Many women have asked what is a chocolate cyst? Also called an endometrioma, it is one of several types of
cysts on ovaries that affect women. A chocolate cyst is a sac or pouch growing
on the ovary that contains fluids and sometimes semi-solid material too, in which case it may be referred to as a
complex ovarian cyst. Because the endometrial tissue inside the cyst
responds to monthly hormones it bleeds and fills the interior of these cysts with unclotted blood. Chocolate cysts
get their name from the dark old blood that grossly resembles chocolate. Other names for chocolate cyst are
endometrial cyst, endometrioma cyst, and chocolate ovarian cyst.
How do chocolate cysts develop? A women with the disease endometriosis will have tissue from the inside
surface of her uterus (endometrium) attach to the ovary. These patches of endometrial cells may form small cysts
that multiply into even more cysts when stimulated by menstrual hormones. As the cysts spread they can become part
of the ovary itself, replacing the normal tissue needed for ovulation. Inflammation and irritation of nearby organs
may result from chocolate cysts spreading around the pelvic cavity.
Millions of women will be affected by endometriomas each year. Approximately five to ten percent of all women
will have one at some point during their life, typically during their childbearing years. Most women will get them
in the ovary on the left side of the body. One of the critical problems with chocolate cysts is that they tend to
reoccur. Usually, the size of an endometrioma ranges from about half an inch (grape size) to four inches or more
(softball size) in diameter.
Chocolate Cyst Picture
Pregnancy and Infertility with Chocolate Cysts
Many women are interested in knowing if a chocolate cyst will prevent or interfere with pregnancy. It is
possible for a woman to still get pregnant even without removing the endometrioma. The odds of being
fertile are very good if there is only one cyst and it is small in size. The answer is not so clear cut in
more advanced cases in which multiple cysts are present and some are larger than a few inches in
Some studies have shown pregnancy rates of 50% in the first 3 years following treatment. Further, the chances of
getting pregnant are optimized within about six months after successful treatment and healing of the ovaries. In
the final analysis, the health of the patient and her wishes for childbearing will be important factors
contributing to the planning of a successful pregnancy.
Chocolate Cysts Symptoms
The symptoms of a chocolate cyst are similar to endometriosis symptoms
since the underlying disease is the same. Some other conditions mimic this disease including ovarian cyst symptoms, pcos symptoms, and ectopic pregnancy. Not
all women will have the same symptoms. In fact, some may have severe symptoms while others have none at all. The
extent and severity of symptoms do not always correlate with how far the disease has progressed. For example, it is
possible for an endometrioma to be present for a long time without symptoms or conversely be very noticeable in the
early stages of its growth.
Abdominal cramping or swelling during a menstrual cycle is a very common symptom for women with endometriomas.
Another possible sign of a cyst is progressively painful periods. Pain may also be felt while emptying the bowels
or bladder. Sexual intercourse and other physical activities such as exercising or bending and stretching may be
painful. In some cases a cyst may press upon the ovary causing it two twist until its blood supply is cut off. This
often results in intense, sharp pain.
Chocolate cyst rupture can also be a source of severe pain. If a chocolate cyst ruptures the contents may spill
out onto the ovaries and other organs of the pelvis. This can lead to complications such as adhesions (scarring),
infection, and intense pelvic pain. A ruptured ovarian cyst can be a
serious medical emergency and you should do something right away if you have symptoms such as excessive bleeding,
fever, vomiting or severe pain.
Bleeding outside the usual menstrual cycle is another symptom of endometriomas. A woman may notice her bleeding
is occurring at odd times or spotting in between periods. Post-menopausal women who have vaginal bleeding should
also be concerned about the presence of a cyst. Excessive bleeding and dark colored discharge from the vagina are
other possible symptoms of a chocolate cyst.
Chocolate Cyst Treatment
Typical options for chocolate cyst treatment include medication with drugs and
surgery. Drugs may be helpful in relieving symptoms temporarily but do not treat or actually remove the cyst.
Danzol and GnRH are two such drugs commonly used. Surgery is often recommended but has its own problems as well.
Often during surgery healthy ovarian tissue is removed with the cyst resulting in lowered fertility for the woman.
Sometimes the entire ovary must be removed depending on the size and number of cysts. Other complications may also
result from surgery such as scarring, adhesions, and cuts to the rectum or bladder. The worst thing a woman can do
is to have unnecessary surgery that causes damage to her ovaries or other organs.