Factors Associated with Symptomatic Outcomes after Surgery for Isolated Ovarian Endometrioma: A Retrospective Cohort Study

Although significant improvement in pain and other endometriosis-related symptoms is often observed following endometrioma surgery, symptomatic response to surgery varies among patients. This study aimed to evaluate changes in dysmenorrhea, pelvic pain, dyspareunia, and bloating following endometrioma surgery and to investigate the independent predictors of the 6-month dysmenorrhea score. This retrospective cohort study included 136 patients who underwent surgery for endometrioma and had symptom assessments both preoperatively and at 6 months postoperatively. Dysmenorrhea, pelvic pain, dyspareunia, and bloating were assessed using a 0-100-mm visual analog scale (VAS). The primary outcome was the dysmenorrhea VAS score at 6 months postoperatively. For the primary analysis, a multivariable linear regression model was constructed, adjusting for age, body mass index (BMI), history of prior surgery, preoperative hormonal therapy, presence of bilateral endometrioma, number of endometriomas, diameter of the largest endometrioma, and preoperative CA-125 levels, with baseline dysmenorrhea VAS score included as a key covariate. Secondary analyses evaluated changes in other symptoms and CA-125 levels between the preoperative and postoperative assessments. A total of 136 patients were included in the study. The mean age was 31.49 ± 6.79 years, and the mean BMI was 26.35 ± 3.77 kg/m². Bilateral endometrioma was present in 48 patients (35.3%), and 47 patients (34.6%) had a history of prior surgery. Fifty-six patients (41.2%) had received preoperative hormonal therapy. The mean dysmenorrhea VAS score decreased from 65.18 ± 15.61 preoperatively to 39.20 ± 14.83 at the 6-month postoperative follow-up (P < .001). Similarly, significant reductions were observed in VAS scores for pelvic pain, dyspareunia, and bloating (all P < .001). CA-125 levels decreased from 83.23 ± 38.90 U/mL to 30.80 ± 18.51 U/mL (P < .001). In the baseline-adjusted multivariable analysis, the preoperative dysmenorrhea VAS score was independently associated with the 6-month dysmenorrhea VAS score (β = 0.611, 95% CI [0.484, 0.738], P < .001). Preoperative hormonal therapy was associated with lower 6-month dysmenorrhea VAS scores, although this association did not reach statistical significance (β = −3.866, 95% CI [−8.029, 0.296], P = .069). Age, BMI, previous surgery, bilaterality, number of endometriomas, cyst diameter, and CA-125 levels were not independently associated with the 6-month dysmenorrhea VAS score. The adjusted R² value of the model was 0.431. Significant improvements in dysmenorrhea, pelvic pain, dyspareunia, and bloating were observed during the 6-month follow-up after endometrioma surgery. Greater preoperative dysmenorrhea severity was independently associated with higher residual dysmenorrhea 6 months after surgery. This finding suggests that baseline symptom burden is an important consideration when evaluating patient-reported outcomes following surgery. However, the prognostic significance of baseline pain severity requires confirmation in larger prospective studies.