ENDOMETRIOSIS and CHOCOLATE CYSTS
Endometriosis is the presence of endometrial glands and tissue outside the uterus. Chocolate cysts are a particular type of ovarian cyst linked to endometriosis. So called “Chocolate cysts” are well known also as Endometriomas – these are cysts in the ovaries formed by endometrial tissue (tissue similar to the lining of the uterus). Actually the chocolate cyst is the cyst of the ovary with intracavitary hemorrhage and formation of a hematoma containing old brown blood. The term chocolate cysts come from the physical appearance as these growths are usually comprised of dried blood making them brown in appearance. Chocolate cysts are formed when endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) grows in the ovaries. Chocolate cysts are usually filled with old, dark, reddish-brown, sludgy-brown blood, hence their moniker. Chocolate cysts can vary between 0.5 and 8 inches (1.5-20cm) in diameter, and are not necessarily a cause for concern. However, if they rupture, their contents can spill into the ovaries and the pelvic cavity. This can be very painful and can also cause some of the organs in the pelvis to bind together. If this happens with the fallopian tubes and ovaries, it can result in infertility.
Chocolate cysts are affecting women during their reproductive period and may cause chronic pelvic pain associated with menstrual periods (menstrual cramps, endometriosis).
Chocolate cyst – Ovarian endometriosis
Chocolate cysts (Ovarian endometriosis) probably start as a surface lesion. This process becomes invasive and the endometriotic lesion internalizes into the ovarian tissue. Once the menstrual flow and debris collect at the site of endometriosis in the ovaries, chocolate cysts form that are filled with chocolate-colored liquid. Actually it is a cyst which represent debris from prolonged cyclic menstruation in an enclosed area (inside of ovary). Chocolate cysts could sometimes attain impressive size, with some documented as large as a baseball or grapefruit that completely obliterate the normal ovary. However, usually there is a well-demarcated separation between the cyst wall and the normal adjacent ovarian tissue.
On a monthly basis, endometrial tissue is produced when a hormonal signal is released preparing the uterus to receive a fertilized egg. When pregnancy does not occur the tissue is shed in the form of a menstrual cycle. Another hormonal release signals this shed of tissue which is effectively released from the body through muscular contractions.
When tissue has grown outside of the uterus this shed is not possible and causes an accumulation of tissue and thus cyst endometriosis occurs.
In general chocolate cysts are not life threatening, they can become such if no action is taken. Chocolate cysts’ rupture could be life threatening and is not something to ignore. In these cases emergency medical service is required.
When a rupture occurs, the contents of the chocolate cyst are released into the body and pelvic cavity. Besides being quite painful (it cannot be unnoticed – could be very strong not-bearable pain) it can lead to further health complications, as the cysts have blood in them and are in the pelvic region.
CHOCOLATE CYSTS’ SYMPTOMS
Most typical symptoms of chocolate cysts are:
- Painful periods – often starting a few days before, and then lasting for the whole of the period;
- Painful sex (Dispareunia) – typically the pain is felt deep inside and lasts for a few hours after sex.
- Pain in the lower abdomen and pelvic area;
- Infertility – as the passage of the egg from the ovary to the fallopian tube may be blocked.
CHOCOLATE CYSTS’ DIAGNOSIS
Chocolate cysts can be diagnosed with x-rays or trans-vaginal ultrasounds. Positive results on a blood test called CA125 can also indicate the presence of a chocolate cyst, although ovarian cancer will also give a positive result, so this could be cause for concern. In these cases, exploratory surgery may be necessary to determine the nature of the problem.
CHOCOLATE CYSTS’ TREATMENT
When chocolate cysts become a problem, causing pain or infertility, the cyst may be surgically removed.
In most cases the chocolate cysts can be removed during laparoscopy – with a small incision and a wand shaped tool minimizing the incision size. In cases where the cyst is very large occasionally the entire ovary can be removed. Sometimes the cystectomy, or removal of only the cyst could be enough. In other cases, if the cyst is very large, poorly located, or if there are multiple cysts involved, a procedure called an oopherectomy, or removal of the ovary, could be required.
Surgery is not generally considered risky however infection is always a factor and therefore doctors may prescribe antibiotics after the procedure. The point here is that while endometriosis is usually treated by preventing the menstrual, there should also be treatment that restores balance to the hormones, as this can be the root cause.
Some specialists suggest that the permanent cure for chocolate ovarian cysts can be done by natural holistic approach. This works on the assumption that all ovarian cysts are an indication of underlying problems within the body. The solution therefore is not to attack the cysts, but to address these underlying problems and restore the body’s natural balance.