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Chocolate cyst

Chocolate cyst (endometrioma, endometrial cyst) is a type of ovarian cyst that affects women – actually it is ovarian endometriosis. Endometriosis is a condition when endometrial tissue grows outside the uterus usually on the ovaries, fallopian tubes or in the pelvis area.

Every month (during menstrual period) the endometrial tissue inside the cyst responds to monthly hormones – it bleeds and fills the interior of these cysts with not clotted dark blood. The terminology “chocolate cysts” came from the dark old blood that grossly resembles chocolate.

If chocolate cyst continues growing, it can become a part of ovary, replacing the normal tissue needed for regular menstrual cycles. Inflammation and irritation from chocolate cysts can spread to nearby organs in pelvic cavity. Endometrial cyst sizes could be different – starting from 1-2 cm (like grapes) and ending by 10-15 cm (softball size) in diameter.

Ovaries are not the most common area for endometriosis. In most cases if woman has a chocolate cyst, she would have spread endometriosis in other pelvic or intestinal locations.

Chocolate cyst symptoms

Chocolate cysts have similar symptoms like during any endometriosis since the underlying disease is the same. Not all women with endometrioma have same symptoms – some women could have severe symptoms while others could mention only slight differences or even not any symptoms. Most common symptoms include the following:

  • Algomenorrhea – pain associated with the menstrual cycle;
  • Abdominal cramping, pain and swelling during monthly menstrual periods;
  • Dark brown discharge, brown spotting or reddish brown spotting before or after menstrual periods;
  • Irregular uterine bleeding or vaginal spotting;
  • Pain during urination;
  • Pain while emptying the bowels;
  • Pain during sexual intercourse;
  • Abdominal pain during some physical exercises (bending or stretching);
  • Intense and sharp abdominal pain sometimes combined with nausea, vomiting and fever (rare but emergency) – in cases of pressed cyst, twisted or ruptured cyst.

Chocolate cyst diagnosis

Chocolate cyst - abdominal pain

Chocolate cyst – abdominal pain

Ovarian cyst itself can be identified by gynecologist during pelvic exam. Ultrasound tests could clarify the endometrial origin of cyst. Best is diagnostic laparoscopy with biopsy. Histology ultimately provides the most accurate diagnosis.

Chocolate cyst treatment

Treatment options include both medication and surgery. Medications for endometriosis could be useful in relieving symptoms temporarily but do not treat or actually remove the cyst. Commonly used Danazol and gonadotrophin-releasing hormone (GnRH) agonist can be pretty effective.

Danazol once prescribed is usually taken orally for long period (about 6-9 months). As all endometriosis symptoms depend on increased levels of estrogens, this drugs work by changing hormone levels in the body, namely by lowering estrogen levels. These medications put women body into false menopause (absence of regular periods) so that the ovaries stop releasing monthly eggs, shrink growths and reduce pains associated with the chocolate cyst. These drugs could have positive improvement rates during one year (treatment period) but there could be also some drawbacks and side-effects.

According to some experts, chocolate cysts don’t respond well to medical therapy and surgery is the best treatment for resolution. Nowadays several modern surgical techniques are available for chocolate cyst treatment.

If surgery recommended, some complications also should be considered including the following:

  • Post-operation adhesions and scars;
  • Removal of whole ovary because sometimes it is not possible to save the healthy tissue;
  • Trauma of neighboring organs (rectum or bladder);
  • Endometriosis recurrences.

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