Endometriosis affects approximately 10% of women of reproductive age and can cause chronic pain, infertility and a significant impact on daily life. Endometriomas, popularly known as chocolate cysts due to their dense, brownish appearance, develop in 20-40% of women who already have endometriosis. According to recent series, up to 30-40% of women who consult for reproductive difficulties have an endometrioma or ovarian endometriosis.
The study, published in the scientific journal Archives of Gynecology and Obstetrics and in which 20 Spanish hospitals have participated, it is the first randomized clinical trial in a real environment that compares both techniques. 167 women between 18 and 40 years old with endometriomas measuring up to 10 centimeters participated.
An alternative just as effective and with better recovery than surgery
The results indicate that sclerotherapy is comparable in safety to surgery: serious complications are very rare (1.1%). After more than two years of follow-up, recurrence is similar between both groups (22.8% in sclerotherapy versus 25.7% in surgery), while pain control shows a favorable trend in patients treated with alcohol (89% relief or disappearance of pain versus 66% in those who underwent surgery).
Unlike surgery, the technique does not require hospital admission, does not carry the risk of adhesions or ovarian extraction in complex cases, and can better preserve ovarian reserve, an aspect that is especially relevant in young women or women with reproductive desire. Furthermore, the hospital cost is almost five times lower than that of laparoscopy.
A step forward for women with endometriosis
Surgery has until now been the reference treatment for endometriomas of a certain size, but it carries risks and can compromise reproductive future. This new approach could significantly reduce the number of surgeries for ovarian endometriosis, especially in young women or women with chronic pain.
“This trial provides solid evidence so that professionals can offer less aggressive options, equally effective and much more efficient from the point of view of the sustainability of the health system,” explains Dr. Amparo García-Tejedor, doctor at the Gynecology Service of Bellvitge Hospital and researcher at IDIBELL, and responsible for the study. “It is an alternative that can transform clinical practice because it could better preserve ovarian function, avoid surgical risks and give women more autonomy,” he adds.
The results reinforce the need for personalized treatments, taking into account age, pain, reproductive desire and the impact of endometriosis on the daily life of each woman.
New lines of research to improve quality of life and fertility
As a continuation of this trial, the Gynecology Service of the Bellvitge Hospital has launched the new ESCOMA study, which has received funding from the Health Research Fund (FIS) of the Carlos III Health Institute. The project will analyze whether ultrasound-guided alcohol puncture can better preserve ovarian function and improve the quality of life of women with ovarian endometriosis.
The study will include 288 women and will compare the evolution of those treated with this technique with that of those who receive only medical treatment. It will evaluate key aspects such as pain, quality of life, fertility, ovarian follicles and pregnancy rates.
According to Dr. García-Tejedor, “at Bellvitge we work to improve the quality of life and fertility of women with endometriosis, offering less aggressive alternatives adapted to their needs.”
The center is the first hospital in the State that has begun recruiting for this multicenter study, and the team is looking for women between 18 and 40 years old with a diagnosis of ovarian endometriosis interested in participating. Candidates can join the study through their reference hospital, which will evaluate whether they meet the inclusion criteria.
Reference article:
García-Tejedor A., et al. Ultrasound-guided ethanol sclerotherapy versus laparoscopic surgery for endometriomas: a randomized clinical trial in a real-world setting Archives of Gynecology and Obstetrics. 2025. DOI: 10.1007/s00404-025-08205-1
