Endometriomas

Most are diagnosed by transvaginal ultrasound using characteristic features, often without the need for surgery to confirm. MRI is added when ultrasound is inconclusive, to rule out look‑alikes, or to map coexisting deep disease before an operation; see Ultrasound and MRI for details. Surgery is pursued for treatment, not just to “prove” the diagnosis, unless imaging raises concern for another process.

Endometriomas can inflame the ovary and surrounding tissue, sometimes lowering response to stimulation and complicating ovulation or egg retrieval. The cyst itself and repeated surgery can both impact reserve, so plans balance cyst size and symptoms with age, AMH/AFc, and reproductive goals. A tailored approach may combine medical suppression, careful surgical technique, or proceeding directly to assisted reproduction; see Fertility & Reproductive Health.

Removal may help when cysts are large (commonly discussed around 4 cm or more), painful, suspicious on imaging, or likely to block access to follicles during retrieval. However, surgery can reduce ovarian reserve, so many people proceed with IVF while monitoring a smaller, typical‑appearing cyst. Decisions are individualized with your fertility specialist; learn more in IVF & ART and Excision Surgery.

Hormonal therapies such as combined pills, progestins, or GnRH‑based options can reduce bleeding into the cyst, ease pain, and sometimes modestly shrink size, but they do not remove the cyst wall. They are useful for symptom control, postoperative suppression to lower recurrence, or when delaying surgery for fertility planning. Adjunctive strategies for comfort are outlined in Pain Relief and At-Home Remedies.

Potential risks include growth with worsening pain, rare rupture or torsion, and a small increased lifetime risk of certain ovarian cancers; the absolute risk remains low, especially with typical imaging features. Monitoring usually involves periodic ultrasound (often every 6–12 months) and reassessment if symptoms change or the cyst develops solid or vascular areas. Rapid growth, new concerning features, or difficulty accessing follicles are reasons to revisit surgical options in Surgery.