Endometriosis (Chocolate Cyst)

Chocolate cyst, medically known as endometriosis, is a condition in which the tissue similar to the inner layer of the uterus is found outside the uterus, especially in the ovaries. Endometriosis, which can cause symptoms such as severe menstrual pain, pelvic pain, pain during sexual intercourse, can cause infertility in women. It can be treated with medication, daily life changes and surgical operation.

What is Endometriosis (Chocolate Cyst)?

Endometriosis can be defined as a condition in which the tissue belonging to the inner layer of the uterus (endometrium) is found outside the uterus, especially in the abdominal organs, which is common in women of reproductive age. Endometriosis usually develops on the ovaries, fallopian tubes, tissue in the pelvis or on the surfaces of the intestines. This tissue normally responds to hormonal changes every month as it does inside the uterus and thickens, sheds and bleeds. However, because it is located outside the uterus, it cannot be removed from the body and this leads to various symptoms and complications.

Chocolate Cyst (Endometrioma): Chocolate cysts are a type of endometriosis and are known as cystic structures, especially in the ovaries. These cysts accumulate dark brown, old blood inside and are therefore called ‘chocolate cysts’. This blood inside the cysts can bleed every menstrual cycle, just like the lining of the uterus, but it accumulates inside the cyst because it cannot find a place to flow out. Over time, this blood coagulates and becomes a dark brown liquid. As they grow, chocolate cysts can damage surrounding tissues and cause chronic pain.

What are the Symptoms of Endometriosis (Chocolate Cyst)?

Symptoms of endometriosis (chocolate cyst) may vary from patient to patient, and while some women do not have obvious symptoms, others may experience severe pain and other discomfort.

• Pain may be more severe than normal during menstrual periods.
• Pelvic pain may persist beyond the menstrual period and may become chronic.
• Endometriosis can cause pain during deep penetration (pain during sexual intercourse).
• Pain and discomfort may be felt during bowel movements.
• Bladder endometriosis may cause symptoms such as burning in the urine, frequent urination and pain during urination.
• Some women may experience more bleeding than normal during menstrual periods.

Symptoms such as nausea, vomiting, dizziness, bloating and weight gain may also accompany endometriosis. These symptoms are often associated with hormonal changes and the body's inflammatory response to endometriosis tissue. The chronic pain and inflammation associated with endometriosis can lower energy levels and cause general fatigue.

How is Endometriosis (Chocolate Cyst) Diagnosed?

When diagnosing a chocolate cyst, the patient is first asked to describe the symptoms in detail. Symptoms such as the patient's menstrual cycle, degree of pain, location and duration of pain, pain during sexual intercourse, problems with bowel movements or infertility are questioned in detail. Pelvic pain or masses caused by endometriosis tissue can be felt by physical examination. However, in the early stages, endometriosis can often go unnoticed on physical examination.

Pelvic ultrasound is commonly used to detect chocolate cysts (endometrioma) in the ovaries but may not be completely definitive. MRI can sometimes be used for more detailed imaging. Laparoscopy is a surgical procedure that is considered the ‘gold standard’ in the diagnosis of endometriosis. Pathological examination of the tissues taken during laparoscopy confirms the diagnosis of endometriosis.

Endometriosis (Chocolate Cyst) Treatment

Endometriosis can be treated with medication and surgery. Endometriosis treatment should be planned individually. The patient's age, severity of symptoms, desire to have a child and general health status should be taken into consideration when determining the treatment option. Painkillers are usually used as the first step in the treatment of mild and moderate pain. Hormone therapy is used to suppress the growth of endometriosis tissue. Hormones ensure that the tissue shrinks and bleeding stops.

Laparoscopic Surgery: It is a minimally invasive surgical method used for diagnosis and treatment. During laparoscopy, endometriosis foci can be removed or burned. This method is particularly effective in relieving pain and treating infertility.

Laparotomy: Open surgery (laparotomy) may be required when larger endometriosis lesions or adhesions need to be removed. It is more invasive than laparoscopy and recovery time is longer.

Hysterectomy: In severe cases and when other treatment options are ineffective, removal of the uterus (and sometimes the ovaries) may be considered. This is usually used as a last resort.

Endometriosis (Chocolate Cyst) and Pregnancy

Endometriosis is one of the common causes of infertility in women. Adhesions between the ovaries, fallopian tubes and other organs in the pelvic area can make it difficult for the egg to be released and fertilised. Approximately 30-50% of these patients suffer from infertility. However, many women with endometriosis can become pregnant naturally. What is important here is how and where endometriosis affects the body. It is recommended that women with endometriosis cooperate with a specialist gynaecologist to increase their chances of pregnancy and have a healthy pregnancy.