Chocolate Cysts (Endometriomas)

Endometriomas, also known as a chocolate cysts or endeometriotic cysts, are a localized form of endometriosis and are usually within the ovary. Other names for chocolate cyst are endometrial cyst, endometrioma cyst, and chocolate ovarian cyst. Part of the condition known as endometriosis. Endometrioma is a type of cyst formed when endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) grows in the ovaries. It affects women during the reproductive years and may cause chronic pelvic pain associated with menstruation.Endometriosis is the presence of endometrial glands and tissue outside the uterus.Women with endometriosis may have problems with fertility.Endometrioid cysts, often filled with dark, reddish-brown blood, may range in size from 0.75-8 inches.

It is one of several types of cysts on ovaries that affect women. A chocolate cyst is a sac or pouch growing on the ovary that contains fluids and sometimes semi-solid material too, in which case it may be referred to as a complex ovarian cyst. Because the endometrial tissue inside the cyst responds to monthly hormones it bleeds and fills the interior of these cysts with unclotted blood. Chocolate cysts get their name from the dark old blood that grossly resembles chocolate.

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How the chocolate cysts develop?

A women with the disease endometriosis will have tissue from the inside surface of her uterus (endometrium) attach to the ovary. These patches of endometrial cells may form small cysts that multiply into even more cysts when stimulated by menstrual hormones. As the cysts spread they can become part of the ovary itself, replacing the normal tissue needed for ovulation. Inflammation and irritation of nearby organs may result from chocolate cysts spreading around the pelvic cavity.

Millions of women will be affected by endometriomas each year. Approximately five to ten percent of all women will have one at some point during their life, typically during their childbearing years. Most women will get them in the ovary on the left side of the body. One of the critical problems with chocolate cysts is that they tend to reoccur. Usually, the size of an endometrioma ranges from about half an inch (grape size) to four inches or more (softball size) in diameter.

Endometriosis is a condition in which cells that normally grow inside as a lining of the uterus (womb), instead grow outside of the uterus in other locations. The ovary is a common site for endometriosis. When endometriosis involves the ovary, the area of endometrial tissue may grow and bleed over time, forming a blood-filled cyst with red- or brown-colored contents called an endometrioma, sometimes referred to as a chocolate cyst or endometrioma. The condition known as polycystic ovarian syndrome (PCOS) is characterized by the presence of multiple small cysts within both ovaries. PCOS is associated with a number of hormonal problems and is the most common cause of infertility in women.

Both benign and malignant tumors of the ovary may also be cystic. Occasionally, the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. Cysts with these abnormal tissues are really tumors called denign cystic teratomas or dermoid cysts.

Infections of the pelvic organs can involve the ovaries and Fallopian tubes. In severe cases, pus-filled cystic spaces may be present on or around the ovary or tubes. These are known as tubo-ovarian abscesses.

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Symptoms of chocolate cysts:

Most ovarian cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the abdomen or pelvis is the most common one. The pain can be caused from:

  • rupture of the cyst,
  • rapid growth and stretching,
  • bleeding into the cyst, or
  • twisting of the cyst around its blood supply (known as torsion).

If the cyst has reached a large size, other symptoms may arise as a result of pressure or distortion of adjacent anatomical structures. These symptoms can include abdominal fullness or bloating, indigestion, feeling full after eating only a small amount (early satiety), urinary urgency, feeling an urge to defecate or having difficult bowel movements, or pain with sexual intercourse.

Abdominal cramping or swelling during a menstrual cycle is a very common symptom for women with endometriomas. Another possible sign of a cyst is progressively painful periods. Pain may also be felt while emptying the bowels or bladder. Sexual intercourse and other physical activities such as exercising or bending and stretching may be painful. In some cases a cyst may press upon the ovary causing it two twists until its blood supply is cut off. This often results in intense, sharp pain.

Chocolate cyst rupture can also be a source of severe pain. If a chocolate cyst ruptures the contents may spill out onto the ovaries and other organs of the pelvis. This can lead to complications such as adhesions (scarring), infection, and intense pelvic pain. A ruptured ovarian cyst can be a serious medical emergency and you should do something right away if you have symptoms such as excessive bleeding, fever, vomiting or severe pain.

Bleeding outside the usual menstrual cycle is another symptom of endometriomas. A woman may notice her bleeding is occurring at odd times or spotting in between periods. Post-menopausal women who have vaginal bleeding should also be concerned about the presence of a cyst. Excessive bleeding and dark colored discharge from the vagina are other possible symptoms of a chocolate cyst.

Chocolate Cyst Treatments:

Typical options for chocolate cyst treatment include medication with drugs and surgery. Drugs may be helpful in relieving symptoms temporarily but do not treat or actually remove the cyst. Danzol and GnRH are two such drugs commonly used. Surgery is often recommended but has its own problems as well. Often during surgery healthy ovarian tissue is removed with the cyst resulting in lowered fertility for the woman. Sometimes the entire ovary must be removed depending on the size and number of cysts. Other complications may also result from surgery such as scarring, adhesions, and cuts to the rectum or bladder. The worst thing a woman can do is to have unnecessary surgery that causes damage to her ovaries or other organs.

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