Hi I’m after some advice!! I have chocolate cyst on both ovaries was told it was either to go on the pill or have a hysterectomy. I went for the less extreme the pill.
Before going on the pill I had no symptoms other than once a month pain which aspirin seemed to help. However now being on the pill I am constantly bloated and in pain most days. Not sure what to do?? Can these be left untreated! Felt so much better when I wasn’t on the pill. Any advice greatly appreciated
🥴 I’ve had chronic pain in the distant past due to adhesions around my ovaries, and now know I also have a cyst on one of them. I don’t need the pill because I’m past menopause, and fortunately the discomfort is intermittent at the moment.
What Are Chocolate Cysts?
Symptoms
Chocolate cysts are noncancerous, fluid-filled cysts that typically form deep within the ovaries. They get their name from their brown, tar-like appearance, looking something like melted chocolate. They’re also called ovarian endometriomas.
The color comes from old menstrual blood and tissue that fills the cavity of the cyst. A chocolate cyst can affect one or both ovaries, and may occur in multiples or singularly.
Chocolate cysts occur in 20 to 40 percent of women who have endometriosis, estimates the Endometriosis Foundation of America.
Endometriosis is a common disorder in which the lining of the uterus, known as the endometrium, grows outside the uterus and onto the ovaries, fallopian tubes, and other areas of the reproductive tract. The overgrowth of this lining causes severe pain and sometimes infertility.
Chocolate cysts are a subgroup of endometriosis. They’re often associated with more severe forms of the disorder.
What are the symptoms?
Chocolate cysts may cause symptoms in some women. Other women may not experience any symptoms.
The size of the cyst also doesn’t necessarily affect the severity or presence of symptoms. This means a woman with a small cyst may experience symptoms, while someone with a large one may not. Cysts can range from 2 to 20 centimeters (cm) in size.
When symptoms do occur, they’re similar to those of endometriosis. They can include:
painful, crampy periods
pelvic pain not related to your menstrual cycle
irregular periods
pain during sex
infertility for some women
If a chocolate cyst ruptures, it can cause severe, sudden abdominal pain on the side of the body where the cyst is located. A ruptured cyst can be a medical emergency. Seek immediate medical attention if you suspect you have a ruptured cyst.
What causes chocolate cysts?
There’s a lot of debate as to how and why chocolate cysts form. One theory is that they may be a result of endometriosis.
The lining of these cysts acts much the way the lining of the uterus does. It grows and is then shed in response to the monthly rise and fall of female hormones.
Instead of leaving the body, this tissue becomes trapped within the cavity of the cyst. Here it can produce inflammation and disrupt the ovaries.
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How are chocolate cysts diagnosed?
Your doctor may order a pelvic ultrasound if:
they feel a cyst during a pelvic exam
they suspect you have endometriosis based on your symptoms
you’re experiencing unexplained infertility
An ultrasound can identify if a cyst is present. But it can’t necessarily determine what type of cyst it is.
To definitively diagnose a chocolate cyst, your doctor will extract fluid and debris from inside the cyst. This is usually done with a needle biopsy.
During a needle biopsy, your doctor will use ultrasound to help them insert a needle through the vagina into the ovarian cyst. The extracted fluid is then examined under a microscope. Your doctor can diagnose the type of cyst using the results from the needle biopsy.
How are chocolate cysts treated?
Treatment will depend on several factors, including:
your age
your symptoms
whether one or both ovaries are affected
whether or not you want to have children
If the cyst is small and not producing symptoms, your doctor may advise a watch-and-wait approach. They may also recommend medication that inhibits ovulation, such as the birth control pill. This can help control pain and slow the growth of cysts, but it can’t cure them.
Surgery to remove the cysts, called an ovarian cystectomy, is often recommended for women who have:
painful symptoms
cysts larger than 4 cm
cysts that may be cancerous (but a 2006 review estimates less than 1 percent of cysts are cancerous)
infertility
The surgery is generally done via a laparoscope. A laparoscope is a thin, long tube with a light and camera on the end that help doctors perform the procedure. It’s inserted through a small incision.
The surgery is controversial in terms of whether it hurts or helps fertility.
Even when the surgeon is highly skilled, healthy ovarian tissue can be removed along with the cyst. That may negatively affect ovarian function. However, the inflammation and toxic environment a chocolate cyst can produce may do more harm to fertility than surgery.
Discuss all of your options and concerns with your doctor before beginning treatment.
What effect do chocolate cysts have on fertility?
Chocolate cysts can invade, damage, and take over healthy ovarian tissue. This can be a serious threat to fertility. These cysts can be difficult to treat, and the pelvic surgeries used to control or remove them can lead to ovarian scarring and reduced fertility.
When compared to women without chocolate cysts, women with them also tend to have:
fewer eggs
eggs that are less likely to mature
higher levels of follicle-stimulating hormone (FSH), which can indicate problems with the ovaries
Despite the damage chocolate cysts do to ovaries, many women with them can conceive naturally.
A 2015 study followed women with regular menstrual cycles and chocolate cysts on only one ovary. Researchers found 43 percent of them were able to become pregnant naturally. The women were followed for 4 years.
In vitro fertilization (IVF) is another option if you have chocolate cysts and difficulty becoming pregnant. Research showsTrusted Source that women with these cysts have similar pregnancy, implantation, and delivery rates with IVF as women with tubal factor infertility.
What’s the outlook?
Chocolate cysts are common in women with endometriosis. Symptoms can often be managed with medication. In some cases, the cysts will need to be removed.
According to a 2006 study, about 30 percent of surgically removed chocolate cysts will return, especially if they were large or medically treated. Getting pregnant after surgery may lower the risk of recurrence.
Talk to your doctor about your treatment options. Let them know if you’re planning or considering having children in the future. This will help them develop an appropriate treatment plan for you.
Thank you for the reply. Endometriosis was mentioned on my doctors report but hasn’t been officially diagnosed. I am 40 and was put on the pill to stop the growth, but i am in so much more pain now than I was before taking the pill. Very frustrating 😡 Once again thank you for your reply
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