What Is Endometrioma (Chocolate Cyst) And How Is It Treated?


Chocolate cyst is a benign tumor of ovaries seen in reproductive age in women. The endometrium, which is sensitive to the hormone, is placed in the ovaries and it bleeds into ovaries through menstruation, and forms a mass of chocolate consistency. We call it a chocolate cyst.

Patients with chocolate cysts often have severe pain before and during menstrual periods. In addition, sexual intercourse may be painful. In some patients, these cysts may be the cause of infertility. The diagnosis is made by ultrasonography. A tumor marker called CA-125 can also be seen in the blood. CA-125 may not be high in every chocolate cyst.

There is no treatment that reduces the chocolate cyst. It continues to grow as long as the women menstruates. Some medications can be used to slow down the grow and reduce pain if there is pain. These are progesterone and contraceptives. Birth control pills or progesterone are given to the patient to prevent menstruation.

The definitive treatment of chocolate cyst is surgery. Surgery should definitely be performed laparoscopically. Adhesion is less and can be opened if any. Also pain and bleeding is less. The patient may stay in hospital for less time and return to work early. An important advantage is that there is no need for incision.

If the patient’s complaints of the chocolate cyst does not respond to the treatment and the pain deteriorates the quality of life, it should be operated regardless of the size of the treatment. In addition, if the size exceeds 5 cm, surgery may be preferred. Ovarian reserve (AMH) can be evaluated before surgery. If the patient wants a child and the reserve is at the border, it is recommended to get pregnant first.

The definitive treatment of chocolate cyst is surgery. Laparoscopy (closed surgery) is the first choice in surgery. In open surgery, skin scar remains and adhesion becomes more. Also pain and bleeding is less.  The patient is discharged late from the hospital and starts working late. For these reasons, surgery should definitely be performed with laparoscopy. In the operation, cautery should be used less and lapaoroscopic suture should be used if it is necessary to stop the bleeding.