Large bilateral ovarian endometriomas. Treatment strategies in the reproductive period

This article presents a rare clinical case of the first-diagnosed large bilateral ovarian endometriomas (up to 110 mm in diameter) in a 22-year-old previously non-pregnant patient. Ethanol sclerotherapy of endometriomas followed by hormonal and stabilization therapy to prevent recurrence with combined oral contraceptive (COC) containing 30 mcg ethinylestradiol (EE) and 2 mg dienogest (DG) (continuous regimen) was chosen as the first (preliminary) stage of treatment. After 52 days, a control pelvic ultrasound revealed a significant reduction in the size of ovarian endometriomas; therefore, it was decided to refrain from laparoscopic cystectomy and to perform repeat sclerosing. After another 122 days, complete elimination of cavity structures with fibrosis formation at the endometrioma site was noted. The patient is under observation, hormonal therapy is continued in the contraception mode. The discussion section covers the treatment of patients with ovarian endometriomas, the role of ethanol sclerosing, and the rationale for COC use as hormonal anti-recurrence therapy. Conclusion. Ethanol sclerotherapy is an exceptional method for the treatment of young patients with large bilateral ovarian endometriomas, but also the only way to preserve ovarian function and provide conditions for further organ-preserving interventions. Key words: large bilateral ovarian endometriomas, sclerotherapy, choice of hormonal therapy, COC, dienogest, Siluette®