Endometrioma: Contemporary Approach to Diagnosis and Management.

Endometriomas affect up to 44% of women with endometriosis and are associated with chronic pelvic pain, infertility, and reduced ovarian reserve. Diagnosis and management are clinically challenging, requiring a nuanced understanding of imaging, clinical presentation, and patient goals. This review offers a comprehensive overview of the diagnosis and management of ovarian endometrioma, with a focus on clinical presentation, advanced diagnostic imaging, and treatment strategies. It addresses the complex balance between symptom relief, disease progression, fertility preservation, and long-term ovarian function, while also exploring emerging innovations in care. Endometriomas are often associated with significant pelvic pathology, including deep endometriosis and adenomyosis. Advanced imaging modalities, such as transvaginal ultrasound and magnetic resonance imaging, have significantly improved diagnostic accuracy. Management strategies range from surveillance in asymptomatic patients to medical therapy for symptom control. Surgical options of laparoscopic cystectomy remain the gold standard for patients with pain, infertility, or concerning imaging findings, but do carry the risk of affecting ovarian reserve. Emerging evidence suggests that conservative surgical techniques and postoperative hormonal therapy may reduce recurrence rates. Endometriomas represent a complex gynecological condition requiring individualized management strategies. Future research should focus on biomarkers for diagnosis and recurrence prediction, refining noninvasive diagnostic tools, and optimizing surgical techniques to minimize ovarian damage.