Chocolate cysts are non-cancerous cysts filled with liquid material and typically located in the deep tissue of the ovary. When they are opened, they are called chocolate cysts because they contain a thick, fluid, brown material that resembles a chocolate waterfall. They are also called 'ovarian endometrioma'. This chocolate color is caused by old blood and tissue residues accumulated inside the cyst. They can affect one or both ovaries, or they can be a single ovary or multiple.
These cysts can be seen in 20-40% of women with endometriosis. The disease we call endometriosis occurs as a result of the tissue called endometrium, which lines the inner surface of the uterus, settling on the ovaries, tubes and other reproductive organs outside the uterus. The growth of this endometriosis tissue can cause severe pain and even infertility.
What kind of complaints does the chocolate cyst cause?
Complaints may vary from cyst to cyst. While some women do not cause any complaints and are detected incidentally, in others they may cause serious complaints. The size of the complaints is not proportional to the size of the cyst. In other words, while a woman with a small cyst may have many complaints, there are also women who have a giant cyst and have no complaints. The size of the cyst can vary from 2cm to 20cm.
Possible complaints in chocolate cyst are as follows:
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Painful and crampy menstrual periods
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Pelvic groin pain, which also occurs outside of menstruation
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Irregular menstruation
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Pain during sexual intercourse
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It may also cause infertility in some women.
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In case of sudden rupture of the chocolate cyst, it may cause severe pain and tenderness and a medical emergency in the person with the cyst in the abdomen. , women with endometrioma should be warned about this.
What causes chocolate cysts?
It is not clear what causes chocolate cysts. There are many theories about why it occurs, but none of them have been proven. The most accepted one is retrograde menstruation, also called reverse menstruation. This means that menstruation penetrates into the abdomen and into the genital organs. It is theorized that it causes adhesions to cysts and tubal obstruction.
How are chocolate cysts diagnosed?
With vaginal ultrasound performed during a routine gynecological examination in women who have no complaints or with the complaints mentioned above. Cysts thought to be endometriomas are easily seen. Rarely, advanced imaging methods may be used. However, it can only be determined pathologically that the cyst is an endometrioma cyst by removal or biopsy. We cannot make a definitive diagnosis of the cyst seen with ultrasonography without removing it, we can only give an opinion.
How are chocolate cysts treated?
The treatment option is determined by some factors:
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Your age,
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Your complaints,
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Whether one or both ovaries are affected,
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Whether or not you want a child
If your cyst is small and does not cause any complaints, only monitoring may be recommended. During this waiting period, no treatment may be applied or birth control pills to prevent ovulation may be used. These medications can be used to control pain and slow the growth of the cyst, but they are not for the treatment of the cyst, that is, they do not destroy the cyst.
However, in the following cases, removal of the cyst called cystectomy, that is, surgical treatment, may be required;
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Severe, unrelieved pain
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Cyst size larger than 4 cm
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Those that may be cancerous (develop in only 1 percent of them)
Chocolate Surgical treatment of cysts is generally performed laparoscopically, called the closed method. The cyst can be removed by making optical and 2-3 5mm holes placed through the belly button without the need for large incisions on the abdominal surface.
The effects of surgical treatment on fertility are controversial. Sometimes, removing the healthy tissues of the ovary along with the cyst may negatively affect ovarian functions. Sometimes the toxic and inflammatory transformations of the cyst can negatively affect ovulation.
What are the effects of chocolate cysts on fertilization?
Chocolate Ancestor cysts can damage the ovarian tissue and reduce the healthy part due to the area they cover. They are difficult to treat, and pelvic surgery to remove them may cause injury to the ovarian surface, which may lead to decreased fertility.
The difference between women with chocolate cysts and those without:
They have fewer eggs
Eggs are less mature.
Higher levels of follicle stimulating hormone (FSH) may cause problems in ovulation.
In women who have a chocolate cyst and cannot get pregnant, in vitro fertilization ( IVF application may be another option
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