Evidence-based gynaecological practice: Clinical review 1 - Management of ovarian endometriomas

Abstract

In this review, the first of a series of evidence-based reviews of clinical practice commissioned by Gynaecological Surgery, we introduce the concept of applying the evidence to focused questions asked frequently by patients about specific treatment options. We pose the question about the appropriate treatment of ovarian endometriomas and search the readily available literature including systematic literature reviews, randomised controlled trials (RCTs) and observational studies. In addition to an overview of the pathophysiology and diagnosis of endometriomas we explore the search strategies used along with methods of focusing the clinical question into a question that can be asked of the literature. The treatment options identified are then used to inform any discussion that one might have with regards to the treatment of endometriomas. We conclude that endometriomas are best treated surgically by capsule stripping and that there is little evidence for the efficacy of adjuvant medical treatment either pre- or post-operatively. The risk of ovarian failure following surgical treatment appears to be small. © 2007 Springer-Verlag.