An endometrioma (chocolate) cyst is a very commonly found type of cyst in the ovary.
Endometriomas are large, fluid-filled cysts that develop due to retrograde menstrual blood that contains endometrial cells. These cells proliferate in the ovary, over time developing into a cyst.1
Women with endometriosis have higher rates of endometriomas. The build-up of menstrual blood starts to eventually leak out of the ovary, with the cystic mass made up of menstrual blood, endometrial tissue, and inflammatory molecules.2,3
Endometriomas are called ‘chocolate cysts’ because they are brown with old blood, making them look brown. If an endometrioma ruptures, it can cause the contents of the cyst to flow into the abdominal cavity, where it adheres.4
Symptoms of endometriomas
- Asymptomatic
- Excruciating pelvic pain, particularly at menstruation
- Infertility
- Menstrual irregularities
Treating ovarian endometriomas
Treatment for ovarian endometriomas includes the surgical removal of the cyst. This is a delicate procedure with the goal to preserve as much ovarian function as possible.5,6
The surgeon will avoid using heat (to avoid ‘cooking’ the eggs), and separate the cyst carefully from the blood vessels. Removal of the ovaries is uncommon.
Outcomes after surgery on endometriomas
Cystectomy performed on those with endometriosis diminished ovarian function due to the loss of ovarian follicles is common.7
References
- 1.Gałczyński K, Jóźwik M, Lewkowicz D, Semczuk-Sikora A, Semczuk A. Ovarian endometrioma – a possible finding in adolescent girls and young women: a mini-review. J Ovarian Res. Published online November 7, 2019. doi:10.1186/s13048-019-0582-5
- 2.Guo SW, Ding D, Shen M, Liu X. Dating Endometriotic Ovarian Cysts Based on the Content of Cyst Fluid and its Potential Clinical Implications. Reprod Sci. Published online July 2015:873-883. doi:10.1177/1933719115570907
- 3.Sanchez AM, Viganò P, Somigliana E, Panina-Bordignon P, Vercellini P, Candiani M. The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Human Reproduction Update. Published online October 14, 2013:217-230. doi:10.1093/humupd/dmt053
- 4.Wang L, Jiang YJ. Rupture of ovarian endometriotic cyst complicated with endometriosis: A case report. WJCC. Published online October 6, 2021:8524-8530. doi:10.12998/wjcc.v9.i28.8524
- 5.Maul LV, Morrision JE, Schollmeyer T, Alkatout I, Mettler L. Surgical Therapy of Ovarian Endometrioma: Recurrence and Pregnancy Rates. JSLS. Published online 2014:e2014.00223. doi:10.4293/jsls.2014.00223
- 6.Chandra DrJA, Chaudhary DrK. Endometrioma: Chocolate cyst case report. Int J Clin Obstet Gynaecol. Published online July 1, 2021:97-99. doi:10.33545/gynae.2021.v5.i4b.970
- 7.Jiang D, Nie X. Effect of endometrioma and its surgical excision on fertility (Review). Exp Ther Med. Published online September 18, 2020:1-1. doi:10.3892/etm.2020.9242
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