Have you heard of chocolate cysts? Yes, you read that right! Cysts filled with old blood are known as chocolate cysts. These are a severe form of endometriosis. So, how can you know if you are suffering from endometriosis or chocolate cysts? What causes this type of cysts and how do you treat them? Read on to find all the answers.
Chocolate cysts, also known as ovarian endometrioma are cysts filled with old blood that look like liquid chocolate. During every menstrual cycle, a woman’s uterus will develop a lining inside, known as the endometrial lining. When tissues similar to this endometrial lining grow on the outside of the uterus, it results in a condition known as endometriosis. When this tissue attaches to the ovary, it is known as endometrioma.
Endometrioma is a severe form of endometriosis and can cause irritation and also attach to other organs. It can grow in size, cause a lot of pain, or even impact a woman’s fertility. Getting the proper treatment at the right time can help.
Pain in the pelvic area is the most common symptom of ovarian endometrioma. Many can confuse the pain and discomfort with symptoms from regular periods. However, this pain can occur even when a woman is not on her period.
Other common symptoms of chocolate cysts are:
● Pain during sex
● Very painful menstrual periods
● Pain during urination or excretion
● The constant urge to urinate
● Nausea and vomiting
● Feeling bloated
● Backaches
The exact cause of endometrioma is not very clear. A possible theory is that endometriosis happens when the body experiences retrograde menstruation – a condition where the shed endometrial lining flows backwards into the body instead of leaving it. According to this theory, some of the shed tissue travels up the fallopian tube and reaches the ovaries instead of leaving the body from the uterus. With every menstrual cycle when the uterus lining sheds as menstrual blood, similar effect is seen with in these ovarian cysts that have the same uterus lining and shed blood which keeps collecting and presents as liquid chocolate (old blood). This results in a lot of pain and discomfort around the pelvic region.
Any menstruating woman is at risk of endometriosis – a condition where the endometrial lining-like tissue grows outside the uterus instead of inside. Ovarian endometrioma is a severe form of endometriosis. Some factors that can increase the risk of endometriosis are:
● Family History – Women with a family history of endometriosis or endometrioma are at a higher risk of suffering from endometriosis themselves.
● Menarche Age – The age at which a girl gets her first period matters. Those who begin menstruating before the age of 11 are at a higher risk of endometriosis.
● Menstrual Cycle Length – The risk is higher if the menstrual cycle is less than 27 days long and the bleeding extends beyond 7 days.
● Abnormalities – Any abnormalities in the uterus or the fallopian tubes can increase the risk.
Apart from the pelvic pain and discomfort that can interfere with regular activities, endometrioma can also cause the following complications:
● Fertility Issues – The formation of scar tissues or inflammation of the ovaries or fallopian tubes can impact fertility by reducing egg reserve and quality by disturbing tubal transport mechanisms.
● Digestion Issues – Chronic constipation, complete blockage of the bowel or bladder, need to urinate frequently.
● Rupture – When the cyst opens or leaks, it can result in an endometrioma rupture, which can be very painful. It will also cause abdominal pain and weakness.
● Ovarian Cancer – Endometrioma can increase the risk of ovarian cancer. However, this is very rare.
Ovarian endometrioma diagnosis is done in the following manner:
● Physical Examination – A large cyst may be easy to notice during a regular pelvic exam.
● Imaging – An MRI or an ultrasound of the pelvis can detect such cysts. If you are experiencing any symptoms, your doctor may ask for a transvaginal ultrasound.
If they find a cyst, the doctor may just take a sample for testing and send it for a biopsy. In case of big cysts that are causing trouble, they may decide to remove the entire cyst via laparoscopy. The cyst sample is sent to a lab for examination by a pathologist.
When you first consult your doctor with any symptoms, they may opt to rule out other conditions with similar symptoms, before narrowing down on endometrioma. Some tests to rule out other conditions are:
● CBC – A complete blood count to check for anaemia or infections. The heavy bleeding caused by endometriosis can lead to low red blood cells in the body.
● Urine Analysis – To rule out urinary tract infections.
● STI Test – To rule out sexually transmitted infections.
There is no cure for endometrioma. If it is causing too much pain or discomfort, the only option is to remove the cyst. The treatment also depends on the size and impact of the cyst and the age of the patient. Chocolate cyst treatment includes –
● Wait and Watch – If the cysts are small and not causing much trouble, doctors may decide to just monitor the cysts carefully at regular intervals.
● Surgery – If the cyst is causing too much pain or is bigger than 4 cm, ovarian endometria surgery can help remove it.
● Medications – Birth control pills, vaginal rings, or patches with hormones can help regulate the hormone fluctuations that are stimulating the endometriosis and improve symptoms.
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There is no way to prevent endometrioma as endometriosis does not have any specific known cause. Not all ovarian endometriomas cause trouble. Some can be small and will require only monitoring. In some cases, the endometrioma can return despite an ovarian endometrioma surgery. There is no sure way to predict or prevent this condition.
Ovarian endometrioma, also known as chocolate cysts, is a severe form of endometriosis that can affect any woman. Seeking medical treatment at the right time can help manage symptoms and reduce discomfort. Removing the cyst surgically can also help improve, if not resolve the issue completely.
Pelvic pain and discomfort are common symptoms of endometrioma. Unlike regular periods of pain, this pain can last even after the menstruation period.
Yes, inflammation of the ovaries or the fallopian tubes can interfere with fertility and even cause infertility in some cases.
When left untreated, the chocolate cyst can grow in size and obstruct or affect other surrounding organs and their functioning. In some cases, the cyst can rupture, causing a medical emergency as the old blood spilling into the abdomen can become dangerous if not attended to immediately.
