Chocolate Cyst (Endometrioma): Severe Period Pain & Infertility Is It Time to Get Checked?

Clitoria Sexual Health Clinic Pelvic exam & gynecology Petchkasem 81, Bangkok

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Chocolate cyst or ovarian endometrioma

is a fluid-filled cyst in the ovary caused by endometriosis.

The fluid inside is old blood, giving it a chocolate-brown appearance.

Common symptoms include progressively worse period pain, chronic pelvic pain, deep pain during sex, and difficulty conceiving.

What is a chocolate cyst (ovarian endometrioma) ?

Normally, the endometrium (uterine lining) stays inside the uterus and sheds each cycle as a period.

A chocolate cyst forms when endometrial tissue grows and implants in the ovary.

The bleeding from each cycle accumulates, turning the cysts content dark brown like chocolate.

This is a common manifestation of endometriosis and may occur alongside pelvic adhesions.

Causes & Risk Factors of ovarian endometrioma

• Retrograde menstruation: menstrual blood and endometrial cells flow backward through the fallopian tubes and implant on the ovary/pelvis.
• Chronic inflammation & immune factors
• Estrogen-driven growth: estrogen promotes lesion proliferation.
• Genetics & family history: higher risk if first-degree relatives have endometriosis/endometrioma.
• Early menarche, short cycles, heavy bleeding: associated with increased risk.

Signs & Symptoms of ovarian endometrioma

• Severe, progressive period pain (progressive dysmenorrhea)
• Chronic pelvic pain, pelvic heaviness, or deep dyspareunia (pain with deep penetration)
• Pain with bowel movements/urination during periods if lesions affect bowel or bladder
• Palpable mass or pelvic bloating, especially with larger cysts
• Infertility due to adhesions and impaired ovulation/sperm-egg interaction

Symptoms dont always correlate with cyst size small cysts can cause severe pain, while large cysts may be minimally symptomatic. Individual assessment by a physician is essential.

Diagnosis of ovarian endometrioma

• History & pelvic examination to assess tenderness, masses, and adhesions
• Transvaginal ultrasound (TVUS): typically shows a thick-walled cyst with homogeneous ground-glass internal echoes
• MRI: for complex cases or surgical planning
• Laparoscopy: gold standard for definitive diagnosis can diagnose and treat in the same session
• Complementary testing: screening for other pelvic conditions and fertility assessment as appropriate

Treatment Options for ovarian endometrioma

Goals are to relieve pain, control recurrence/progression, and address infertility:

• NSAIDs for pain control as needed
• Hormonal suppression to quiet endometrial activity: combined oral contraceptives or progestin-only pills, depot/implant progestins, LNG-IUD, or GnRH agonist/antagonist (chosen based on indication & side-effects)
• Laparoscopic cystectomy when cysts are large, pain is severe, medical therapy fails, infertility is present, or lesions look complex. Surgery aims to preserve as much normal ovarian tissue as possible.
• Infertility care: may involve laparoscopy, assisted reproductive technology (ART/IVF), and coordinated care with reproductive specialists.

Treatment choice depends on symptoms, cyst size/location, age, fertility goals, and prior treatments. Decisions are shared between you and your doctor with clear, compassionate, judgment-free information.

Self-Care Tips

• Keep a pain diary (cycle, triggers, severity) to guide treatment plans
• Take prescribed medicines/hormones consistently
• Use warm compresses, gentle stretching, breathing/mindfulness to relax pelvic floor muscles
• Balanced nutrition, adequate sleep, and appropriate exercise help lower chronic inflammation
• Attend scheduled ultrasound follow-ups; if planning pregnancy, discuss timing and options with your doctor

Frequently Asked Questions

1) Is an ovarian endometrioma cancer?

In most cases, no. Malignant transformation is rare (<1%), but risk is slightly higher in women >40 years or with cysts >68 cm. Routine ultrasound every 612 months helps monitor changes.

2) Can ovarian endometrioma be cured?

Endometrioma is a chronic condition that is usually controlled rather than permanently cured. With complete treatment and regular follow-up, most patients lead normal lives. Recurrence drops markedly with continuous postoperative hormonal suppression or consistent ongoing hormonal therapy.

3) Can I get pregnant if I have a chocolate cyst?

Yes, pregnancy is possible, but chances may be reduced by adhesions/inflammation affecting ovulation or sperm-egg interaction. If you plan to conceive, consult a reproductive specialist early and plan timing (sometimes before surgery).

4) Do all ovarian endometrioma require surgery?

No. Surgery is considered for severe symptoms, large cysts (5 cm), or when malignancy is suspected. If symptoms are mild or ovarian reserve is a concern, medical/hormonal management may be offered first.

5) Will ovarian endometrioma come back after surgery?

Recurrence occurs in roughly 2040% within 5 years, especially without postoperative hormonal suppression. Continuous hormonal therapy after surgery significantly lowers recurrence.

6) Do foods affect ovarian endometrioma?

Diets high in saturated fat/red meat may raise systemic inflammation. Favor omega-3 rich foods (e.g., salmon), avocados, leafy greens, and reduce caffeine/alcohol.

7) When should I see a doctor for severe period pain?

If pain worsens over time, you have deep pain with sex, rectal pain, or unusually heavy periods, book an ultrasound promptly. Early evaluation can help prevent adhesions and infertility.

8) How do I prepare for an ovarian endometrioma check?

No fasting required. A transvaginal ultrasound (TVUS) takes 510 minutes, is safe, and generally not painful. It can be done even during menstruation.

9) Does pregnancy make ovarian endometrioma go away?

Symptoms may improve temporarily during pregnancy due to high progesterone levels, but this isnt a cure. After hormones normalize postpartum, symptoms may recur.

10) What if I dont treat ovarian endometrioma?

The cyst may enlarge, pain can worsen, adhesions may form, and rarely a cyst can rupture causing internal bleeding. Observation without a plan is not recommended.

Ovarian Endometrioma Package Care

Tel. 081-116-3788

For compassionate, sex-positive gynecology and endometriosis care in Bangkok,

contact Clitoria Clinic, Petchkasem 81.

Tel. 081-116-3788

Line OA: @dr.clitoria