Laparoscopic excision is considered as the 'gold standard' treatment of ovarian 
endometrioma. However, a frustrating aspect is that disease can recur. While 
laparoscopic excision is known to improve fertility, recurrence can cause 
significant ovarian damage and adverse affects on fertility. It is therefore 
crucial to prevent recurrence in order to conserve 'improved' fertility. 
Recurrence rates for endometrioma are reported from 11 to 32% within 1-5 years 
after excision. The recurrence rate is higher in patients with advanced 
endometriosis at surgery and in younger patients. Previous medical treatment for 
endometriosis prior laparoscopy is a risk factor for recurrence. Pregnancy soon 
after surgery has a protective effect for recurrence. The accumulating evidence 
suggests that the administration of oral contraceptives (OC), 
levonorgestrel-releasing intrauterine system (LNG-IUS) and a combination of 
gonadotropin releasing hormone (GnRH) analogue and OC may also have therapeutic 
benefits. Collectively, we propose that women should be well informed about the 
risks of endometrioma recurrence. We recommend that women who wish pregnancy 
should try conception as soon as possible. Further, we strongly advise hormonal 
therapy for patients, who do not want to conceive immediately, and until 
pregnancy is desired.