Chocolate Cyst

The presence of this endometrial tissue, which is normally only in the uterus, thickens after menstruation and allows the baby to settle, and is regenerated with each menstrual period, in the ovaries also leads to menstrual-like bleeding and leads to chocolate cyst (Endometrioma) as a result of dark old brown blood accumulation in the ovary.

What is a Chocolate Cyst?

The chocolate cyst is a type of cyst that occurs as a result of endometriosis disease. In general, many women with endometriosis also have chocolate cysts.

What is Chocolate Cyst (Endometrioma)?

The ovaries play a very important role for women by secreting many hormones (andorgen, estrogen, progesterone, etc.). The presence of endometriosis in the ovaries also negatively affects the ovaries.

The formation of the lining of the uterus, in other words the endometrium, outside the uterus (for example, in the abdominal cavity, ovaries or anywhere in the body) is called endometriosis.

The presence of this endometrial tissue, which is normally only in the uterus, thickens after menstruation and allows the baby to settle, and is regenerated with each menstrual period, in the ovaries also leads to menstrual-like bleeding and leads to chocolate cyst (Endometrioma) as a result of dark old brown blood accumulation in the ovary.

These cysts are named so because the fluid that accumulates in them is dark in consistency, like old menstrual blood, and resembles chocolate in color. Unlike functional cysts seen in normal menstrual periods, these cysts do not regress and disappear.

Does Every Woman with Endometriosis Have a Chocolate Cyst?

Chocolate cysts are found in both ovaries in approximately one-quarter (28%) of patients. Endometriosis, which is most common in the 25-34 age group, is a very common health problem that affects approximately 10 percent of women.

17-50% of patients with endometriosis have chocolate cysts. Chocolate cysts in 15% of women of reproductive age; It is found in 30% of women with infertility problems.

Chocolate Cyst (Endometrioma) Symptoms

All symptoms of endometriosis (pain, infertility) can also be seen in patients with chocolate cysts. Some patients may have no complaints. It can be detected in normal gynecological examination. If these cysts become very large, they can cause serious problems such as pain, rupture of the cyst wall (wall), and very rarely, cancer may develop in the cyst wall in endometrioma (chocolate) cysts.

Chocolate Cyst (Endometrioma) Diagnosis

Gynecological examination and ultrasonographic examination help in the diagnosis of chocolate cyst. It should be differentiated from other cysts of the ovary. Transvaginal ultrasonography plays a very important role in the differential diagnosis of ovarian cysts detected during examination.

Diagnosis of chocolate cysts can be made by ultrasonography. If there is a possibility of tumoral cyst with ultrasound, surgery should be performed.

In addition, measurement of some tumor markers in the blood helps in diagnosis. The most commonly used are Ca125 and HE 4. Laparoscopic (closed) surgery can be recommended if the patient with endometriosis and chocolate cyst has a predominant complaint of pain and adversely affects his daily life and quality of life.

Chocolate Cyst (Endometrioma) Treatment

There is no permanent cure for endometriosis. The reason for this is that although the treatment varies among individuals, the 2-year recurrence frequency of endometriosis is around 20 percent and the risk increases as the duration increases.

The aim of treatments such as drug therapy or surgical method is to relieve severe pain and to eliminate infertility, if any, and to ensure that the woman becomes pregnant. Which treatment will be applied is decided by looking at the severity of the disease, the problems it causes and other characteristics of the patient.

Chocolate Cyst (Endometrioma) Surgery

Closed (laparoscopic) surgery is better in terms of both results and patient comfort compared to opening the abdomen. During the surgery, chocolate cysts should be removed without damaging the ovaries, adhesions should be opened and other endometriosis foci should be destroyed.

In order not to damage the ovarian capacity during the surgery, it should be performed using atraumatic methods as much as possible.

It is the best approach to follow up the patients who do not have any complaints and who are incidentally found to have chocolate cysts during the examination. Surgery may be considered in cases where the Ca125 value is high or the cyst size is over 5 cm.

Preoperatively, ovarian capacity should be evaluated with ultrasound and AMH measurement, and surgery should be avoided as much as possible in women with low ovarian capacity and without children.

Endometriosis Symptoms

What Are the Symptoms of Endometriosis?

Endometriosis, that is, chocolate cyst, is one of the diseases that is very common in women in the world and in our country and is the last to be diagnosed. It is known that it is seen in almost one out of every 10 women and becomes widespread.

While endometriosis can progress without any symptoms in some patients, it can lead to severe complaints in some patients. During a routine control of the patient, it can be seen as a chocolate cyst in the ovaries or as a nodular lesion on the membranes lining the intestine or at the back of the uterus between the intestines.

Where are endometrial implants (diseased tissue) most commonly found?

Endometriosis is mostly found in the ovaries, but can also be found in other foci such as:

fallopian tubes

Ligaments that support the uterus

intestines

Bladder

Vagina

The inner space between the vagina and the rectum (bowel)

outer circumference of the uterus

Boundaries surrounding the inguinal cavity

Scars from abdominal surgery

Chocolate cyst, which can be seen in one of every 10 women, is a disease that can make the life of people who have this disease very difficult. In addition, since the complaints caused by the disease are similar to other gynecological disorders, it can take a long time to make the correct diagnosis and apply treatment to the patients.

Endometriosis can manifest itself with unexpected symptoms, some of which are: extreme tiredness and inability to concentrate on the work being done.

Some of the common findings are as follows:

Chronic Fatigue

Chronic fatigue syndrome, which is one of the least known symptoms seen in women with endometriosis, can cause a constant feeling of fatigue and focusing problems in the patient. It is necessary to consider the long-lasting spring fatigue and evaluate the possibility of endometriosis.

Waist, back, abdomen, groin pain

Low back and back pain are among the most common complaints in women. It is not thought that the treatment of these pains is mostly done by obstetricians. However, chocolate cyst may be the basis of long-lasting waist, back, abdomen and groin pain. When patients realize this disease and apply to the doctor for treatment, they state that they are far from social activities, often sluggish and tired.

No desire to go to the toilet

If the chocolate cyst that has spread over the intestines narrows the intestine; Severe pain may occur when going to the toilet. Apart from this, it can also cause problems in the organs in the pelvis.

Defecation and not wanting to urinate are among the most prominent complaints. Especially during urination, serious pain and burning can be seen, because these organs are very close to each other, the movement of any of them can affect the lesion on the other side and cause burning and pain.

Infertility

The relationship between infertility, that is, infertility and endometriosis, is a frequently discussed topic. Endometriosis foci can cause obstructions and adhesions, especially in the tubes and ovaries, which leads to infertility. This disease can also occur when some couples go to the doctor upon their request to have a child.

painful intercourse

Many women who experience pain during sexual intercourse do not think that there may be a gynecological disease underlying this problem. This situation can cause various problems between spouses; It can cause serious problems, such as alienation from the relationship, separation. Therefore, it may be necessary to consider chocolate cyst or chocolate cyst in such problems.

severe menstrual cramps

Severe menstrual pain is the most obvious discomfort that can be seen in almost every woman and can be shown among the symptoms of chocolate cyst according to the severity of the pain. Although women act with the thought that these pains are normal and experienced by almost every woman, this is shown as the most prominent feature by gynecologists.

Gas and bloating in the abdomen

Another symptom of this disease is pain and bloating in the abdomen. The patient complains of uncomfortable bloating in the abdomen, especially during the menstrual period. As there may be other reasons behind this swelling, the danger of endometriosis should also be considered.

Depression

Depression is one of the most common causes of this disease. In fact, the symptom of chronic depression, which may be a result of the disorders caused by the disease, can go as far as disruptions in the daily work of the person, sexual problems and reluctance, chronic fatigue and thus not being able to enjoy life.

People with the above findings; They should consult their doctor, as the cause of their symptoms may also be caused by other conditions.

How is endometriosis linked to infertility?

Endometriosis is considered one of the three main causes of infertility. Infertility can occur even in mild or moderate cases. In such cases, surgery to remove adhesions, cysts, and diseased tissue can restore fertility. However, in some cases (a low rate), women may not be able to regain their fertility. How endometriosis affects fertility is not fully understood.

It is thought that endometriosis affects the release of the egg from the ovary and prevents its access to the fallopian tubes. Another suggested mechanism is changes in the uterine wall that prevents the fertilized egg from attaching to the uterus.

What is Endometriosis?

The name of the endometriosis disease comes from the “endometrium” (the tissue that makes up the inner wall of the uterus). In women with endometriosis, the cells that make up the endometrium are located on organs other than the uterus.

This localization can usually be in the ovaries, other reproductive organs such as the tubes, the abdominal cavity or distant organs.

Contrary to what is seen in menstrual bleeding, the tissue cannot expel itself from the body and the bleeding originating from this tissue causes inflammation and swelling in the surrounding tissues. This process can cause scar tissue in the area, causing lesions or other growths.

Especially in cases involving the ovaries, the blood can be embedded in the inner part of the tissues, causing blood accumulation and the formation of chocolate cysts as a result.

What kind of disease is endometriosis?

Endometriosis affects approximately 2 million women in Turkey every year; It affects negatively because it causes severe periodic pain, infertility and pain during intercourse. This number means that there is one-tenth of women of the same age.

Endometriosis affects 10-17% of women of reproductive age and 35-60% of women with chronic pelvic pain and can lead to infertility.

Pain associated with endometriosis is not only a very common finding, but also one of the most serious pains that needs to be treated.

Since the diagnosis of the patient may take up to 7-8 years; Most of the patients suffer from pain without receiving the appropriate treatment method and both their daily life and sexual life are seriously affected.

Endometriosis treatment; It may vary according to the patient's age, desire for pregnancy and the severity of the symptoms. The main aim of the treatment is to control the pain and to prevent or delay the progression of the disease and the formation of new foci as much as possible. This aim can be achieved by surgical method or drug treatment.

Those at Risk

Any woman can have endometriosis, but there are also some factors that put women at risk for the condition:

Having a first-degree relative with this disease

Those who will give birth for the first time after the age of 30

white women

Those with abnormalities in the uterine structure

not have given birth

Seeing menstruation at an early age

Entering menopause at a late age

Having a higher estrogen hormone ratio in the body or more exposure to the body's lifetime production of estrogen

Low BMI (body mass index)

Alcohol consumption

Having one or more relatives with endometriosis (mother, aunt/aunt or sister)

Any condition that interferes with the normal excretion of menstrual blood from the body

Abnormalities in the uterus

Who is at risk for endometriosis?

Endometriosis usually begins to develop a few years after the onset of menstruation. Symptoms of endometriosis disappear temporarily with pregnancy and permanently during menopause.

What Are the Stages of Endometriosis?

The Society of Reproductive Medicine of America has developed a classification system for Endometriosis as follows. Stage of endometriosis; It may vary according to the region, amount, depth and size of the implants of the intrauterine tissue.

Some of the specific criteria are:

Amount of spread of diseased tissue

Relationship of female internal organs (tubes and ovaries) with disease

The amount of adhesions in the female internal organs

The amount of fallopian tubes affected

What are the different stages of endometriosis?

The stage of endometriosis may not be a direct indicator of the severity of pain, the risk of infertility, or other signs. For example, a woman in Stage 1 may feel a great deal of pain, while a woman in Stage 4 may be asymptomatic.

Another important point is that women with the disease in the first two stages of onset are the group with the highest chance of regaining their fertility if treated early. Progression of the disease reduces the chance of pregnancy and reduces the possibility of benefiting from treatment.

How is the diagnosis made?

To diagnose endometriosis, your doctor checks your body for abnormalities, asks about your findings, and starts with a gynecological examination. However, it is difficult to get accurate results in diagnosing abnormalities without further testing.

Some of these tests are as follows:

gynecological examination

It is done to check the patient's vagina, uterus, bladder and rectum. The doctor checks by feeling whether there is a change in the shape and size of these organs or whether there is any mass. To check the vagina and upper part of the cervix, the doctor inserts an instrument called a "speculum" into the vagina.

Transvaginal Ultrasound

In this test, the doctor inserts a device that sends high-frequency sound waves into the vagina. The way sound waves resonate creates an image.

laparoscopy

This surgical procedure is performed using a vision device called a laparoscope to view the organs inside the pelvis (groin) and other organs in the abdomen. This operation is performed with incisions as small as 1 cm from the navel.

CA125 Test

This test checks the level of a protein in the blood known as CA125, a hallmark of tumors in some gynecological cancers, but also present in the blood of women who have endometriosis. However, CA125 levels can also be high due to pregnancy, menstruation, and other gynecological diseases or cancers.

Endometriosis Treatment

Treatment of endometriosis is generally done with drugs and surgery. The treatment method you and your doctor will choose may vary depending on the severity of your symptoms and whether you want to become pregnant. In general, doctors recommend conservative (preventive) treatment methods first and consider surgery as a last resort.

Your doctor may recommend some medications with pain-relieving properties to help relieve your pain. If the maximum dose of the given drugs is not enough to reduce your pain, you may need to try another method to control your symptoms.

Drug (Hormone) Treatment

Hormone supplements can sometimes be effective in relieving pain from endometriosis. The fluctuations and fluctuations of hormones during the menstrual cycle cause the intrauterine tissue foci located outside the uterus to thicken, then dissolve and bleed. Hormone therapy can slow the growth of endometrial tissue and prevent the formation of new foci.

Hormone therapy is not a permanent solution for endometriosis. It is possible for symptoms to recur after stopping treatment. Hormone therapies used to treat endometriosis are as follows:

Hormonal Birth Control Pills

Birth control pills, tapes and vaginal rings help control the hormones that cause endometrial tissue to accumulate each month. These methods help relieve mild to moderate pain caused by endometriosis.

Progesterone Treatment

With a progesterone treatment such as an intrauterine device, birth control pill or birth control injection, menstrual bleeding and the growth of endometrial foci can be stopped, thereby reducing the pain and symptoms caused by endometriosis.

Endometriosis Surgery

If you have endometriosis and are trying to get pregnant, you can increase your chances of getting pregnant by protecting your uterus and ovaries with successful surgeries that eliminate endometriosis.

Conservative Surgery

If you are suffering from severe pain due to endometriosis, surgery may still be beneficial. However, post-operative pain may recur.

Your doctor may begin this treatment laparoscopically or, for larger cases, with open surgery. In laparoscopic surgery, the surgeon makes a thin incision in the abdominal cavity and inserts a visual device called the laparoscope, which will pass through the belly button, thus removing the endometrial tissues through another small incision.

hysterectomy

Known as the last option in severe endometriosis cases, total hysterectomy surgery is the best option to remove the uterus, cervix and ovaries.

However, hysterectomy surgery, in which only the uterus is removed, may not be effective because the ovaries that continue to produce estrogen can trigger endometriosis tissue and cause the pain to come back.

Hysterectomy is seen as a last resort, especially for women of childbearing age. The reason for this is that pregnancy formation is not possible after hysterectomy.

It is very important to act with a doctor you trust in the treatment of endometriosis. You may also want to get a second opinion before starting treatment to learn about all your options and to make sure you choose the best method.