Fertility-Preserving Laparoscopic Management of Bilateral Ovarian Endometriomas in a Young Unmarried Nulligravid Woman: A Case Report

Background: Ovarian endometrioma in young women requires more than removal of a cystic mass; it demands recognition of pain history, respect for sexual and cultural context, preservation of ovarian cortex, and prevention of recurrence. Bilateral large endometriomas are particularly challenging because surgery may relieve pain and confirm histology, yet may also compromise future ovarian reserve. Case presentation: A 24-year-old unmarried nulligravid woman presented with progressively worsening dysmenorrhea that had begun during adolescence. Her menstrual cycles were irregular, occurring every 35–60 days, and pain had required repeated ibuprofen use, home remedies, and absence from school. Symptoms later impaired daily function and contributed to discontinuation of studies. She had never been sexually active, so vaginal examination was avoided. Digital rectal examination revealed a smooth, tender, cystic pelvic mass with limited mobility. Ultrasonography showed an enlarged uterus and a 7.29 × 7.28 cm cystic adnexal mass with homogeneous low-level internal echoes, consistent with an endometrioma. Operative laparoscopy identified bilateral ovarian endometriomas, approximately 8 cm each, an enlarged uterus compatible with adenomyosis, and normal patent fallopian tubes. Bilateral ovarian cystectomy was performed with careful dissection of the cyst wall from the normal ovarian cortex. Hemostasis was secured, a pelvic drain was placed, and no intraoperative complication occurred. Histopathology confirmed an endometriosis cyst. Early recovery was uneventful, pain improved, and postoperative planning included GnRH agonist therapy with ultrasonographic surveillance. Conclusion: This case emphasizes early evaluation of disabling adolescent dysmenorrhea and meticulous fertility-preserving surgery for bilateral endometrioma, with long-term attention to recurrence risk and ovarian reserve.