Ethanol Sclerotherapy of an Endometrioma

Ethanol sclerotherapy, also known as alcoholisation, is a procedure used to treat certain ovarian endometriomas. Under ultrasound guidance, the contents of the cyst are aspirated and the cyst cavity is treated with medical-grade ethanol.

The procedure does not involve surgical removal of the cyst capsule and may be considered a less invasive approach, particularly when preserving ovarian function is important for the patient’s reproductive plan.

Ethanol sclerotherapy is not suitable for every cyst and does not treat endometriosis as a whole. At Adella Clinic, we assess the finding, symptoms, ovarian reserve, and pregnancy plans before recommending the most appropriate approach.

Duration

Depends on the size and location of the cyst and the type of pain relief used

Stay at the Clinic

You will remain at the clinic for a short period of observation after the procedure

Feeling

Pelvic pain, cramping, tenderness, and light spotting may occur

Identifying the Finding and Assessing Ovarian Reserve

What Is an Endometrioma?

What Does It Mean?

An endometrioma, also known as an endometriotic cyst, develops when endometriosis affects the ovary. Its contents are thick and often have a characteristic ultrasound appearance.
An endometrioma may be associated with pelvic pain, chronic discomfort during sexual intercourse, or reproductive difficulties.
When a characteristic endometrioma is identified, the cyst does not always need to be treated before reproductive treatment.

What Is Important to Know?

Not every ovarian cyst is an endometrioma. Some cysts are related to the menstrual cycle, while others have a different origin.
The presence of an endometrioma does not automatically mean that immediate treatment is necessary. The size, ultrasound appearance, symptoms, and age are important considerations.
The endometrioma itself may affect ovarian tissue. Surgical removal also carries a risk to ovarian reserve.

Minimally Invasive Treatment Under Ultrasound Guidance

What Does Ethanol Sclerotherapy Involve?

1
Aspiration of the Cyst

The procedure is usually performed through transvaginal puncture under continuous ultrasound guidance.
The doctor reaches the cyst with a needle and aspirates its contents in a way similar to the approach used during ovarian puncture.
2
Treatment with Medical-Grade Ethanol

After the cyst has been drained, medical-grade ethanol is introduced into the cyst cavity.
It remains in contact with the inner surface for a specified period and is then aspirated according to the medical protocol used
3
Difference from Simple Aspiration

With simple aspiration, the contents are drained, but the inner surface of the cyst is not treated. For this reason, the cyst may refill.
With ethanol sclerotherapy, the ethanol acts on the cells lining the inner surface. However, recurrence remains possible.
4
The Cyst Capsule Remains in the Ovary

Unlike surgical cystectomy, the endometrioma capsule is not removed.
This limits the direct excision of healthy ovarian tissue but does not allow a complete histological examination of the cyst capsule.

Who May Be Considered for the Procedure?

Ethanol sclerotherapy may be considered when there is a medical reason to treat the endometrioma but preserving ovarian tissue is a key priority.
It may be discussed in cases of diminished ovarian reserve, bilateral endometriomas, or recurrence of a cyst following previous surgical treatment.
The procedure may form part of preparation for IVF when the size or location of the cyst makes access to the follicles difficult. The decision is always individual.

When Might Another Approach Be More Appropriate?

A small endometrioma with a typical ultrasound appearance, no significant symptoms, and no impact on reproductive treatment may sometimes simply be monitored.
Surgery may be considered in cases of severe or persistent pain, a large or complex finding, suspected complication, or concern about another type of lesion.
Hormonal therapy may help control pain and the activity of endometriosis, but it does not remove the contents of an already formed cyst.

We Choose the Plan According to the Overall Reproductive Situation

The decision begins with a detailed medical and reproductive history. We assess symptoms, previous surgery, ultrasound findings, ovarian reserve, and plans for pregnancy.

The finding should have characteristics consistent with an endometrioma, and its size and location should allow safe access. If the appearance is atypical, there are solid areas, or other suspicious features are present, we discuss additional diagnostic assessment and a different approach.

When IVF is planned, we consider when the procedure should be performed, when ovarian stimulation can begin, and whether additional monitoring is required. We also discuss the available alternatives.

How Should You Prepare for the Procedure?

Before ethanol sclerotherapy, you will receive individual instructions regarding the necessary tests, food and fluid intake, medications, and your arrival time.

Tell the team about any medical conditions, allergies, previous surgery, medications, and dietary supplements you are taking. Do not stop anticoagulants or any other prescribed treatment on your own.

If you develop a fever, infection, unusual discharge, or a change in your general health, contact Adella Clinic before the procedure.

The approach to pain relief or sedation is determined in advance. If sedation is used, you will need to arrange for someone to accompany you and you should not drive for the specified period.

Sterile Conditions and Continuous Ultrasound Guidance

How Is Ethanol Sclerotherapy Performed at Adella Clinic?

What Happens During the Procedure?

Before the procedure begins, we confirm the medical plan, the location of the cyst, and the type of pain relief.
Under transvaginal ultrasound guidance, a needle is advanced into the cyst and its contents are aspirated.
Medical-grade ethanol is introduced into the cyst cavity and remains in contact with the inner surface for a specified period.
When necessary, the cavity is flushed or checked for leakage. The team monitors your condition throughout the procedure.

What Happens After the Procedure?

You will remain under observation for a short period, which depends on the type of pain relief used and how you feel.
You will receive instructions regarding medication, physical activity, intimate contact, and when you can return to your normal routine.
During the first few hours, pain, cramping, tenderness, and light vaginal spotting may occur.
A follow-up appointment will be scheduled to monitor how the cyst changes and whether it refills.

Recovery, Risks and Follow-Up

What Should You Know After Ethanol Sclerotherapy?

Rest on the day of the procedure and take only the medications that have been recommended. With a normal recovery, many patients can return to their usual activities the following day, although more time may be needed after sedation, with physical exertion, or if discomfort persists.

Possible complications include pain, bleeding, infection, injury to the ovary or a nearby structure, and a reaction to pain relief or anaesthesia. Leakage of ethanol may cause severe pain and irritation of the surrounding tissues. The procedure is performed under sterile conditions, and antibiotic prophylaxis is prescribed only when there is a medical indication.

When Should You Contact the Clinic?

Seek medical advice if you experience severe or increasing pain or heavy bleeding.
Contact the team if you develop a fever, chills, or repeated vomiting.
Seek medical attention if you experience difficulty breathing or any other symptom that concerns you.

What Are Realistic Expectations?

Ethanol sclerotherapy may reduce the size of an endometrioma without surgically removing the capsule or directly excising ovarian tissue.
The procedure does not restore ovarian reserve that has already been lost and does not eliminate the possibility of recurrence of the same cyst or the development of a new endometrioma.
It does not treat other areas of endometriosis and cannot guarantee a better outcome from a future IVF procedure

Frequently Asked Questions

An endometrioma is associated with endometriosis and contains old blood. It often has a characteristic ultrasound appearance, although additional tests may sometimes be needed.
Other ovarian cysts may be related to ovulation or may have a different origin. The approach to them is not the same.
Pelvic pain and cramping may occur during and after the procedure. The type of pain relief or sedation is determined in advance.
After the procedure, you will receive instructions on which pain-relief medications are suitable for you.
The duration depends on the size, location, and contents of the cyst, as well as on the medical protocol used.
You should allow additional time for preparation and observation after the procedure.
With aspiration, the contents of the cyst are drained. With ethanol sclerotherapy, the cavity is additionally treated with medical-grade ethanol.
The treatment aims to reduce the likelihood of the cyst filling again, but it cannot completely eliminate the risk of recurrence.
Yes. Ethanol sclerotherapy does not remove the underlying cause of the endometrioma, and the cyst may refill or a new endometrioma may develop.
This is why ultrasound follow-up is an important part of treatment.
Neither approach is better for every patient. Ethanol sclerotherapy may limit the direct removal of ovarian tissue, but it does not remove the cyst capsule and does not treat other areas of endometriosis.
Surgery may be more appropriate in cases of severe pain, a suspicious finding, or when more extensive treatment is required.
Ethanol sclerotherapy cannot restore ovarian reserve that has already been lost. Its potential advantage is that it does not involve surgical excision of the cyst capsule and adjacent ovarian tissue.
The timing depends on the size of the cyst, how the procedure has progressed, and the findings at the follow-up examination.
At Adella Clinic, we coordinate recovery and the next steps according to your individual reproductive plan.