To capture current real-world practice patterns, as reflected in a structured opinion-based voting exercise, for endometrioma management across typical clinical scenarios, integrating audience and expert panel voting from the 2024 Geneva SEUD Annual Meeting consensus session.

The consensus session featured presentations on endometrioma common management strategies: cystectomy, ablation/vaporization, sclerotherapy, and ART (Assisted Reproductive Technology) as first-line treatment for associated infertility. Delegates then voted on 25 clinically relevant scenarios, stratified by patient age (<35 vs ≥35 years), cyst size (<4 cm vs ≥4 cm), presence or absence of pain symptoms, fertility desire, diagnosis of infertility, and recurrence after previous treatment.

While hormonal treatment was strongly supported in women without pregnancy desire, and ART was favored for small endometriomas associated with infertility for both younger and older women, the role of surgery remains debated particularly in older women and in the context of large or recurrent cysts. When surgery is indicated, tissue-preserving ablative techniques were endorsed. Overall, the discussion underscored that management must be individualized, balancing patient priorities, reproductive goals, and the limitations of current evidence, which remains insufficient in several key clinical scenarios.

SEUD consensus session during the Geneva annual congress highlighted, for the first time using a voting process, both areas of agreement and ongoing controversy in the management of endometriomas.