A chocolate cyst is a growth on the ovaries caused by endometrial cells breaking off and attaching themselves to the ovaries. Women with endometriosis are at risk. Symptoms include pelvic pain and hormonal fluctuations affect their size. Diagnosis involves a medical history, physical exam, blood test, and ultrasound. Treatment may involve surgery.
A chocolate cyst is a type of growth that occurs on the ovaries. It is caused by endometrial cells, which usually form the lining of the uterus, breaking off and traveling to the outside of the ovaries, where they attach themselves, grow, and sometimes replace part of the ovarian tissue. Also called endometriomas, they are filled with old blood that forms a thick, brown substance that resembles chocolate.
Women with endometriosis are at risk of developing a chocolate cyst. This condition causes endometrial cells, normally found only inside the uterus, to grow outside the uterus as well. Once these clusters of outer endometrial cells have formed, there is a possibility that they may detach and migrate to the ovaries. These cysts are sometimes called ovarian endometriosis.
The main symptom of this condition is pelvic pain, although smaller cysts can be asymptomatic. Hormonal fluctuations during the menstrual cycle affect their size, so the pain can come and go over the course of a month. They typically don’t cause infertility directly, but they can interfere with ovulation. Sometimes these types of cysts rupture, causing chocolate-like material to leak into the pelvic cavity, where it will enter the spaces between organs. A rupture can be very painful, and the leakage of material can cause the affected organs to bind together.
Diagnosing a chocolate cyst can include several steps. Typically, your medical history will be reviewed to determine if you have had cysts before or if you have endometriosis. A doctor may perform a physical exam to try and locate masses on the ovaries. A blood test called a CA 125 will then typically be used to look for evidence of a cyst. The same test is also used in diagnosing ovarian cancer, however, a biopsy may also be needed for true confirmation. An ultrasound, typically done transvaginally, can also help confirm the presence of cysts.
Unless a chocolate cyst becomes painful or threatens to rupture, treatment may not be necessary. In cases where the condition becomes problematic, surgery may be required. The preferable option is to remove just the cyst using a procedure called a cystectomy. In extreme cases where the cyst is too large or there are too many, removal of the ovary may be necessary. This procedure is known as an oopherectomy.
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