Background: Endometriosis is a chronic condition affecting females in the reproductive period. Variable medical treatment options have been provided with comparable results to surgery.  Objective: Comparing dienogest treatment and surgical excision of endometrioma regarding patients' satisfaction and Quality of life.    Study design: This randomized clinical trial was conducted at a tertiary hospital from Nov 1, 2020, to Jul 31, 2022. We recruited patients according to specific inclusion and exclusion criteria. The study population was randomly allocated into two groups; group one received Dienogest, and group two had laparoscopic cystectomy. Group one patients received medical treatment with Dienogest (2mg/day) starting on the first day of the first menstrual cycle for three months. After three months, patients were subjected to clinical evaluation, including cyst diameter, recurrence after surgical excision, evaluation of patient satisfaction using the endometriosis treatment satisfaction questionnaire (ETSQ), and Quality of life using the SF-36 questionnaire.       Results: The recurrence rate after excision was 12/60 (20%). There was a significant difference in patient satisfaction after medical treatment rather than surgical excision. This was noted in each item of the satisfaction questionnaire and the total score (p-value <0.05). There was a significant improvement in all aspects of the Quality of life with dienogest therapy rather than surgical treatment (p-value <0.05). Conclusion: Dienogest greatly improved patients' Quality of life and satisfaction rather than surgical intervention.