Knez, J; Bean, E; Nijjar, S; Mavrelos, D; Jurkovic, D; (2024) Ultrasound study of natural progression of ovarian endometriomas. Ultrasound in Obstetrics and Gynecology 10.1002/uog.27607. (In press).

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Abstract

OBJECTIVES: The aim of this study was to determine the natural history of ovarian endometriomas in women who are managed expectantly. METHODS: This was a retrospective cohort study of 83 women with evidence of ovarian endometriomas, who were managed expectantly between April 2007 to May 2022. The study was conducted in the Department of Women's Health, University College London Hospitals and The Gynecology Ultrasound Centre, London, UK. We searched our ultrasound clinic databases to identify women aged 18 years or older with evidence of ovarian endometriomas that were managed expectantly for ≥ 6 months. All women attended for a minimum of two ultrasound scans by a single expert ultrasound operator. In addition to patient demographics, we recorded the number, mean diameter and location of each cyst. The cyst growth rate was expressed as annual change in the mean diameter. RESULTS: 1,922 women attended our gynecology clinic during the study period who were found to have evidence of moderate or severe endometriosis on pelvic ultrasound examination. A total of 83 women had evidence of ovarian endometriomas and were managed expectantly. The median age of women was 39 (range 26 - 51). Each woman had at least two ultrasound scans performed by a single expert operator at a minimum interval of ≥6 months. 50/83 (60%, 95% CI 49-71) women had single cysts and the remainder had multiple cysts. The median number of endometriomas per patient was 1 (range 1 - 5) and the median follow up time was 634 days (range 187 - 2984). 39/83 (47%, 95% CI 36 - 58) women experienced an overall reduction in size of cysts, in 18/83 (22%, 95% CI 13 - 32) the cysts increased in size and in 26/83 (31% 95% CI 22 - 42) women, no meaningful change was observed. The median change in mean diameter of cysts per woman during the study period was -2.7 mm (-57.7 - +39.3), with an annual growth rate of -1.7 mm/year/woman (-24.6 - +42.0). Overall, cysts were smaller at the follow up visit [median diameter 22.3mm (6.7 - 77) vs. 18.5mm (5 - 72) p = 0.009]. We did not identify any clinical characteristics that could reliably predict the chance of endometrioma progression. CONCLUSION: In the majority of women with ultrasound diagnosis of ovarian endometriomas, the cysts do not increase in size significantly over time and they could be managed expectantly. This evidence may help clinicians when counselling asymptomatic or minimally symptomatic women about the options to manage their ovarian endometriomas. This article is protected by copyright. All rights reserved.

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