis. Except in cases of exclusive indications, laparoscopic surgery is suggested as the ideal choice of surgical procedures for infertile women with endometriotic cysts. By far, laparoscopy is reported to be superior in terms of symptoms and improvement in quality of life in women with endometrial ovarian cyst.