What Are the Symptoms of Chocolate Cysts? Can They Go Away on Their Own? Can You Still Get Pregnant?

Chocolate Cyst: Symptoms, When to See a Doctor, and Its Impact on Fertility

Chocolate cyst (ovarian endometrioma) is a common condition among women. It is often associated with severe menstrual pain and irregular periods. But what are the real symptoms of a chocolate cyst? At what stage should you see a doctor? Does it always require surgery, or can it heal on its own? And most importantly, does having a chocolate cyst truly make it harder to conceive?

Let's explore the answers to these important questions.

A chocolate cyst (ovarian endometrioma) occurs when menstrual blood flows backward through the fallopian tubes into the abdominal cavity, where it implants on the ovaries and forms a cyst filled with accumulated blood. These cysts can also develop in other organs, such as the pelvic cavity, fallopian tubes, intestines, vagina, uterus, and bladder. Any woman can potentially develop this condition.

The cause of chocolate cysts is related to menstrual blood or the shedding of the uterine lining. Normally, the uterine lining sheds during menstruation, releasing blood.

However, when the endometrial tissue grows in the ovaries, it continues to shed blood, but since there is no natural outlet for this blood, it starts to accumulate. Over time, it forms a cyst, similar to a balloon gradually filling with water, increasing in size as more blood is trapped inside.

If the blood remains inside the cyst for a long time, it turns dark brown, resembling melted chocolate. This is why it is called a “chocolate cyst” or “endometriotic cyst.”

Warning signs of chocolate cysts that women should be aware of include:

• Chronic pelvic pain that worsens during menstruation.

• Severe menstrual pain that starts 2-3 days before the period and lasts until it ends, unlike typical menstrual cramps that occur in the first few days and are less intense.

• Spotting or abnormal vaginal bleeding, similar to menstrual symptoms.

• Pain or discomfort in the vaginal area during intercourse, which may persist for 1-2 hours afterward.

• Infertility.

• In some cases, pain during bowel movements or severe pelvic pain while urinating.

The most common locations where chocolate cysts are found include:

• Pelvic cavity

• Fallopian tubes

• Intestines

• Vagina

• Uterus

• Ovaries (most commonly found)

Risk factors for developing chocolate cysts include:

• Early onset of menstruation

• Short menstrual cycles, especially those less than 27 days apart

• Heavy or prolonged periods lasting more than 7 days

• Family history of the condition (e.g., mother, grandmother, or sister)

• Abnormalities such as an imperforate hymen or cervical abnormalities

Pelvic Exam
A pelvic exam is performed to check for abnormalities in the pelvic organs. This allows the doctor to see if there is endometrial tissue growing outside the uterus or if the uterus has become enlarged. It can also help identify any lumps near the uterus or ovaries. However, in cases where the cyst is very small, it might not be detected.

Ultrasound Exam
An ultrasound exam uses high-frequency sound waves to view inside the abdomen. The ultrasound device may be placed on the abdomen or inserted through the vagina (Hysteroscopy) to examine the pelvic organs. This method can detect small cysts but may not provide a detailed diagnosis of the condition.

Laparoscopy
Laparoscopy is the most accurate diagnostic method. The doctor will insert a small camera into the abdomen through a small incision below the navel to view internal abnormalities. This method allows the doctor to clearly see and assess the size and location of the cyst, which helps determine the most appropriate treatment plan.

In general, chocolate cysts can be treated with medication or surgery, as detailed below

These drugs are used to relieve mild abdominal pain or pain during menstruation. Common examples of NSAIDs include Ibuprofen and Naproxen.

Hormone Therapy
In cases of severe pain and when pregnancy is not planned in the near future, doctors may recommend hormone therapy. Changes in hormone levels during the menstrual cycle can affect the growth of the endometrial tissue.

Hormone therapy helps slow down the growth of endometrial cells and prevents new cells from implanting. This treatment may need to be used for 3-6 months, depending on the individual's situation. However, in some cases, symptoms may return after discontinuing the medication.

Common hormone medications include various forms of birth control pills, Gonadotropin Releasing Hormone (GnRH) agonists, Progestin therapy, and Danazol.

When treatment with medication does not improve and the patient continues to experience severe abdominal pain due to a large cyst that may affect other organs, doctors usually recommend surgery to remove the endometrial tissue from the ovaries.

Most of the time, laparoscopic surgery is preferred over open abdominal surgery because it involves smaller incisions, a shorter recovery time, and it allows the patient to maintain fertility in the future.

In cases of severe symptoms, doctors may consider removing the uterus or ovaries entirely, which will cause premature menopause. In such cases, hormone replacement therapy (HRT) will be necessary to help manage the symptoms of menopause.

Complications that may occur from chocolate cysts include:

• Adhesions in the pelvic cavity

• Chronic lower abdominal pain

• Cyst inflammation, infection, or rupture, leading to acute lower abdominal pain that requires emergency surgery

• Infertility due to blocked fallopian tubes and difficulty for the embryo to implant

• Adhesions pressing on the ureter, causing swelling of the ureter or kidneys

Since the endometrial tissue grows in the wrong place, it affects the functioning of the ovaries, leading to infertility.

Infertility can be treated using reproductive technologies that assist in conception, such as in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and intrauterine insemination (IUI).

Currently, there is no way to prevent the occurrence of chocolate cysts. However, if you experience unusually severe menstrual pain, heavy or prolonged periods, or pain that interferes with daily life, you should undergo an internal examination for accurate diagnosis. Additionally, regular health check-ups every year can help reduce the risk of serious diseases later on.

Foods to Avoid to Prevent Chocolate Cysts:

1. Fried and greasy foods

2. Grilled or barbecued foods

3. Foods with high sugar content such as tea, chocolate, and carbonated drinks

4. Processed and packaged foods

5. Fruits and vegetables with pesticide residues or other chemicals that may cause contamination

6. Red meats such as beef and pork, or any meat that has been treated with growth hormones or chemicals to promote growth

Is chocolate cyst dangerous?
Chocolate cysts are usually small and not immediately dangerous. The severity of symptoms varies from person to person. Some may experience no symptoms, while others may have mild or severe discomfort.

Can chocolate cysts heal on their own?
Chocolate cysts cannot heal on their own. If you experience severe abdominal pain, it’s important to consult a doctor for diagnosis. If diagnosed with a chocolate cyst, prompt treatment is necessary and should not be ignored or left untreated.