Chocolate Cyst - a silent threat women should be aware of

Getting to Know and Properly Caring for “Chocolate Cysts”

What is a Chocolate Cyst?
Endometriosis, commonly known as “chocolate cysts,” is a condition that is closer to us than we might think and not as frightening as it seems if we take care of our health and observe ourselves carefully. Medically, it is believed to occur due to retrograde menstruation, where instead of blood flowing out through the vagina as usual, some menstrual blood flows backward through the fallopian tubes into the abdominal cavity and attaches to the ovaries, forming a cyst filled with blood. These cysts can grow in various organs, such as the pelvis, fallopian tubes, intestines, vagina, uterus, and bladder. Any woman can develop this condition, but whether it shows symptoms or impacts the body varies from person to person.

Symptoms of Chocolate Cysts
The risk symptoms for chocolate cysts include severe abdominal pain during menstruation, which increases each month. The pain can occur in both the front and back areas, from the belly button to the pelvis and from the waist to the tailbone. Other symptoms include lower abdominal pain during intercourse, excessive menstrual bleeding lasting longer than 7 days, and abnormal vaginal bleeding. Menstrual cycles may become more frequent, with periods occurring more than twice a month. Other signs include frequent urination, potentially due to the cyst pressing against the bladder, making it function abnormally. There may also be blood in the stool or urine during menstruation. If a person is slim but has a protruding belly, there could be a large cyst forming inside. Frequent migraines, especially before and during menstruation, are another symptom. In some cases, there may be no symptoms, but a firm mass is felt in the lower abdomen, which could be the result of the cyst growing large and becoming dangerous. In some cases, this condition can cause infertility due to blocked fallopian tubes, which prevents eggs from traveling properly. This happens because the cysts on the ovaries reduce their ability to produce eggs and hormones.

Diagnosing Chocolate Cysts
The doctor will inquire about the patient’s medical history, including family history related to the condition, and the nature of the symptoms, such as the type and location of the pain, when it occurs, and menstrual and sexual history. A general health examination will follow. The main diagnostic tests that complement the patient’s history include:

Pelvic Examination: This checks for abnormalities in the pelvic organs, genital organs, and rectum to see if there are signs of endometriosis or an enlarged uterus with cysts on the ovaries. In cases of very small cysts, they may not be detectable by this method.
Ultrasound: This high-frequency sound wave test is conducted via the abdominal wall or by inserting an ultrasound probe into the vagina to visualize the pelvic organs. It can detect small masses, but it may not provide a detailed diagnosis, such as the presence of scar tissue.
Laparoscopy: If the above methods do not provide sufficient information, the doctor may recommend laparoscopy, the most accurate way to diagnose the condition. This procedure involves the use of a small camera inserted through a small incision near the belly button to visually examine the inside of the abdomen. This allows the doctor to identify the cysts’ size and location and select the most suitable treatment.

Treating Chocolate Cysts
Treatment usually involves medication and surgery, depending on the severity of the symptoms and the patient’s desire to have children. Medications can be divided into two main types:

Pain Relievers (NSAIDs): Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are commonly used to relieve mild abdominal pain or menstrual cramps. Common examples include ibuprofen and naproxen.
Hormonal Therapy: For patients with severe pain who do not plan to conceive soon, doctors may recommend hormonal therapy. Hormonal fluctuations during menstruation can affect the growth of endometrial cells, and the medication helps slow down their growth and prevent new tissue from forming. Hormonal treatments may need to be used for 3 to 6 months, depending on the individual, but symptoms may return after discontinuation. Common medications include various forms of birth control pills.