Hi, what is the recommended treatment approach for patients with larger (5 cm) endometriomas that don’t impact fertility or cause obvious pain? I’m 32 years old and have bilateral endometriomas that are asymptomatic as far as I can tell. I also don’t want children. Should I do anything surgically? My priority is to protect the health and function of my organs and to protect my long-term hormonal health. However, I feel like I’m stuck between a rock and a hard place because I understand that endometriomas themselves pose a risk to ovarian reserve and function. Also, I have found a few studies suggesting that bilateral cystectomy can put people at higher risk of early menopause and ovarian failure. So which is worse? Any words of advice?
Endometriosis
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In women with large but asymptomatic bilateral endometriomas and no desire for future fertility, as in your case, the most prudent approach is usually to avoid surgery initially. If there is no pain, progressive growth, or oncologic concern, it is best to maintain regular monitoring with ultrasound, and consider medical suppressive therapy to reduce inflammation and stabilize the disease. This strategy prioritizes the preservation of long-term ovarian and hormonal function, reserving surgery only for cases with symptoms or complications.