Objective To explore the therapeutic effect of dienogest-assisted laparoscopic cystectomy for ovarian endometriomas, and its impact on postoperative anti-Müllerian hormone (AMH) levels and recurrence.Methods The 102 patients with ovarian endometriomas admitted to the Suqian Hospital Affiliated to Xuzhou Medical University from April 2020 to July 2023 were selected and divided into an observation group and a control group using the odd-even number method, with 51 cases in each group. Both groups underwent cystectomy for ovarian endometriomas. The control group was treated with leuprorelin and the observation group received dienogest postoperatively. The operative duration, postoperative blood loss, and length of hospital stay were recorded for both groups. After 3 months of treatment, serum levels of AMH, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), progesterone (P), estradiol (E2), and CA125 were compared between the two groups. The severity of lower abdominal pain, dysmenorrhea, and dyspareunia was evaluated. Adverse events occurring during the treatment period were documented. All patients were followed for one year postoperatively to assess recurrence rates and natural pregnancy rates.Results The operative duration, postoperative blood loss and postoperative length of hospital stay were not different between the observation group and the control group (P > 0.05). The differences in levels of FSH, LH, T, P, E2, and CA125, lower abdominal pain scores, dysmenorrhea scores and dyspareunia scores before and after treatment in the observation group were higher than those in the control group (P < 0.05). The difference in AMH levels before and after treatment was lower in the observation group than in the control group (P < 0.05). Comparison of the incidence of adverse reactions between the observation group and the control group showed no statistically significant difference (P > 0.05). The recurrence rate in the observation group was lower than that in the control group 1 year after surgery (P < 0.05). The rate of natural pregnancy in the observation group was higher than that in the control group 1 year after surgery (P < 0.05).Conclusion Dienogest-assisted laparoscopic cystectomy for ovarian endometriomas promotes the recovery of ovarian function, suppresses tumor marker levels, reduces the risk of postoperative recurrence, and demonstrates a high level of safety.