Chocolate Cyst is a type of ovarian cyst that is caused by abnormal growth of endometrial cells. When menstruation occurs, blood accumulates and forms into a cyst with a thick, chocolate-like fluid inside. In medical terms, it is also called a chocolate cyst.
Chocolate cysts are a type of endometriosis that occurs in menstruating women. They often cause abdominal pain and abnormal vaginal bleeding. If they are examined and treated appropriately according to the severity and characteristics of the symptoms, the symptoms will improve . However, if the cysts are very large, they can cause dangerous complications.
Causes of Chocolate Cysts
The exact cause of this condition is currently unknown, but it is assumed that it is caused by menstrual flow back into the ovaries (Retrograde Menstruation). This is because during normal menstruation, a lining is created in the uterus each month to support the implanted egg. However, when implantation does not occur, the lining that has been created is shed as menstrual blood through the vagina.
But in the case of chocolate cysts, some contractions of the uterus cause menstrual blood to flow back toward the end of the fallopian tube instead of flowing down through the vagina only. This causes the cells of the uterine lining to implant and grow in the ovaries until a cyst is formed. When menstruation occurs, the cyst will bleed into the sac as if the lining of the uterus has shed. The cyst will gradually become larger and will have the appearance of old blood inside.
In addition, the formation of chocolate cysts may be due to other causes such as:
- Irritation of the peritoneum (Transformation Of Peritoneal Cells) due to hormonal or immune changes.
- Embryonic Cell Transformation due to Hormonal Influences
- Postoperative wound
- Immune system disorders
It was also found that there are risk factors that can easily develop chocolate cysts in some groups of people, especially women aged 25-40 years, have a family history of this disease, have never had children before, or have an irregular menstrual cycle, such as heavy and longer than normal menstrual periods, short menstrual periods, and having their first menstrual period at a young age.
Symptoms of Chocolate Cysts
Most chocolate cysts are small and relatively harmless. Symptoms vary from person to person, ranging from no visible signs of illness, to mild or severe. Common symptoms include:
- Chronic pelvic pain that is more severe during menstruation.
- Severe menstrual pain, which usually begins 2–3 days before your period and continues until the end of your period. This is different from normal menstrual pain, which usually occurs during the first few days and is not severe.
- Spotting or other vaginal bleeding or symptoms similar to menstruation
- Pain and soreness in the vagina during intercourse, which may persist for about 1–2 hours after intercourse.
- Some people may experience pain during defecation, severe pain in the pelvic area during urination, and back pain.
- Bloating, nausea, vomiting
- Infertility
Symptoms of chocolate cysts that should prompt a visit to the doctor
If you have sudden and severe abdominal pain, fever, vomiting, fatigue , dizziness like you might faint, you should see a doctor immediately because these symptoms may be signs that the chocolate cyst is very large, which may become cancerous, or the cyst has ruptured and burst, which is an emergency that should be treated immediately.
Diagnosis of chocolate cysts
The doctor will ask about the medical history of the patient and family members who may be involved with the disease. The patient’s symptoms range from what kind of pain it is, where the pain is, when it occurred, or history of menstrual pain and sexual intercourse. Then there will be a general health examination. The main tests used to make a diagnosis along with the information asked of the patient are divided into:
Internal examination
Internal examination is a check for abnormalities in the pelvic organs, genitals and rectum. This allows the doctor to see if there is endometriosis or if the uterus is larger than before. There are no lumps in the uterus and ovaries. However, in cases where the cysts are very small, there is a chance that they may not be detected.
Ultrasound examination
Ultrasound is an examination using high-frequency sound waves through the abdominal wall into the abdomen or inserting an ultrasound device into the vagina to examine the organs in the pelvis. It can detect small lumps but cannot diagnose diseases in detail, such as adhesions.
Laparoscopic
When the above examinations do not provide enough information to conclude, the doctor may perform a laparoscopy to examine for abnormalities within the abdomen, which is the most accurate method for diagnosis. It begins with local anesthesia. Then a small wound is opened below the navel and a special camera is inserted to examine inside. This allows the doctor to see the abnormalities clearly and identify the location and size of the cysts found in order to select the most appropriate treatment method for the patient.
Chocolate cyst treatment
Most treatment options involve medication and surgery, depending on the severity of the symptoms and the patient’s desire to have children. If the chocolate cyst is small, treatment may not be required, but the doctor will schedule a follow-up appointment. In cases where the patient is experiencing pain or is at risk of negative health effects, the doctor may treat with various methods, including:
- Treatment with medication
Medications used to treat chocolate cysts are divided into two groups:
NSAIDs
Non-steroidal anti-inflammatory drugs (NSAIDs ) are used to relieve mild menstrual pain or pain during menstruation. Examples of commonly used NSAIDs include ibuprofen and naproxen.
Hormone Therapy
Hormone therapy is used if the patient is experiencing severe pain and is not planning to become pregnant in the near future. Your doctor may recommend hormone therapy because the increase or decrease in hormone levels during your menstrual cycle can affect the growth of your uterine lining.
The drug helps slow down cell growth and prevents new implantation of endometrial cells. Patients may need to take the drug for about 3–6 months, depending on the individual. However, in some cases, symptoms may reappear after stopping the drug. Examples of commonly used drugs include:
- Birth control pillsin various forms
- Gonadotropin Releasing Hormone (GnRH)
- Progesteronehormone therapy
- Danazol
- Surgery
When medication does not help, patients still have severe abdominal pain because the cyst is so large that it may affect other organs. Doctors often recommend that patients undergo surgery to remove the lining cells from the ovaries. Most often, this is a laparoscopic surgery rather than an abdominal surgery because the scars are small, the recovery period is short, and it is still possible to have children in the future.
In severe cases, doctors may consider surgically removing the uterus or ovaries, which will allow the patient to enter menopause earlier than normal, and hormone replacement therapy may be used as an additional aid.
Complications of chocolate cysts
Large chocolate cysts can cause chronic abdominal pain in patients. Some patients may experience rupture or tear of the cyst, requiring urgent surgery. In addition, infertility can occur because the cyst can prevent the egg from implanting completely in the uterus.
Chocolate cyst prevention
Chocolate cysts cannot be prevented because the exact cause is unknown. However, patients should take care of their health , exercise regularly, and see a doctor if any abnormalities are found.
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