What is Chocolate Cyst (Endometrioma)?

The ovaries play a very important role for women by secreting many hormones (andorgen, estrogen, progesterone, etc.) apart from egg production. The presence of endometriosis in the ovaries also negatively affects the ovaries.

The formation of the lining of the uterus, in other words the endometrium, outside the uterus (for example, in the abdominal cavity, ovaries or anywhere in the body) is called endometriosis.

The presence of this endometrial tissue, which is normally only in the uterus, thickens after menstruation and allows the baby to settle, and is regenerated with each menstrual period, in the ovaries also leads to menstrual-like bleeding and leads to chocolate cyst (Endometrioma) as a result of the accumulation of dark old brown blood in the ovary.

These cysts are named so because the fluid that accumulates in them is dark in consistency, like old menstrual blood, and resembles chocolate in color. Unlike functional cysts seen in normal menstrual periods, these cysts do not regress and disappear.

Does Every Woman with Endometriosis Have a Chocolate Cyst?

Chocolate cysts are found in both ovaries in approximately one-quarter (28%) of patients. Endometriosis, which is most common in the 25-34 age group, is a very common health problem that affects approximately 10 percent of women.

17-50% of patients with endometriosis have chocolate cysts. Chocolate cysts in 15% of women of reproductive age; It is found in 30% of women with infertility problems.

Who Gets Chocolate Cyst (Endometrioma)?

Pain is seen in 60-70% of endometriosis patients. In some women, it does not cause any symptoms and is seen on surgery or ultrasonography. Endometriosis, the cause of which is unknown, can cause many problems that can impair the quality of life of women.

Chocolate Cyst (Endometrioma) Symptoms

All symptoms of endometriosis (pain, infertility) can also be seen in patients with chocolate cysts. Some patients may have no complaints. It can be detected in normal gynecological examination. If these cysts become too large, they can cause serious problems such as pain, rupture of the cyst wall (wall), and very rarely, cancer may develop in the cyst wall in endometrioma (chocolate) cysts.

Chocolate Cyst (Endometrioma) Diagnosis

Gynecological examination and ultrasonographic examination help in the diagnosis of chocolate cyst. It should be differentiated from other cysts of the ovary. Transvaginal ultrasonography plays a very important role in the differential diagnosis of ovarian cysts detected during examination.

Diagnosis of chocolate cysts can be made by ultrasonography. If there is a possibility of tumoral cyst with ultrasound, surgery should be performed.

In addition, measurement of some tumor markers in the blood helps in diagnosis. The most commonly used are Ca125 and HE 4. Laparoscopic (closed) surgery can be recommended if the patient with endometriosis and chocolate cyst has a predominant complaint of pain and adversely affects his daily life and quality of life.

Chocolate Cyst (Endometrioma) Treatment

There is no permanent cure for endometriosis. The reason for this is that although the treatment varies among individuals, the 2-year recurrence frequency of endometriosis is around 20 percent and the risk increases as the duration increases.

The aim of treatments such as drug therapy or surgical method is to relieve severe pain and to eliminate infertility, if any, and to ensure that the woman becomes pregnant. Which treatment to apply is decided by looking at the severity of the disease, the problems it causes, and other characteristics of the patient.

Chocolate Cyst (Endometrioma) Surgery

Closed (laparoscopic) surgery is better in terms of both results and patient comfort compared to opening the abdomen. During the surgery, chocolate cysts should be removed without damaging the ovaries, adhesions should be opened and other endometriosis foci should be destroyed.

In order not to damage the ovarian capacity during the surgery, it should be performed using atraumatic methods as much as possible.

It is the best approach to follow up patients who do not have any complaints and who are incidentally found to have chocolate cysts during the examination. Surgery may be considered in cases where the Ca125 value is high or the cyst size is over 5 cm.

Preoperatively, ovarian capacity should be evaluated with ultrasound and AMH measurement, and surgery should be avoided as much as possible in women with low ovarian capacity and without children.

Endometriosis Symptoms
What Are the Symptoms of Endometriosis?

Endometriosis, that is, chocolate cyst, is one of the diseases that is very common in women in the world and in our country and is the last to be diagnosed. It is known that it is seen in almost one out of every 10 women and becomes widespread.

While endometriosis can progress without any symptoms in some patients, it can lead to severe complaints in some patients. The patient’s routine