Why is managing endometriomas a challenge—and what are the barriers to expert care?
Q: Hi Dr. Bagaria – Would you start by giving a brief background of your expertise in endometriosis?
A: I’m a fellowship-trained minimally invasive gynecologic surgeon with a focused practice in endometriosis and complex pelvic pain. I’ve trained at top-tier academic institutions and now practice at Endometriosis Surgical Specialists International (ESSI), where we provide advanced care for patients with endometriosis, including surgical excision of deep disease and endometriomas.
Q: How do you define an endometrioma? What exactly is it?
A: An endometrioma is a type of ovarian cyst caused by endometriosis. It forms when endometrial-like tissue grows within the ovary and bleeds over time. This trapped blood accumulates and thickens, forming a cystic structure.
Q: Why does it go by the name “chocolate cyst”?
A: The nickname “chocolate cyst” comes from its appearance—it’s filled with old, dark brown blood that resembles melted chocolate. While the term may sound harmless, endometriomas can be complex and require expert evaluation and treatment.
Q: Does the stage of endometriosis relate to the presence of endometriomas?
A: Yes. Endometriomas are typically associated with more advanced stages of endometriosis, especially Stage III or IV. Their presence often signals more severe disease, with possible involvement of other pelvic structures and organs.
Q: Can endometriomas lead to pelvic pain and infertility?
A: Absolutely. Endometriomas are a common cause of chronic pelvic pain and can significantly affect fertility. They may reduce ovarian reserve, interfere with ovulation, and create a hostile environment for egg quality and embryo development.
Q: How many women diagnosed with endometriosis will experience an endometrioma?
A: It’s estimated that between 17% and 44% of women with endometriosis will develop an endometrioma. They’re relatively common among patients with moderate to severe disease.
Q: The cause of endometriomas seems to be a controversial topic. What are your thoughts?
A: While the exact cause is still debated, one prevailing theory is that endometrial-like cells implant on the ovary, bleed cyclically, and gradually form a cyst. I also believe that the hormonal and inflammatory environment plays a significant role in their development and progression.
Q: What is your clinical experience with endometriomas? Do you encounter them often in surgery?
A: I encounter endometriomas frequently during excision surgeries. They’re one of the more visible manifestations of endometriosis and often appear alongside other deep infiltrating disease. Careful surgical planning is essential to ensure effective removal while preserving ovarian function.
Q: What is your surgical approach when you find endometriomas?
A: My approach involves complete excision of the cyst wall while preserving as much healthy ovarian tissue as possible. This requires precise and delicate technique to minimize the risk of recurrence and maintain fertility.
Q: Why is it so difficult to find expert care for endometriomas?
A: One major barrier is awareness—both among the general public and healthcare providers. Many patients are misdiagnosed or told their pain is “normal.” Endometriomas require treatment from specialists trained in advanced excision surgery, and unfortunately, there are not enough of those surgeons available.
Q: Are there any other barriers to accessing expert care?
A: In addition to low awareness, there are often delays in diagnosis and referral. Many providers may not recognize the signs of endometriosis or know when to refer to a specialist. This leads to years of unnecessary suffering for many patients.
Q: You’ve built a strong reputation as a surgeon—what do you think sets you apart?
A: I’m proud of my training and of being part of the ESSI team, where we prioritize surgical excellence and compassionate care. What sets me apart is my patient-centered approach. I strive to build trust and make every patient feel seen and supported throughout their journey. Empathy is essential—every patient deserves to feel understood.
Q: Where can patients see you?
A: I currently see patients in New Jersey and New York. We also offer virtual consultations, which allow us to care for patients who may not live nearby.
Q: Do you speak any other languages?
A: Yes, in addition to English, I speak Hindi. This allows me to connect more closely with many of my patients and make sure they feel comfortable discussing their symptoms and concerns.
Interested in having a consultation with Dr. Bagaria, follow the link here: https://internationalendo.com/drmadhubagaria/
