Chocolate cyst should not be overlooked — it might lead to infertility

One of the most common reproductive disorders, especially in women aged over 35, that leads to being infertile is “chocolate cyst”. Chocolate cyst is an ovarian cyst filled with old blood. This condition is frequently found in women with endometriosis, a condition where tissue which normally lines the inside of the uterus (the endometrium) grows outside the uterus. Untreated chocolate cyst not only causes serious complications such as ruptured cysts and severe internal bleeding but also significantly increases the chance of infertility.

“Laparoscopic gynecologic surgery” is a minimally invasive procedure to safely remove ovarian cysts through smaller incisions, resulting in less pain, fewer complications and faster recovery time. Patients can quickly return to their normal life and activities without delays.

Chocolate cyst explained

Chocolate cyst (also known as ovarian endometrioma) is noncancerous, fluid-filled sac with brown, melted chocolate-like appearance. It develops as a result of a condition in which uterine endometrial cells grow outside the uterus (endometriosis). Some of the tissue can attach to the ovary and form a growth. The size of the cyst will usually be enlarged from previous menstrual blood and tissue that fill the cavity of the cyst. A chocolate cyst can affect one or both sides of the ovary. It may occur as a single cyst or multiple cysts. Besides endometriosis, contributing factors to chocolate cyst include genetics, reverse direction of menstrual flow, immune disorders, injury during caesarean delivery, hormonal problems and severe pelvic infection.

Signs and symptoms of chocolate cyst

Typical findings include an increased endometrial thickness, severe pelvic pain before, during or after menstrual periods and irregular menstrual patterns. Other related symptoms are pain during sexual intercourse, digestive problems, bloating and painful bowel movement. Complications often involve ovarian torsion and cyst ruptures. Cystic ovarian masses that develop after menopause might turn to be cancerous.

Diagnosis of chocolate cysts

To diagnose chocolate cysts, the gynaecologists usually perform pelvic examination combined with a pelvic ultrasound (radiological imaging test). Created images from ultrasound scan clearly reveal the abnormalities of uterus and ovaries on a video screen.

Treatment of chocolate cysts

Selected treatment entirely depends on size and location of cyst, disease severity, symptoms and individual patient condition. Treatment options include medications (hormonal contraceptives such as birth control pills) and surgical approaches. “Laparoscopic gynecologic surgery” is a minimally invasive procedure to safely remove cysts via small incisions without having an open cut required in conventional surgery. The surgical instruments including a laparoscope (a narrow tube with a camera) are inserted through these small incisions. This allows surgeons to clearly visualize all dimensions of gynaecologic organs displayed on a monitoring screen before having the cysts removed accurately and safely. Laparoscopic surgery results in less pain and more safety associated with fewer post-operative complications, such as lower rate of infections, less blood loss and less fibrosis formation after surgery. More importantly, faster recovery time and shorter hospital stay enable patients to quickly return to their daily lives and activities.

Although there is no definite way to prevent chocolate cysts, regular pelvic exams help to ensure that changes in the ovaries are diagnosed as early as possible. It is highly recommended to be alert to changes in your monthly cycle, including unusual symptoms. If abnormal signs or symptoms arise, immediate medical attention should be sought in order to receive accurate diagnosis and timely treatment before the disease progresses.

Source: Dr. Yingchi Wang
Obstetrician and Gynecologist (Gynecologic Endoscopy and Minimally Invasive Surgery)
Women’s Health Center, Bangkok Hospital

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