Question

How will you manage a case of 16-year-old girl presenting with bilateral endometriomas of size 8cmx8cm?

Hint:

Surgical management should aim at preserving ovarian function to maintain fertility, especially in adolescents with large endometriomas.

Answer 1

Step 1: Initial Assessment.
A 16-year-old girl with bilateral endometriomas of 8cm x 8cm requires careful management, as large endometriomas can lead to pain, fertility issues, or complications. The first step is to confirm the diagnosis, assess her symptoms, and evaluate the impact on her reproductive health.
Step 2: Conservative Management (If Symptoms Are Mil.
If the patient has minimal symptoms or if fertility preservation is a priority, conservative management options should be considered. These include:
(1) Hormonal Therapy:
- Combined Oral Contraceptives (COCs): Used to suppress ovarian function and reduce endometriosis activity.
- Progestins or IUDs: Help in controlling the growth of endometriomas and reducing symptoms such as dysmenorrhea.
- GnRH Agonists: Can induce a temporary menopausal state to reduce endometrial growth, though long-term use is typically avoided due to side effects (bone loss).
- Danazol: A synthetic androgen that suppresses ovarian function and helps in shrinking endometriomas.
(2) Pain Management:
Non-steroidal anti-inflammatory drugs (NSAIDs) can be used to manage the pain associated with endometriomas.
Step 3: Surgical Management (If Symptoms Are Severe or Fertility Is A Concern).
If the endometriomas cause significant pain, fertility issues, or are growing, surgical intervention may be necessary. Surgical options include:
(1) Laparoscopic Cystectomy:
- This minimally invasive procedure removes the endometriomas while preserving the ovarian tissue to maximize fertility potential.
- The goal is to remove as much of the cyst as possible while minimizing damage to the ovaries.
- Laparoscopy can also help assess the spread of endometriosis and treat other areas with lesions.
(2) Ovarian Drilling (If Neede:
In some cases, ovarian drilling may be done during laparoscopy to reduce the size of the endometriomas.
Step 4: Follow-Up and Long-Term Management.
After surgery, the patient should be closely monitored for recurrence of symptoms and endometriomas. Hormonal therapy (e.g., COCs or IU may be continued to prevent recurrence.
Step 5: Fertility Considerations.
Given her age, fertility preservation is a significant concern. If the patient wishes to preserve fertility, ovarian tissue preservation (e.g., cryopreservation of eggs) or assisted reproductive techniques may be discussed.