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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Emergency contraceptive pill - short term and long term side effects due to repeated usage

The short term side effects of emergency contraceptive pill are,
-they can cause menstrual irregularities like,
if taken in the first half of cycle they can prepone the menstruation, if taken in the second half they can postpone the menstruation.
They can lead to spotting, brownish discharge etc in between periods,
-nausea, vomitings, fluid retention, bloating sensation of the abdomen, breast tenderness, headache, sinus congestion etc symptoms can occur.
-less effective than regular pills with around 13% of failure rate,
-will not protect against sexually transmitted diseases,

Long term side effects:
-Because of repeated usage of pill the pattern of ovulation can change, it may become delayed or gets inhibited which will cause problem in getting pregnant for some months.
-if pregnancy occurs after repeated intake of pill baby may have some kinds of defects,
-repeated usage will decrease the effectiveness of the pill,
-it can affect the growth of endometrium leading to altered menstruation that can lead to amenorrhea or polymenorrhea,
-if used frequently with less than two months interval, that can lead to arrest of growth of ovum leading to formation of cysts that may lead to poly cystic ovarian disease sometimes according to few studies.

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Mittelschmerz

 Mittelschmerz and associated symptoms:

mittelschmerz means ovulatory pain seen on one side of abdomen usually, which can occur due to,
- stretching of capsule of ovary during release of ovum,
-contraction of fallopian tubes to recieve ovum,
-contraction of smooth muscle cells on ovary or of ligaments  due to release of prostaglandins,
-irritation of peritoneum due to blood and fluid released from ovarian follicle,
that pain sometimes can cause nausea,

mild spotting or brownish discharge etc can be seen associated with it due to the decrease in level of estrogen during ovulation,
other symptoms like head ache etc may also be due to release of prostaglandins etc during ovulation,
some women may also experience breast tenderness, bloating sensation, water retention, swelling of genital parts etc,
more intense ovulatory pain can be seen in endometriosis and pelvic inflammatory disease etc conditions.

 if  symptoms subsided soon and if that not severe enough to seek medical advice then no need to bother, if  symptoms persist or become severe better to consult gynecologist once to rule out any other possible cause.