A chocolate cyst (endometriosis) is a disease that develops with the growth of endometrial tissue, which lines the inner part of the uterus, outside the uterus. It can be seen in the ovaries and pelvic area. Endometriosis, which occurs in approximately 10% of women of reproductive age, is detected in 25–30% of women experiencing infertility issues. Severe pain during menstruation is a notable symptom, but as the disease progresses, different complaints that affect the quality of life may also be observed. Early diagnosis is important for both pain control and the preservation of reproductive health.
What is a Chocolate Cyst (Endometriosis)?
Chocolate cyst is a type of cyst that forms in the ovaries during endometriosis disease, filled with dark-colored fluid. Endometriosis is a chronic condition that develops with the presence of tissue similar to the uterine lining outside the uterus. Since this tissue responds to hormonal changes during each menstrual cycle, over time, it may cause problems such as inflammation, adhesions, and masses in the area where it forms.
Chocolate cysts are found in the ovaries and, depending on the prevalence of the disease, can present various indications such as pain, changes in menstrual regulation, or impacts on reproductive functions. The most important factors determining the course of the disease are the size of the cyst, its location, and the prevalence of accompanying endometriosis foci.
What Causes Endometriosis (Chocolate Cyst)?
A commonly encountered mechanism in the formation of endometriosis is the passage of some tissue that sheds during menstruation into the abdominal cavity from the fallopian tubes. These cells can multiply over time by attaching to the pelvic area and turn into cystic structures. Especially during menstrual periods, it may cause increased pain and, in some patients, pelvic discomfort that affects the quality of life.
The factors that cause the development of chocolate cysts include:
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Retrograde menstrual flow
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Genetic predisposition
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Immune system dysfunctions
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High estrogen levels
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Cell transfer after procedures such as cesarean section or pelvic surgery
What Are the Symptoms of a Chocolate Cyst?
A chocolate cyst can cause different complaints depending on its size and location. Symptoms may vary based on the tissue's response to hormones, the inflammation formed, and the pressure the cyst exerts on surrounding tissues.
Symptoms observed in individuals with a chocolate cyst include:
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Severe pain during menstruation
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Chronic pain in the lower back, groin, and lower abdomen
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Pain during sexual intercourse
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Pain and pressure sensation during bowel movements
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Menstrual irregularities or heavy menstrual bleeding
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Nausea, abdominal bloating, and indigestion
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Difficulty in conceiving
In some patients, the pain may not be prominent, but as the cyst grows, a feeling of fullness or pressure in the lower abdomen may occur. Therefore, specialist evaluation is essential in cases of recurring menstrual cramps or unexplained pelvic pain.
How Is a Chocolate Cyst Diagnosed?
The diagnosis of a chocolate cyst is mostly made via pelvic examination and imaging methods. Ultrasound is the first-step imaging method, especially in the evaluation of cystic structures in the ovaries. In cases requiring more detailed assessment, MRI (Magnetic Resonance Imaging) may be preferred. The gold standard method for definite diagnosis and assessment of the prevalence of endometriosis foci is laparoscopy. With this method, it is possible to both diagnose and treat the foci in the same session.
How Is a Chocolate Cyst (Endometriosis) Treated?
A chocolate cyst is a condition that can be managed with the correct approach. Treatment can be planned with different methods according to the patient's age, complaints, cyst size, and desire to have children. In cases where pain is the forefront complaint or the disease is mild to moderate, medical treatment is usually preferred, while surgical options may be considered in advanced stages or in cases of pregnancy desire.
In patients who have applied due to inability to conceive for a certain period, assisted reproductive techniques such as insemination or in vitro fertilization may be evaluated in the initial stage. Many patients can achieve pregnancy with these methods. However, if insufficient response is obtained from these applications or if it is considered that the cyst affects reproductive functions, surgical intervention may be planned.
In surgical treatment, the laparoscopic method can be used. During this procedure, the aim is to clean the chocolate cyst, open any adhesions, and restore the functional structure of the tubes. The removal of nodules in deep-seated and surrounding tissues influenced by endometriosis foci may also be included in the treatment process.
It is important to monitor patients over 40 more carefully. In this age group, the risk that some endometriosis foci may be associated with ovarian cancer is taken into account. If a suspicious structure is detected in ultrasound and MRI imaging, surgical removal of the related ovary or tube may be among the treatment options.
Frequently Asked Questions
Can a chocolate cyst cause symptoms other than pain?
Yes, it can cause different complaints such as pain during bowel movements, bloating, stomach discomfort, pain during intercourse, or heavy menstrual bleeding. Symptoms can vary from person to person.
Does endometriosis make it difficult to get pregnant?
Yes, endometriosis can affect the function of the ovaries and tubes in some women, making it difficult to conceive. However, with appropriate treatment and assisted reproductive methods if necessary, a healthy pregnancy can be achieved.
Does a chocolate cyst recur?
Yes, endometriosis foci may recur in some patients after treatment. Recurrence risk can be reduced with regular follow-up and adherence to doctor's recommendations.
Can a chocolate cyst turn into cancer?
The vast majority of chocolate cysts are benign. However, it is important to monitor cysts in patients over 40; if a suspect image is detected, further evaluation may be needed.
