Chocolate cysts are noncancerous, fluid-filled cysts that typically form deep within the ovaries. They get their name from their brown, tar-like appearance, looking something like melted chocolate. They’re also called ovarian endometriomas.
The color comes from old menstrual blood and tissue that fills the cavity of the cyst. A chocolate cyst can affect one or both ovaries, and may occur in multiples or singularly.
Ovarian endometrioma is a benign, estrogen-dependent cyst found in women of reproductive age. Infertility is associated with ovarian endometriomas; although the exact cause is unknown, oocyte quantity and quality are thought to be affected.
Chocolate cysts occur in 20 to 40 percent of women who have endometriosis, estimates the Endometriosis Foundation of America.
Chocolate cysts are a subgroup of endometriosis. They’re often associated with more severe forms of the disorder.
WHAT ARE THE SYMPTOMS?
Chocolate cysts may cause symptoms in some women. Other women may not experience any symptom.
The size of the cyst also doesn’t necessarily affect the severity or presence of symptoms. This means a woman with a small cyst may experience symptoms, while someone with a large one may not. Cysts can range from 2 to 20 centimeters (cm) in size.
When symptoms do occur, they’re similar to those of endometriosis. They can include:
- Painful, crampy periods
- Pelvic pain not related to your menstrual cycle
- Irregular periods
- Pain during sex
- Infertility for some women
If a chocolate cyst ruptures, it can cause severe, sudden abdominal pain on the side of the body where the cyst is located. A ruptured cyst can be a medical emergency. Seek immediate medical attention if you suspect you have a ruptured cyst.
Your doctor may order a pelvic ultrasound to diagnose Endometriomas.
HOW ARE CHOCOLATE CYST TREATED?
Treatment will depend on several factors, including:
- Your age
- Your symptoms
- Whether one or both ovaries are affected
- Whether or not you want to have children
If the cyst is small and not producing symptoms, your doctor may advise a watch-and-wait approach. They may also recommend medication that inhibits ovulation, such as the birth control pill. This can help control pain and slow the growth of cysts, but it can’t cure them.
Surgery to remove the cysts, called an ovarian cystectomy, is often recommended for women who have:
- Painful symptoms
- Cysts larger than 4 cm
- Cysts that may be cancerous (but a 2006 review estimates less than 1 percent of cysts are cancerous)
infertility
The surgery is generally done via a laparoscope. A laparoscope is a thin, long tube with a light and camera on the end that help doctors perform the procedure. It’s inserted through a small incision.
WHAT EFFECT DO CHOCOLATE CYST HAVE ON FERTILITY?
Chocolate cysts can invade, damage, and take over healthy ovarian tissue. This can be a serious threat to fertility. These cysts can be difficult to treat, and the pelvic surgeries used to control or remove them can lead to ovarian scarring and reduced fertility.
When compared to women without chocolate cysts, women with them also tend to have:
- Fewer eggs
- Eggs that are less likely to mature
- Higher levels of follicle-stimulating hormone (FSH), which can indicate problems with the ovaries
Despite the damage chocolate cysts do to ovaries, many women with them can conceive naturally.
A 2015 study followed women with regular menstrual cycles and chocolate cysts on only one ovary. Researchers found 43 percent of them were able to become pregnant naturally. The women were followed for 4 years.
In vitro fertilization (IVF) is another option if you have chocolate cysts and difficulty becoming pregnant. Research showsTrusted Source that women with these cysts have similar pregnancy, implantation, and delivery rates with IVF as women with tubal factor infertility.