BACKGROUND: Endometriosis affects approximately 10% of women of reproductive age with a mean diagnostic delay of 7-10 years. Image-guided procedures show increasingly promising results as minimally invasive alternatives to excision. OBJECTIVE: Structured overview of image-guided minimally invasive treatment options for endometriosis with focus on percutaneous cryoablation. RESULTS: Percutaneous cryoablation demonstrates the strongest evidence for extraperitoneal and intramuscular lesions and represents a valid minimally invasive alternative to excision. Three institutional cases illustrate technique and outcomes. Ethanol sclerotherapy is established for ovarian endometriomas. High-intensity focused ultrasound (HIFU) shows promising results for abdominal wall disease; radiofrequency ablation (RFA) and microwave ablation are investigational. CONCLUSION: Interventional radiology offers a growing therapeutic spectrum. Prospective randomized trials are needed for guideline integration.