Endometriomas are enigmatic. Dr Parikshit Tank discusses the highlights in successfully navigating the maze of clinical options for endometriomas. Ovarian lesions are common and usually associated with severe grades of the disease. On diagnosis, care should begin with a long-term plan and a detailed discussion with the woman. The course covers surgical case selection and modalities in endoscopic surgery followed by postoperative care. The challenges of assisted reproduction in these women are outlined.