02/03/2026
“More Than Meets the Eye”: The Bigger Picture Behind an Ovarian Endometrioma
By Jennifer Jaggi, MD
Ovarian endometriomas are cysts of endometriosis within the ovaries and are almost always accompanied by endometriosis in other locations. While endometriosis in general is notorious for being missed on routine imaging, endometriomas are somewhat unique in that they are often identified on routine ultrasound—sometimes ordered by a primary care clinician or performed in the emergency department. Because of this, patients with endometriomas often receive a diagnosis of endometriosis before surgery, creating an opportunity to seek out specialized care from the start.
When an endometrioma is present, seeking care from a surgeon with expertise in endometriosis is particularly important for several reasons. First, a general OB-GYN may remove only the ovarian cyst without addressing endometriosis in other locations, which can leave patients with persistent or recurrent pain. When surgery focuses narrowly on the o***y alone, disease elsewhere in the pelvis may continue to drive symptoms. At Pacific Endometriosis and Pelvic Surgery (PEPS), we carefully evaluate the pelvis and abdomen and excise all visible endometriosis—not just the cyst itself.
The second reason to seek out an experienced endometriosis surgeon is that there are real risks when endometriomas are removed by surgeons who do not regularly operate on them. One concern is removing too much healthy ovarian tissue—or, in some cases, the entire o***y—because endometriomas can be difficult to separate from normal ovarian tissue. This can have implications for future fertility and hormone production. The opposite risk is incomplete removal, in which part of the endometrioma cyst wall is left behind, increasing the likelihood of ongoing pain or cyst recurrence.
For patients, the key takeaway is that an ovarian endometrioma deserves thoughtful evaluation by a surgeon experienced with endometriosis, and in some cases, collaboration with a fertility specialist as well. The goal is not simply cyst removal, but a thorough approach that addresses the full extent of disease while preserving ovarian function whenever possible. If you’ve been told you have “just an endometrioma,” it may be worth pausing to ask whether the bigger picture has truly been considered.
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