The general consensus is that ovarian endometriomas larger than 4 cm should be removed, both to reduce pain and to improve spontaneous conception rates. The removal of ovarian endometriomas can be difficult, as the capsule is often densely adherent.

What happens if you don't remove endometrioma?

If not treated, endometriosis can lead to complications such as: Infertility. Debilitating pelvic pain. Adhesions and ovarian cysts.

When is endometrioma surgery needed?

Generally, if an ovarian cyst looks like an endometrioma on ultrasound, and persists and is greater than > 4 cm (by current standards) surgery is necessary to rule out a malignant tumor. Surgery is also indicated when severe chronic pelvic pain is present.