Evidence Grows for Sclerotherapy as Safe, Cost-Saving Alternative to Surgery in Endometrioma

A Shift in Endometrioma Treatment Paradigms

Ovarian endometriomas—painful cysts affecting nearly 6% of reproductive-age women—have long been managed by laparoscopic surgery. But what if a simpler, less invasive, and more affordable approach could offer comparable results, or even better pain relief? A major multicenter clinical trial recently published in the Archives of Gynecology and Obstetrics suggests just that.

Comparing Two Paths: Surgery vs. Sclerotherapy

Researchers across 20 centers in Spain randomized 167 women with endometriomas to receive either standard laparoscopic cystectomy or ultrasound-guided ethanol sclerotherapy (a procedure where cysts are drained and treated with alcohol to prevent recurrence). The main goal: compare complications, recurrence, pain relief, and hospital costs.

Complications: Both groups reported low complication rates (about 12%), but serious (grade III) issues were more common after surgery (4.1% vs. 1.1%).

Cost: Sclerotherapy was dramatically less expensive, averaging €472 per patient compared to €2,128 for surgery.

Recurrence: After about two years, recurrence rates were nearly identical—22.8% for sclerotherapy and 25.7% for surgery.

Pain Relief: At six months, 89% of sclerotherapy patients reported pain improvement or resolution, versus 66% of those who had surgery.

Why Does Sclerotherapy Work So Well?

Sclerotherapy is performed on an outpatient basis with minimal anesthesia and a quick recovery. By draining the cyst and instilling ethanol, it destroys the cyst lining, helping prevent regrowth. Importantly, the procedure avoids some of the adhesions and tissue damage that can occur with surgery, which may help explain the slightly better pain scores.

Patient-Centered Benefits & Real-World Practice

This study’s design mirrors real-world clinical practice, making the results especially applicable. The findings suggest that for many women, sclerotherapy could offer a safe, effective, and far more accessible way to manage endometriomas—especially for those hoping to avoid surgery or reduce costs. However, larger cysts (over 6.5 cm) might have a slightly higher risk of recurrence.

What’s Next?

While these results are promising, the authors recommend more research—especially on long-term fertility outcomes and the combined effect of hormonal therapy with sclerotherapy.

Key Takeaways

Sclerotherapy matches surgery for recurrence and offers better pain relief at lower cost.

Major complications are rarer with sclerotherapy.

The procedure is minimally invasive and usually done in an outpatient setting.

Recurrence rates are similar for both approaches after two years.

Sclerotherapy could be a suitable first-line treatment for many women with endometriomas.

Citation:

García-Tejedor, A., Guevara-Peralta, R., Martinez-Garcia, J.M., et al. (2025). Ultrasound-guided ethanol sclerotherapy versus laparoscopic surgery for endometriomas: a randomized clinical trial in a real-world setting. Archives of Gynecology and Obstetrics, 312, 2199–2210. https://doi.org/10.1007/s00404-025-08205-1