Chocolate cyst or endometrioma

Sometimes when endometriosis affects ovary that can form endometrioma or chocolate cyst,

 

endometriotic cyst usually show some characteristic features like hypo-echoic area with thick wall etc,
and cancerous cysts will have features like thick septa, irregular wall, hetero-echoic areas etc.
usually blood test can detect the levels of CA 125, but it that can be supportive but not confirmatory for diagnosis.

CA 125 levels will be elevated in many conditions other than carcinoma and endometriosis is one of them,
by taking into consideration of ultrasound features and elevated CA 125 levels  possible diagnosis of endometrioma can be made sometimes, but confirmation can be done by histopathological examination only.

as  ovaries are involved in endometriosis by forming chocolate cyst that can also lead to increased frequency of cycles called polymenorrhoea that may also be one cause for early onset of periods.
menorrhagia(excessive bleeding during periods) and dysmenorrhoea(pain during periods) are symptoms of endometriosis,
size of the chocolate cyst of ovary can increase during periods due to accumulation of cyclical blood and after periods there may be some amount of shrinkage due to absorption of serum,

though it is said that some type of foods can affect estrogen levels, theoretically in the pathogenesis of endometriosis these are not stressed.

Normally small cysts can be managed with medicines like analgesics, hormonal therapy like contraceptive pills, progesterone only pills,

as the cyst contains endometrial tissue it can secrete blood periodically, which can cause enlargement of the cyst, so better to take medical treatment like  small dose oral contraceptive pills cyclically or preferably continuously which can cause endometrial tissue atrophy leading to limiting the growth of the cyst.
other medicines like danazol or GnRH analogues etc can also be used.

But for a cyst with size of more than 4 cms  surgical removal is best option, as hormonal treatment in this case is only partially effective and can cause side effects also,
patient can go for laparoscopic surgical approach, as laser surgery and cauterization are less effective and recurrence chance is there , better to go for laparoscopic excision of ovarian adhesions and endometrioma.
Patient can travel but have to be careful and take precautions like, avoid lifting, pushing, pulling weights etc, avoid acts that will increase abdominal pressure like constipation etc, but should be cautious and if pain abdomen etc occurs have to consult doctor immediately.

usually chocolate cyst will rupture because of some strenuous activity or by external pressure on the abdomen etc, by limiting these things we can prevent spontaneous rupture to some extent.

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