What Are Chocolate Cysts, What Are Their Symptoms?

Chocolate cysts, also known as endometriomas, are a type of non-functional ovarian cyst. These cysts are sac-like structures that may contain fluid or semi-solid material and are filled with old menstrual blood.

Functional ovarian cysts, which are common in women before menopause, typically form as part of the menstrual cycle. In contrast, chocolate cysts are associated with endometriosis, a condition where endometrial tissue grows outside the uterus.

These cysts are non-functional and not related to the menstrual cycle. While they are usually benign, chocolate cysts can lead to discomfort and a range of symptoms.

Chocolate Cysts

Chocolate cysts get their name from the dark brown, syrup-like fluid inside them, resembling melted chocolate. These cysts are formed by endometrial tissue, similar to the uterine lining, but located outside the uterus. The presence of these cysts is a strong indicator of endometriosis.

Chocolate Cysts and Endometriosis

Endometriosis occurs when endometrial tissue grows outside the uterus, often on one or both ovaries. In some cases, deeper deposits of endometrial tissue form fluid-filled cavities, known as chocolate cysts or endometriomas.

How Common Are Chocolate Cysts?

Chocolate cysts can affect women between the ages of 25 and 40. Approximately 17% to 44% of women with endometriosis may develop chocolate cysts.

Chocolate Cysts Causes

The exact cause of endometriomas is not known. Healthcare professionals theorize that during menstruation, some menstrual blood may flow back (retrograde flow) toward the ovaries through the fallopian tubes.

This results in the abnormal seeding of endometrial tissue deposits in the ovaries.

With each menstrual cycle, this endometrial tissue sheds similarly to the endometrial lining of the uterus.

Eventually, these anomalous endometrial deposits become inflamed and lead to the formation of ovarian endometriomas/chocolate cysts.

Chocolate Cysts Symptoms

Ovarian chocolate cysts may be large or small in size. The severity of chocolate cyst symptoms are irrespective of the size of the cysts, though.

The symptoms include:

• Pain in the lower abdomen or pelvic area during periods
• May cause pelvic pain without periods as well.
• Pain in the lower back
• Irregular menstruation
• Dyspareunia or painful intercourse
• Pain while using the toilet (urination, defecation)

Ovarian chocolate cysts may cause weight gain, feelings of nausea, vomiting, and bloating during periods. It may be due to the excessive release of prostaglandins that cause the uterus to contract painfully.

Another symptom of this type of ovarian cyst is leg pain. It is a form of referred pain that occurs due to a shared nerve supply between the leg and ovaries.

Ovarian endometrioma chocolate cysts may lead to discharge and excessive bleeding during periods as well.

Chocolate Cyst Complications

Chocolate cysts have several complications. Such as chronic pain (pelvis, lower abdomen, back), infertility, and low risk of malignancy.

Chocolate cyst burst causing acute abdominal or pelvic pain. Larger endometriomas may lead to torsion, compromising the ovarian blood supply. Both of these events are medical emergencies and require immediate intervention.

Chocolate Cyst Diagnosis

A pelvic ultrasound detects the presence of a chocolate cyst ovarian. To confirm the diagnosis of endometrioma, your doctor may order a biopsy of the fluid from inside the cyst. There is no definitive chocolate cyst cure. Treatment options include monitoring for asymptomatic chocolate cysts, laparoscopic removal if painful or larger than 4 cm in size, and removal of the uterus or ovaries.

Suitable treatment options depend on age, severity of symptoms, plans for pregnancy or IVF, and the risk of malignancy.

Chocolate Cysts while Pregnant

One of the most curious topics is the ovarian cyst while pregnancy. The presence of chocolate cysts may affect fertility rates adversely, but they generally do not cause problems during pregnancy. Some may even decrease in size.

Chocolate Cysts and Fertility

Chocolate cyst fertility affects negatively because they are present in the deeper layers of the ovaries. They damage normal ovarian tissue, leading to fewer viable and mature eggs.

In some cases, surgical removal of chocolate cysts and underlying endometriosis leads to an improvement in fertility rates. It also benefits females undergoing IVF, as it gives the doctors better ovarian access.

If you are someone battling infertility due to chocolate cysts and endometriosis, all hope is not lost. At the British Cyprus IVF Hospital, we offer alternative assisted conception techniques such as IVF to make your dream of parenthood a reality.

Don’t hold back; make an appointment today!