What is a Chocolate Cyst? Causes, Treatment & Fertility Impact

What is a Chocolate Cyst?

A chocolate cyst is an ovarian cyst that contains old blood. The cyst is brown due to the presence of old blood, a condition known as a chocolate cyst. These cysts are seen in women with endometriosis, in which endometrial cells and tissues accumulate in the ovaries instead of being shed during periods. Chocolate cysts can increase in size, causing infertility.

What are the Causes of Chocolate Cysts?

The real cause of chocolate cysts is unknown, but some factors associated with the formation of chocolate cysts are given below:

• Chocolate cysts are seen in women suffering from endometriosis. In endometriosis, tissue similar to the uterine lining starts growing outside the uterus, and this causes the formation of cysts.
• An imbalance of hormones also plays a role in the development of chocolate cysts. Estrogen and progesterone are the main hormones that are important for the development of endometrial tissue.
• Older women above 30 years are more prone to suffer from chocolate cysts.
• Genes also play a role in the development of chocolate cysts. These are commonly seen in women from the same family.

Impact of Chocolate Cysts on Fertility

Chocolate cysts can impact women of reproductive age. The presence of chocolate cysts can affect egg quality by causing scarring. This can result in blocked fallopian tubes that prevent fertilisation. Therefore, it is important to consult with a fertility expert if a woman is unable to get pregnant despite trying regularly for a year without any protection.

Other ways in which chocolate cysts can affect fertility are:

• If chocolate cysts damage ovarian tissue due to inflammation or oxidative stress, this can impede egg development.
• If endometriosis occurs somewhere else in the pelvic region, it can hinder the egg from being picked up and fertilised.

If chocolate cysts are removed surgically, they may damage healthy ovarian tissue or injure the blood vessels supplying the ovaries. Therefore, surgery is recommended in severe cases and has to be performed by specialist doctors if fertility is a concern.

How to Diagnose the Chocolate Ovarian Cysts?

A doctor can suggest some tests to diagnose ovarian cysts. Common tests done to diagnose chocolate cysts are:

• A doctor may perform a pelvic examination to check for any lumps or swelling.
• An ultrasound may be performed to assess cyst size and its impact on the reproductive organs.
• In some cases, a fertility expert may recommend an MRI for a detailed evaluation of the cysts.
• Laparoscopy may be used to visualise the cysts and, if possible, remove them.

What Other Tests Are Done to Diagnose a Chocolate Cyst?

The doctor may order additional tests to rule out other health problems responsible for the symptoms. Other tests include:

• A complete blood count can help the doctor know if there is an infection or anaemia. People with chocolate cysts usually have a low red blood cell count due to heavy bleeding.
• A urine test may be done to rule out a urinary tract infection.
• Sometimes, a sexually transmitted disease may present with similar symptoms; therefore, the doctor will order STD related blood tests.

Treatment of Chocolate Ovarian Cysts

The doctor evaluates the size of the cysts, symptoms, and fertility to recommend the best treatment for chocolate cysts. Commonly suggested treatment options are:

• Hormonal Medication: A doctor may prescribe hormonal medicines to regulate the menstrual cycle, relieve symptoms, and reduce endometrial growth.
• Pain Medication: Pain medications may be given to reduce pain and discomfort.
• Surgery: If the size of the cysts is large enough to cause a problem in conception, the doctor will recommend surgery. Laparoscopic surgery may be done to remove cysts while caring for other reproductive organs.
• Fertility Treatment: If a woman fails to conceive due to the presence of ovarian cysts, the doctor will suggest the best fertility treatment based on the individual symptoms of the woman.

Complications of Chocolate Ovarian Cysts

Chocolate cysts may cause complications if left untreated for a long time and if they grow in size. Some complications of chocolate ovarian cysts are:

• Blockage of bladder or bowel movements.
• Infertility due to the presence of scar tissue in the ovaries and fallopian tubes.
• The risk of ovarian cancer increases.
• If the cyst opens and leaks, it may cause severe pain.

What to Expect When Meeting a Doctor?

When you visit a doctor for assessment of your reproductive health, the doctor may work in the following direction:

• The doctor will ask about your symptoms, perform a pelvic examination, and recommend a transvaginal ultrasound. The doctor may also order blood tests to diagnose other possible infections.
• The doctor will discuss the treatment plan based on your symptoms and the severity of the condition. The doctor may initially prescribe pain-relieving medication to manage your pain. If the cyst is larger, the doctor may suggest other treatment options.
• If surgery is recommended, the doctor will plan laparoscopic removal of cysts to achieve the best results.

Conclusion

A chocolate cyst, also known as an ovarian endometrioma, is a common gynaecological problem. It is one of the common causes of infertility in women. Proper diagnosis and treatment can help manage symptoms. When it affects fertility, you must consult with a fertility expert to get the best guidance and treatment. Early diagnosis, intervention, and treatment can help reduce the risk of complications. Therefore, if you aim to achieve pregnancy, you must consult with a fertility expert to get a tailored treatment based on your symptoms.