Healthy ovaries are very important for a woman’s reproductive and overall well-being. One of the common problems with Indian women’s reproductive health is the development of ovarian cysts. There are more than 10 million cases per year in India for the same, this only goes to show it is a growing problem and many women require treatment. There are various types of ovarian cysts – chocolate cysts or endometriomas are one of them. In this blog by Dr. Banker and team, we are going to look at these chocolate cysts – what are these, their symptoms and it’s diagnosis. We will look at factors that play a role in chocolate cyst treatment and what are the possible solutions for the condition.
 

What is a chocolate cyst?
 
Chocolate cyst or endometrioma is a type of ovarian cyst filled with older blood. These chocolate cysts are a type of endometriosis. Endometriomas can be noticed in the form of implants on the surface or inside the ovaries as well. They can be present on one or both ovaries and vary in size. They are usually not cancerous but they do require treatment as they can lead to infertility. Endometriomas are a sign that a person’s endometriosis is quite severe. After cancerous tumors, doctors agree that chocolate cysts pose a serious threat to healthy ovaries and the woman herself. More than 20% of the people diagnosed with endometriosis experience chocolate cysts. Endometriosis is a painful disorder in which the tissue that grows on the line of the uterus, grows outside the uterus.
 
How do chocolate cysts cause health problems?
 
As the growth takes place outside of the uterus, they may swell, and bleed, similar to the lining inside of the uterus. However, in this case, since the placement of the tissue growth is abnormal, the blood cannot expel out of your body.
 
Treatment for endometriomas is required to avoid problems such as:

• Pain, especially during periods.
• Fallopian tubes being blocked due to growth in the ovaries leading to improper disposal of blood. Blood that is trapped in the ovaries can create cysts.
• Scar tissue or adhesions of tissues
• Intestinal or bladder problems
• Infertility – these chocolate cysts are space-occupying lesions in the ovary and can cause mechanical damage to the growing eggs. These also secrete inflammatory chemicals which further increase the damage.

Chocolate cyst is a type of endometriosis. As mentioned earlier, endometriosis causes the tissues that line the uterus to grow outside the uterus. Slowly, over time, these tissues can latch onto or attach themselves to ovaries, fallopian tubes, or even the bladder. This causes heavy menstrual cycles and severe cramps. Apart from this, it can also damage healthy ovaries and healthy organs. Medical health professionals have divided endometriosis into stages. These stages are determined by how far the tissue has spread itself to other parts of the body. The most severe stages are 3 and 4, where endometriomas or chocolate cysts can be observed. Unless the person has visited a doctor for ovarian cyst management, it can grow vastly and chocolate cysts may develop. In many cases, when a person is ignorant of chocolate cyst symptoms, it has stopped them from conceiving and has caused ovarian dysfunction. For treating both endometriosis or chocolate cysts and resultant infertility, simply search on google “Fertility specialist near me” and you will find infertility specialists such as Dr. Manish Banker, Ahmedabad. Ensure that the IVF fertility clinic follows all health and safety regulations for Covid-19.

 
So who is more likely to be affected by chocolate cysts?
 
The following groups of people are more susceptible to be affected by endometriosis and chocolate cysts.

– History of endometriosis: In case the person has a family history of endometriosis, then they are more likely to be affected.
 

– Retrograde flow: In a few cases, the menstrual blood flows in the reverse direction going up the fallopian tubes instead of out of the vagina. However, some doctors feel that this is a myth.
 

– Immune disorders: Autoimmune disorders are also one of the chocolate cyst causes. Immune problems can also lead to this condition.
 

– Damage to the uterus or areas around the uterus can disrupt ovarian function increasing the risk of endometriosis. For example, a common injury can occur during c-section delivery.

Chocolate cyst symptoms:
 
Before learning about the signs, one must know that the symptoms may be the cause of another problem as well. Without a doctor’s examination, one cannot guarantee that they are chocolate cysts just with the symptoms.
 

• Excruciating periods is one of the main chocolate cyst symptoms, if your period interrupts you from doing your basic daily chores then it is considered to be painful periods.

 

• Severe pelvic pain during menstruation

 

• Pain during intercourse is experienced by people with endometriomas. It also includes deep pain in the vagina during intercourse.

 

• Painful bowel movements

 

• Digestive issues such as diarrhea, bloating, nausea especially during menstruation are all indicators

 

• Infertility or trouble conceiving is a common indicator.

If you or a loved one is experiencing any of the above chocolate cyst symptoms, it is recommended to visit a doctor immediately. You can google “Fertility specialists near me” and book an appointment to help the condition.
 

Chocolate cyst diagnosis
 
The first step is to first diagnose the issue. Many women turn a blind eye to the chocolate cyst symptoms until they’re not able to conceive. That is why it is highly recommended to visit a fertility specialist after noticing one or two of the signs.
 
Ways to diagnosis endometriomas are as follow:
 

• Pelvic exams- While conducting a pelvic exam, doctors will feel for cysts or scars located in the back of your uterus. Smaller and less intense cases of endometriosis can be difficult to find while conducting a pelvic exam.

 

• Imaging test- One of the most common ways to find out if chocolate cysts are present. The doctor inserts a wand-like scanner into your vagina to check for cysts. He or she may move a scanner across your abdomen. Both types of ultrasounds make use of sound waves to view the internal structures. Another common imaging test is MRIs or Magnetic resonance imaging.

 

Factors to consider before chocolate cyst treatment:
 
When it comes to endometriosis, there is no cure. However, there are treatment options available for endometriosis, chocolate cyst symptoms, and the issues they cause. The treatment for the condition depends on many factors like:

• Your age
• The intensity, severity of your symptoms, and the symptoms by itself
• Whether both ovaries have the condition
• Whether or not you’d like to conceive in the future.

In the case of small chocolate cysts, doctors recommend waiting and observing. They may prescribe medication that inhibits ovulation, for example- birth control pills. However, this cannot do more than helping with pain and stagnating growth.
 

• Medication:
  – These are usually the first line of treatment in case of smaller cysts.
  – Birth control pills will be recommended to reduce pain during menstrual cycles
  – GnRH analogues are used to lower the amount of estrogen in your body. They also help with pain during periods.
   
  It is imperative to know that this is not a definite treatment and the symptoms can recur.

Treatment options also include surgery, also called ovarian cystectomy, and is recommended for women who are experiencing
 

• Severe symptoms
• Cysts bigger than 4cm
• Cysts interfering in Infertility treatment

This particular procedure is done via a laparoscope. It is a slender, lengthy tube with a camera that helps doctors perform the surgery. The surgery is important because the inflammation and harmful environment a chocolate cyst can create can cause harm to fertility.
 

Chocolate cyst and IVF Success
 
This is an effective treatment option for infertile women with chocolate cysts. In most cases, the chocolate cysts have already done damage to the ovarian reserve. In this circumstance, it is better to go for IVF before undergoing surgery. It has been documented that surgery, even in expert hands, can cause additional damage to the already affected ovary and hence can further reduce the ovarian reserve. Early intervention with IVF can give good results.
 

In conclusion, some women with endometriosis experience chocolate cysts. In a few cases, we can treat chocolate cyst symptoms with just medication. In other severe cases, chocolate cyst treatment includes surgery as well. For women with infertility, early intervention with IVF can give good results with a shorter time to achieve a pregnancy. It is important to visit a doctor for an early and accurate diagnosis. For treating both endometriosis or chocolate cysts and resultant infertility, you can contact a fertility specialist near you, such as Dr. Manish Banker, Ahmedabad. Book your slot in two minutes, not to worry, BankerIVF clinic takes utmost precaution for the COVID-19 pandemic. To read more useful blogs, visit our blog page.

 
 

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FAQs for this blog:
 

1. What are some chocolate cyst causes?
There is no exact or single reason for chocolate cyst and this can be caused due to a variety of reasons which can be at an anatomical or a genetic level.,. Around 20-40% of the people affected by endometriosis have chocolate cysts. These cysts grow outside the lining of the uterus and cause damage to healthy ovaries and tissues.

 
2. Can chocolate cysts cause weight gain?
It is not likely that one can gain weight due to this cyst. The underlying pathology of endometriosis can hamper daily activities, however, it is unlikely to experience weight gain.
 

3. Can you see chocolate cysts on ultrasound?
Chocolate cysts can be seen on ultrasounds. Doctors may first feel for cysts during diagnosis, however, if they are small in size, they can only be seen through image testing such as ultrasound or MRIs.
 

4. Do chocolate cysts cause pain?
Yes, chocolate cysts can cause pain. Especially during menstruation. As they are a result of endometriosis, some of the main symptoms are severe menstrual cramps, painful intercourse, digestive issues, and infertility.