TOP TENS.

1.Symptoms (hyper polimenorrhea, dysparheunia, bowel and urine troubles, Infertility)
2.Palpable mass
3.Sonography Imagen
4.MRI definition
5.Hormonal inhibition
6.Endoscopic access
7.Capsule excision  & Ovarian Reconstruction
8.Functional ovary (oocyte preservation)
9.Support
10.Follow up

 Palpable Mass
Influence on infertility is multiple, direct mechanical influence, tubal stenosis or blockage, cyst formation in the ovary, blockage in the pouch of Douglas with bleeding, activation of macrophages, activation of cytokines and immune resistance. 

Diagnosis
Laboratory. Tumoral markers Ca 125.
Ultrasound first approach and MRI Diagnosis: Evidences of masses between 1 a 5 cm of diameter. Diferenciated endometrial masses with peritoneal metastasis. 

Medical management:
Endocrine supression previous surgey 4 to 6 weeks, after surgery 4 to 6 months increase the fecundation rates, diminished pain and prevent restart endometriosis (GnRH analogous).

 Surgical management:
Endometriomata  enucleation: Performance without spilling, Endobag extraction, Flushing of the wound, Coagulation of reminder tissue, Adaptation of wound , Edges with sutures ?
Ovariectomy

 Support :
Neurovegetative support.
Psycoemotionals swings.
Replacement therapy to avoid bone loss : Calcium, Calcitonine, Diphosfonats.
Add back with estradiol in lower dosis. 

Follow up :
Symptoms
Estradiol levels evaluation (pg/ml).
Endometrial biopsy.
Sonogram.
Bone density evaluation.
Lipid Profile (HDL- LDL).
Emotional disorders
Long term Management with OC, progesterone