Dr. Steve Vasilev, MD, Gynecologist, Endometriosis Surgeon*:

Every situation is very different and there is not enough information here to give a specific answer. But, six months is pretty fast for an endometrioma to recur. This suggests perhaps it was not removed while another one that was next to it was removed or perhaps it was not completely excised or simply drained. Removing these intact without spill is the best way to prevent a recurrence but this takes specialized skill and optimal instrumentation. Having said that, this is easier said than done and endo grows in multiple areas, including various parts of the ovary (superficial and deep). So, even after an apparently highly successful surgery, endometriomas can recur by growing from tiny endometriotic cysts that were simply not visible during surgery. If the prior surgery was not robotic, consider a robotic excision surgeon’s opinion because with more difficult cases, the optics and instruments are far better than standard laparoscopy. In general, hormonal therapy will stop or slow down an endometrioma from growing but may not eliminate it, and you have to weigh the side effects of medical therapy vs the risks of surgery. Medical therapy with hormones takes a long time to eliminate endometriomas because the old blood just does not get readily reabsorbed within the ovary (possibly 1-2 years). Having said that, if there are no symptoms and fertility is not immediately affected, an often quoted cutoff for surgery as opposed to using medical therapy to keep it from growing and possibly slowly eliminate it is 3cm. It is really individualized, so this is a rough number. Finally, depending on age and any family history of cancer, there is an overlap of molecular/genetic factors that can cause endo to be more aggressive in some people. So, given the rapid recurrence, an expert opinion from a robotic endo expert and surgeon who also understands these potential molecular changes may be prudent.

*This is not medical advice and is aimed for informational use only. Don’t hesitate to get in touch with the doctor’s office or consult your doctor for any medical questions.