Endometriomas, also known as “chocolate cysts,” are a common form of ovarian cysts that occur in women with endometriosis. These cysts, which are filled with dark, old blood, can cause significant discomfort and fertility issues. There is a common question among patients – can an endometrioma disappear? Let’s delve into the subject to find out more.
What is Endometrioma?
Endometrioma is a type of ovarian cyst formed when endometrial tissue, the tissue that lines the uterus, grows in the ovaries. It’s a subset of a broader condition known as endometriosis, where endometrial tissue grows outside the uterus.
Prevalence of Endometrioma
Endometrioma affects 20-40% of women with endometriosis. They are a significant concern due to their potential impact on ovarian function and fertility. In fact, an endometrioma may be considered the most severe threat to a woman’s reproductive potential, exceeded only by cancerous tumors of the reproductive tract.
How Does Endometrioma Form?
Endometriomas are believed to form when endometrial tissue pushes into the ovary, creating a cystic mass lined by endometriosis tissue. The most common location for endometriomas is the ovaries, presumably because the ovary is the principal site of estradiol production. Estradiol is a form of estrogen that, in excess, can stimulate the growth of endometriosis lesions.
Symptoms and Diagnosis of Endometrioma
Endometriomas can cause pelvic pain, contribute to infertility, and decrease ovarian function. They can also interfere with assisted reproductive technologies. Diagnosis is usually suspected based on ultrasound imaging. The presence of deep endometriosis is frequently seen in patients having ovarian endometrioma. The final confirmation of the disease must be based on microscopic examination of the cyst itself.
Can an Endometrioma Disappear?
Endometriomas are not believed to regress spontaneously. In order to control pain symptoms, endometriomas are commonly managed by surgical excision. However, it’s essential to understand that even minimally invasive, conservative, standard techniques for excision can result in permanent damage to the ovary.
Treatment Options for Endometrioma
Treatment of endometrioma should be individualized to a patient’s goals and expectations. The discussion should include current and future goals related to pain, relationships, and fertility. It’s crucial that patients understand that prolonged observation or even pain relief can allow the endometriosis to progress and negatively impact fertility further.
Observation
In some cases, especially when the cyst is small and not causing significant symptoms, doctors may recommend a watchful waiting approach. Regular monitoring through ultrasound can help track any changes in the size of the endometrioma. usually, observation without medical treatment leads to an increase in the diameter of the cyst.
Medical Treatment
Hormonal therapies may help manage symptoms associated with endometriomas but will not make them disappear. Induction of amenorrhea sometimes decreases the size of an endometrioma.
Surgical Treatment
Surgery remains the mainstay of modern management of endometriomas. The choice of surgical methods depends on several factors, including the patient’s age, the size and location of the endometrioma, and the patient’s desire for future fertility.
The first surgery for an endometrioma is the most critical. The more surgeries performed for an endometrioma, the more damage is done, and the more difficult full, appropriate treatment becomes.
Implications of Endometrioma on Fertility
The presence of an endometrioma can negatively impact ovarian reserve or the number of ovarian follicles contributing to the hormone cycle allowing ovulation. This can lead to problems with ovulation or decreased ovarian function. In fact, surgical excision of endometriomas may decrease ovarian reserve and the number of oocytes retrieved for subsequent In Vitro Fertilization (IVF).
Endometrioma and Pregnancy
During pregnancy, decidualization can occur in ovarian endometrioma due to elevated serum progesterone levels. This condition mimics malignancy on ultrasonography. Moreover, decidualized ovarian endometrioma may rupture and cause acute abdominal pain during pregnancy.
Endometrioma and Cancer Risk
Women with endometrioma also have a slightly increased risk of developing certain types of ovarian cancer. However, this risk is relatively small and should be balanced against the potential benefits of treatment.
Conclusion
So, can an endometrioma disappear? Without intervention, it’s unlikely. However, various treatment options can help manage this condition and even reduce the size of the endometrioma significantly. It’s crucial to remember that each case is unique, and the treatment plan should be customized to the individual patient’s needs and future plans. If you have been diagnosed with an endometrioma, it’s essential to discuss all treatment options with your healthcare provider to decide on the best course of action.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515259/