Associated ovarian endometrioma is a marker for greater severity of deeply infiltrating endometriosis.

Objective: To investigate whether an associated ovarian endometrioma is a marker for severity of deep infiltrating endometriosis (DIE).

Design: Observational study between June 1992 and December 2005.

Setting: University tertiary referral center.

Patient(s): Five hundred patients with histologically assessed DIE.

Intervention(s): Complete surgical exeresis of deep endometriotic lesions.

Main Outcome Measure(s): Severity of the disease was quantified according to the mean number of DIE lesions and the type of main lesion.

Result(s): In patients with associated ovarian endometrioma, the number of single isolated DIE lesions was statistically significantly lower (41.9% vs. 61.1%). The mean number of DIE lesions was statistically significantly higher in patients presenting with an associated ovarian endometrioma (2.51 +/- 1.72 vs. 1.64 +/- 1.0). For patients with associated ovarian endometrioma DIE lesions were more severe with an increased rate of vaginal, intestinal, and ureteral lesions.

Conclusion(s): Associated ovarian endometrioma is a marker for the severity of the DIE. In a clinical context suggestive of DIE, when there is an ovarian endometrioma, the practitioner should investigate the extent of the disease to check for severe and multifocal DIE lesions.