🩸 Endometrioma Management Simulator

Endometrioma Identified on Ultrasound

A cystic ovarian mass raises suspicion for endometriosis.

• 17–44%: Prevalence in endometriosis (of patients)
• 2–10 cm: Typical size at diagnosis (cystic diameter)
• ~93%: Ultrasound sensitivity (for endometrioma)
• ~20%: Bilateral involvement (of cases)

Ground-glass appearance

Homogeneous low-level echoes signal old blood.

Differential diagnosis

Rules out hemorrhagic cyst, dermoid, malignancy.

Baseline AMH testing

Ovarian reserve checked before any treatment.

Monitoring Without Intervention

Serial scans track size and symptoms over time.

• ~10%: Growth rate untreated (per year, average)
• 3–6 mo: Recheck interval (ultrasound follow-up)
• rare: Spontaneous resolution (endometriomas persist)
• <1%: Malignant transformation (lifetime risk)

Symptom tracking

Pain and cycle changes guide next steps.

Size threshold

Growth past 6–7 cm often prompts action.

Fertility clock

Age and pregnancy plans shape waiting time.

Hormonal Therapy Limits Growth

Suppression shrinks the cyst but rarely eliminates it.

• ~20–30%: Size reduction on therapy (typical shrinkage)
• uncommon: Complete resolution (cyst usually persists)
• GnRH / OCPs: Common agents (progestins also used)
• high: Symptom relief (pain scores drop)

Mechanism

Estrogen suppression starves ectopic endometrial tissue.

Bridge therapy

Often used before or instead of surgery.

Rebound risk

Cyst can regrow once treatment stops.

Surgical Excision of the Cyst Wall

Laparoscopic stripping removes the cyst and some healthy ovary.

• ~15–30%: Recurrence after surgery (over 5 years)
• ~30–40%: AMH drop post-op (average decline)
• higher loss: Larger cyst impact (more tissue excised)
• Stripping: Technique (vs. ablation / fenestration)

Excision technique

Cyst wall is peeled from healthy cortex.

Collateral tissue loss

Follicle-rich cortex often comes away too.

Alternative techniques

Ablation spares tissue but recurs more often.

Comparing Ovarian Reserve Impact

AMH and reserve outcomes diverge by chosen approach.

• Largest: Cystectomy AMH loss (especially big cysts)
• Moderate: Medical therapy loss (reversible suppression)
• Smallest: Watchful waiting loss (no surgical trauma)
• Essential: Shared decision-making (age, fertility, symptoms)

Reserve trade-off

Every approach balances symptoms against fertility.

Cyst size matters

Bigger cysts mean bigger surgical AMH drops.

Individualized care

Choice depends on age and family planning.