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.) apart from egg production. The presence of endometriosis in the ovaries also affects the ovaries negatively.
The formation of the lining of the uterus, in other words, the endometrium layer outside the uterus (for example, in the abdominal cavity, ovaries or anywhere in the body) is called endometriosis.
The presence of this endometrial tissue in the ovaries, which is normally only found in the uterus, thickens after menstruation and allows the baby to settle, and is regenerated with each menstrual period, also leads to menstrual-like bleeding and leads to chocolate cyst (Endometrioma) as a result of the accumulation of dark old brown blood in the ovary.
These cysts are named so because the fluid that accumulates in these cysts 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.
Who Gets Chocolate Cyst (Endometrioma) ?
Pain is seen in 60-70% of endometriosis patients. In some women, it does not cause any symptoms and is seen in surgery or ultrasonography. Endometriosis, the cause of which is not fully known, can cause many problems that can impair the quality of life of women.
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 too large, it 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 rate 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 so as not to damage 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 the patients who do not have any complaints and who are found to have chocolate cysts incidentally during the examination for a while. In cases where the Ca125 value is high or the cyst size is over 5 cm, surgery may be considered.
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.
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 it 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:
-Ligaments that support the uterus
-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 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 can 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.
Not wanting 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.
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.
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 and 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. While there may be other reasons behind this swelling, the danger of endometriosis should also be considered.
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 discomforts caused by the disease, can go as far as disruptions in daily work, 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 interior of the tissues, causing blood accumulation and the formation of chocolate cysts as a result.
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 findings. The main purpose 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 therapy.
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
-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)
-Having one or more relatives with endometriosis (mother, aunt/aunt, or sister)
-Any condition that prevents the normal excretion of menstrual blood from the body
-Abnormalities in the uterus
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 depending on 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 the female internal organs (tubes and ovaries) with the disease
-The amount of adhesions in the female internal organs
-The amount of fallopian tubes affected
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 will check your body for abnormalities, ask about your findings and start with a gynecological examination. However, without further testing, it is difficult to get accurate results in diagnosing abnormalities.
Some of these tests are as follows:
It is done to check the patient's vagina, uterus, bladder and rectum. The doctor checks these organs by feeling whether there is a change in shape and size or if there is any mass. To check the vagina and upper parts of the cervix, the doctor inserts an instrument called a "speculum" into the vagina.
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.
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.
This test checks the level of a protein known as CA125 in the blood, which is a hallmark of tumors in some gynecological cancers but is 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.
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. Generally, 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 hormones that cause endometrial tissue to accumulate each month. These methods help relieve mild to moderate pain caused by endometriosis.
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.
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.
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 laparoscope that will pass through the belly button, thus removing the endometrial tissues through another small incision.
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, where 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 all your options and make sure you choose the best method.
Endometriosis and Pregnancy
Does Endometriosis Cause Infertility ?
Endometriosis is one of the most common health problems among women between the ages of 25 and 45 and is faced by 1 in 10 women. Endometriosis, which is one of the most frequently encountered gynecological diseases today, can cause severe pain during menstruation and sexual intercourse, leading to a decrease in the quality of life of the person.
Endometriosis disease can cause severe pain during sexual intercourse and menstrual period, as well as cause infertility by damaging reproductive health. Between 30 and 50% of women with endometriosis may face infertility problem.
While endometriosis is manifested by severe pain and irritable bowel syndrome in some women, it does not show any symptoms in some women. In patients without any signs of endometriosis, the diagnosis of this disease may take 6 to 10 years. For this reason, it is important that women who suffer from menstrual cramps, which are considered normal, should see an obstetrician.
Can Endometriosis Patient Conceive ?
In order for pregnancy to occur, the ovaries moving in the direction of the tube must be fertilized by a sperm and placed on the uterine wall. However, in endometriosis disease, diseased tissues spread outside the uterus can damage the tubes and ovaries and cause infertility. Endometriosis can prevent pregnancy by greatly damaging the sperm and ovaries. For this reason, it is recommended that expectant mothers who want to have children should not delay their decision to become pregnant.
Reproductive methods such as in vitro fertilization and vaccination or conservative surgery can help expectant mothers to become pregnant and the fertility rate can increase up to 15%. If endometriosis is not treated, the fertility rate can vary between 2 and 3%.
In vitro fertilization treatment increases the chance of getting pregnant by 50-60% of expectant mothers, especially at young ages. The treatment to be applied for endometriosis disease determines the age of the expectant mother, the diseases she has and fertility factors. Endometriosis can be treated with drugs, vaccination, surgery and in vitro fertilization, which are among the treatment methods that the physician deems appropriate.