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Chocolate cyst

Dimple Doshi

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The epic name; CHOCOLATE CYST;   is quite suggestive. its contents resemble a melted chocolate;  so the word CHOCOLATE CYST.  The name appears sweet but the condition can be quite nasty at times and give a lot of trouble to the one having it.

The other name of chocolate cyst is ovarian endometrioma. Chocolate cysts range from 2 to 20 cm in size.

Chocolate cysts are found in about 20 to 40% of women having endometriosis, and endometriosis affects about 10% of women in the reproductive age group worldwide.


What are Chocolate Cysts?

Chocolate cysts are non-cancerous ; fluid filled cysts containing old blood and tissues giving it a chocolate sauce like appearance.  In most of the cases the chocolate cysts are associated with endometriosis; a condition in which the tissues which line the cavity of the uterus are also implanted somewhere else in the abdomen and pelvis.

Types of Chocolate Cysts

There are two types of chocolate cysts or ovarian endometrioma:

Type 1 chocolate cysts: They are usually small; less than 5cm ; and situated deep within the ovary.; difficult to remove.

Type 2 chocolate cysts: They are larger ; superficial and easy to remove .

Causes of Chocolate Cyst

Chocolate cysts mostly result from endometriosis stage 3 where the endometrium or tissue which lines the uterus from inside gets implanted on or inside the ovary and bleeds in response to the cyclical hormonal changes. This leads to blood getting collected inside the ovary; Old blood changing its color from red to chocolate.

Symptoms of Chocolate Cysts

Majority of chocolate cysts are symptomatic .

And the size of the cyst also does not affect the severity of symptoms; small cysts can cause severe symptoms while large chocolate cysts may not cause significant discomfort .

The symptoms are:

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Diagnosis of Chocolate Cysts

Consult your gynecologist immediately if ; you have painful periods; difficulty in getting pregnant; or pain during sexual intercourse. A visit to your gynecologist  will involve:

  1. Thorough history taking
  2. Suspecting that you have endometriosis
  3. Your gynecologist may be able to feel it while doing physical examination
  4. Pelvic ultrasound
  5. Laparoscopy done to investigate the cause of infertility may reveal presence of small chocolate cystsand endometriosis

Treatment of Chocolate Cyst

Treatment of chocolate cyst depends on :

  1. Your age
  2. Your symptoms
  3. Size of chocolate cyst
  4. Whether one or both ovaries are affected
  5. Whether you want to have children

Conservative Treatment:

If the chocolate cyst is small and not producing any symptoms; your doctor may advice you

  1. Birth control pills to control pain and growth of cysts; though it can not cure the chocolate cysts completely.
  2. GnRh agonists to control endometriosis will also control small or micro chocolate cyst.
  3. Pain killers like ibuprofen; drotaverine or naproxen may be used to control pain caused by chocolate cyst.

Surgical Treatment for Chocolate Cyst

Surgery to remove the chocolate cyst is called cystectomy or the excision of the chocolate cyst.

Surgery is indicated if

  1. There is pain
  2. Cyst is bigger than 4cm
  3. There is difficulty in getting pregnant.

Laparoscopy is the method of choice for the treatment of chocolate cyst.

Laparoscopy involves putting a tiny incision on the abdomen; through which a slender telescope is inserted and through high definition  camera system ; excision of the chocolate cyst is performed.

About 30% of the chocolate cysts which are removed laparoscopically; may recur.

Chocolate Cysts and Fertility

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Chocolate Cyst and Cancer

Chocolate cysts and endometriosis are widely known benign diseases. Only about 0.5 to 1% cases are associated with malignancy. The cancers which are associated with endometriosis are:  endometrioid  carcinoma and clear cell adenocarcinoma


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