Chocolate Cysts : Causes, Symptoms & Treatment

All you must know about Chocolate Cysts

Women’s health is a tricky domain. It has some unique ailments that may sound benign but can have deeper, more fatal implications. One such ailment is a chocolate cyst. 

What is a chocolate cyst?

Chocolate cysts are sacs or pouch-like formations around the ovaries filled with fluids, mostly blood. Due to the accumulation of old menstrual blood it looks chocolate coloured and hence the name. These are also called endometriomas and are not cancerous. So when an endometrial tissue grows abnormally and attaches itself to the ovarian cavity, it is called a chocolate cyst. 

Initially these are small cysts but they multiply when triggered mainly by hormonal imbalance. In case the person is not pregnant, these cysts break off and flow out from the uterus during the menstrual cycle. But if it has reached the stage of endometriosis, the blood may collect and irritate the surrounding tissues.

What are the causes of chocolate cyst? 

Most reproductive ailments are attributed to a family history. Which is why it is not surprising that females with a family history of chocolate cysts are more likely to suffer from this condition. Some of the major causes of chocolate cyst are: 

• Retrogressive Menstruation: the reverse flow of PMS blood into ovarian ducts. 
• Genetic Auto-immune Disease: Family history of auto-immune disorders
• History of any form of injury due to miscarriage or caesarian delivery.

What are the symptoms of chocolate cysts?

These cysts are not so common, but their symptoms are very common. This needs proper and timely reporting to a specialist to investigate and identify the issue correctly. These are:

• Painful menstrual cycle: Cramps and excruciating pains during PMS can be due to the obstruction faced from the chocolate cyst restricting the flow.
• Pain during sexual intercourse: By this we do not mean the act of the intercourse is rough, rather any attempt towards intercourse will make it painful for a woman suffering from chocolate cysts. 
• Heavy bleeding or irregular flow: The chocolate cysts are causing obstruction to the menstrual blood flow and therefore leading to either excess or lowered flow.
• Heaviness of abdomen: Due to the accumulations of chocolate cysts which already contain blood, there is a constant feeling of bloating or heaviness in the lower abdomen.
  
• Pain during exercise: While exercising the pelvic muscles are also activated. This in turn creates pressure on the underlying chocolate cysts creating shooting pains similar to period cramps while working out. 

Chocolate cysts may end up causing torsion of ovaries. By this it means the ovaries shift from their usual location to make place for the cysts. This leads to nausea, pelvic pain and sometimes vomiting. In extreme circumstances, a rupture in these cysts can trigger internal bleeding that would require immediate medical attention.

Also Read: What is PCOS?

What is the available treatment for chocolate cysts?

Whenever few of the symptoms surface, reach out to your gynaecologist for an immediate consultation. After going through the patient’s medical history, they will perform a pelvic examination, a trans vaginal ultrasound, an X-ray and/or a blood test. Based on the investigation’s outcome the patient will be diagnosed with the severity of the situation. 

Smaller cysts can be diluted if they are very small. Treatment of a bigger chocolate cyst includes removal of ovaries. This is opted in case of older women who are not looking to conceive in the near future. Those diagnosed with larger cysts usually undergo painful periods. Based on the severity of the case and the patient’s condition, it may also have to be removed by surgery.

If the patient is looking to undergo fertility treatment like IVF, surgical removal of cyst might not improve fertility, since this procedure has a high risk of sterility. 

Since there is a huge risk involved in this case, it is advisable that when faced with menstruation problems, always reach out to your gynaecologist and undergo regular pelvic examination to help diagnose disorders in its early stages for a safe and effective cure. 

FAQ’s :

How do you know if you have chocolate cysts?

Chocolate cysts are dark small sacs of old menstrual blood that accumulates around the ovaries. These do not have any sure shot symptoms and sometimes the symptoms don’t even surface until the matter has become severe. 

The most common signs you should be concerned about are:

• Pain in the back, obliques and pelvic regions of the body
• Symptoms similar to PCOS like hirsutism, obesity and hormonal imbalance, since there can be two conditions co-existing at the same time
• Pain in the pelvic region during specific activities like exercise and sexual intercourse
• Painful cramps and other discomforts during menstruation, including spotting, irregular flow and any kind of abnormality. 

It is always advisable to go for regular pelvic checking with your trusted gynaecologist in case one or more of the above happens.  

How do you get rid of chocolate cysts?

There are two ways to get rid of chocolate cysts, these depend on the following factors:

• Age of the person
• Family medical history of the person
• Fertility history of the person
• The size of the chocolate cyst 
• The existing comorbidities of the person

One of the easiest ways for small sized cysts is medication. The doctors often prescribe contraceptives to regularise the periods and help the cysts flow out with regular flow and not accumulate around the ovaries.

But in case the cyst has become bigger and is creating bigger concerns which might even be suggestive of cancer, then the same must be surgically removed. But this also adds a very high risk of sterility and might even involve taking out the patient’s ovaries. If the patient is undergoing fertility treatments then it is possible that surgery will reduce the overall effectiveness of the treatments. 

Does a chocolate cyst mean I have endometriosis?

It is very difficult to differentiate between a chocolate cyst and endometriosis since they have very similar symptoms. However, every cyst has a potential to reach endometriosis since the growth happens away from the ovaries and around it. So at best chocolate cysts are a subset of endometriosis.

Do chocolate cysts cause spotting?

Like most ovarian cysts, chocolate cysts also can trigger uterine bleeding, before or after the menstruation process. This can lead to brown vaginal discharge or spotting in case of some women. It is not the same for everyone, and medical history is very vital to properly diagnose these cases.