Gynecology and Obstetrics, Gynecological Oncology Specialist Prof. Dr. Mete Güngör talked about the most curious questions about the chocolate cyst and gave important warnings.
The presence of the endometrium layer, which thickens and sheds every month in women lining the inside of the uterus and menstruating, outside the uterus due to various factors, for example, in the ovaries, tubes, peritoneum, intestines and bladder is called 'endometriosis'. The formation of endometriosis in the ovaries is called a 'chocolate cyst'. While endometriosis is seen in one out of every 10 women of reproductive age in Turkey, approximately 17-44 percent of these patients are diagnosed with a chocolate cyst in their ovaries. The most common symptoms are pain during menstruation, sexual intercourse or defecation. In addition, chronic pelvic pain is also a common symptom.
Explaining with which symptoms it manifests itself, Prof. Dr. Mete Güngör continued as follows:
“Chocolate cysts, when their size is small (< 4 cm), may not cause any symptoms and damage, that is, there may be no pain. In addition, patients can easily become pregnant with these cysts. However, chocolate cyst can cause varying degrees of pain, especially when it affects the ovary and other regions. Chocolate cyst, which is the form of endometriosis in the ovaries, can cause any of the symptoms such as painful menstruation, pain during sexual intercourse, pain during urination or defecation, low back or chronic pelvic pain, nausea-vomiting and abdominal bloating. The most common symptoms are pain during menstruation, sexual intercourse or defecation, and chronic pelvic pain.
On the occurrence of pregnancy, Prof. Dr. Mete Güngör said, “The endometrium layer in the ovary turns into a cyst as a result of bleeding every month. Since the liquid accumulated in this layer is in the form of melted chocolate, it is called a 'chocolate cyst'. Chocolate cysts are seen as one of the most important obstacles to getting pregnant. So much so that 17 percent of women who cannot get pregnant are diagnosed with chocolate cysts. This is because the chocolate cyst can make it difficult to get pregnant by disrupting ovulation functions and forming adhesions in the tubes and ovaries.” he said.
Mentioning that chocolate cysts can turn into malignant tumors, although rarely, Prof. Dr. Mete Güngör said, "For this reason, chocolate cysts diagnosed in elderly patients are evaluated much more carefully."
prof. Dr. Mete Güngör said the following about treatment methods:
“There is no definitive treatment for endometriosis, a chronic disease, and chocolate cysts. If the chocolate cyst is small and does not give any symptoms, it is sufficient to follow up. Which method will be used in the treatment; It varies depending on the size of the cyst, its symptoms, and whether the patient wants to have children. In cases where pain is the main problem, drug treatment is usually applied first. With medical treatment, the complaints caused by the cysts can be reduced or eliminated. It can also slow the progression of endometriosis and reduce the risk of re-development if the cyst is surgically removed. Progestins, vaginal ring, birth control pills, hormonal spiral and GnRH agonists constitute the medical treatment methods.
prof. Dr. Mete Güngör said that if the symptoms of chocolate cysts affect the quality of life and there is no response from medical treatment, if the patient cannot get pregnant despite in vitro fertilization treatment, or if the existing cyst is likely to be carcinogenic, a surgical option is on the agenda.
"Surgical removal of the chocolate cyst not only helps to eliminate the complaints, but also prevents the progression of the damage to the ovary and increases the chance of pregnancy," said Prof. Dr. Mete Güngör, "In addition, the destruction of chocolate cysts in patients who will receive IVF treatment facilitates the egg collection process." used the phrases. Gynecology and Obstetrics / Gynecological Oncology Specialist Prof. Dr. Pointing out that chocolate cysts are a recurrent disease, Mete Güngör said, "There is a 9-25 percent chance of recurrence of the disease, depending on the type of surgery performed and the medical treatment applied after the surgery."
Today, the closed surgical method is generally preferred for the removal of the chocolate cyst from the body. In this method, called laparoscopy, the ovaries and uterus can be viewed thanks to high-resolution cameras. Thus, it is possible to remove the chocolate cyst without the need for large incisions. prof. Dr. Mete Güngör stated that laparoscopic surgery can be applied in chocolate cyst in two ways and continued as follows:
Laparoscopic cystectomy: By preserving the intact tissues in the ovary, only the capsule of the chocolate cyst can be removed or the cyst can be emptied and its wall burned. In this way, the cyst is cleaned with minimal damage to the intact tissue.
Laparoscopic Oophorectomy: In advanced cases, in patients who have no idea of pregnancy, or in cases where the cyst is suspicious for cancer, the entire ovary is removed.