What is Endometriosis?
Endometriosis is a benign condition in women characterized by the presence of small fragments of the endometrium (the inner lining of the uterus) outside the uterus, where they are not typically found. Common sites for endometrial tissue outside the uterus include the ovaries, colon, Douglas pouch, urinary system, fallopian tubes, intestines, and, in rare cases, even distant organs like the lungs or, extremely rarely, the eyes.
Symptoms that may indicate endometriosis include:
- Painful menstruation (dysmenorrhea),
- Painful sexual intercourse (dyspareunia),
- Heavy menstrual bleeding (menorrhagia),
- Chronic pelvic pain that may occur before and after menstrual cycles, and
- Infertility.
Other symptoms may include fatigue, painful bowel movements during cycles, diarrhea, or constipation. In some cases, endometriosis can be asymptomatic.
Endometriosis commonly affects women during their reproductive years. Its prevalence in the general population is below 10%, but it can be as high as 20% among women experiencing infertility.
While many theories exist regarding its cause, the origin and mechanisms of endometriosis remain unclear. The condition usually subsides with menopause. Although benign, in extremely rare cases, endometriosis can lead to malignant changes.
What are “Chocolate” Cysts?
“Chocolate” cysts, or ovarian endometriotic cysts, are one type of ovarian cyst. While the term “chocolate” may sound harmless, these cysts require careful attention once diagnosed.
During menstrual bleeding, hormonal levels drop, leading to “mini menstruations” in the endometriosis sites. Endometriotic cells shed, causing small or large bleedings. Since this blood has no outlet, cysts form, creating localized inflammation and adhesions, which can cause fallopian tube blockage and other gynecological issues.
In some women, endometriosis foci progressively enlarge, complicated by adhesions and cysts filled with dense content. The term “chocolate cysts” comes from the dark brown or nearly black color of their contents.
Common symptoms of chocolate cysts include:
- Painful menstruation,
- Pelvic pain,
- Painful intercourse,
- Painful bowel and bladder movements, and
- Infertility.
Some cases also report associations with autoimmune diseases such as Systemic Lupus Erythematosus and Hashimoto’s thyroiditis.
When Should You Be Concerned and What Are the Treatment Options?
Suspected chocolate cysts require thorough clinical evaluation, including several diagnostic procedures to confirm their presence. Alongside symptom evaluation, an ultrasound scan is essential.
Additional imaging, such as CT (computed tomography) and MRI (magnetic resonance imaging), may be done if indicated. The most definitive diagnostic technique is laparoscopy, which allows direct examination of the cyst and biopsy sampling for histopathological analysis, establishing a conclusive diagnosis.
If chocolate cysts are confirmed, it is essential to discuss treatment options with a gynecologist. Laparoscopy can improve fertility prospects, but the doctor may recommend additional medications as needed. Post-laparoscopy follow-up is important, as cysts may recur, and further infertility investigation may be required for both the patient and her partner.
Treatment
Treatment depends on multiple factors, including the patient’s age, health condition, cyst location, and presence of infertility.
Options include surgical, medicinal, or combined approaches. The goal is to preserve the woman’s reproductive system, alleviate symptoms, or at least reduce them as much as possible, and address infertility.
How Do Chocolate Cysts Affect Fertility?
Endometriosis can impact reproductive function in several ways. Endometriosis and chocolate cysts may cause adhesions that “push” other organs and tissues, leading to anatomical changes in the female reproductive organs. This can reduce the function of reproductive organs and create mechanical barriers to conception.
Advice and Recommendations
Upon noticing early signs or symptoms, which can occur even during adolescence, it is advisable to seek advice and examination from a specialist gynecologist. Early diagnosis, combined with conservative and surgical treatments, can help preserve the female reproductive system, prevent various discomforts, and ensure that women feel good in their own bodies on a daily basis.