What is endometriosis (chocolate cyst)? What does it mean? What are the symptoms? How to understand the explosion? How is it treated? What happens if it is not treated? You can find the answers to all these questions and much more below.

What is endometriosis (chocolate cyst)?

Endometriosis, also known as a chocolate cyst, puts the tissue that makes up the lining of the uterus in contact with other organs in your body. This is most often found in the lower abdomen or what we call the pelvis, but it can occur anywhere in the body. Women with this disease experience abdominal pain after sexual intercourse, pain that comes and goes, or pain during sexual intercourse. Women affected by this condition may report having trouble conceiving. On the other hand, some women with this problem may have no symptoms at all.

Endometriosis is estimated to affect between 3% and 10% of women of reproductive age. Endometriosis (chocolate cyst) can only be diagnosed by a laparoscopy doctor taking a sample of suspicious tissue and examining it.

Chocolate cyst is almost never seen before the start of the menstrual cycle in girls. It usually occurs between the ages of 30 and 40, but is sometimes seen in young girls with painful menstrual periods.

What causes endometriosis (chocolate cyst)?

There are various ideas about how and why endometriosis occurs. One of them is that when a woman enters her menstrual cycle, some of the blood and tissue from her uterus spreads from the fallopian tubes into the abdominal cavity. This is called retrograde menstruation .

Another idea is that some cells in the body outside of the womb change, turning into the same cells as the womb. This seems to be a common explanation for endometriosis (chocolate cyst) in unusual areas such as the thumb or knee.

Another possible explanation is that cells from the lining of the uterus move through the blood vessels or lymphatic system to other organs or body parts. Also, this disease can spread during surgery.

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Interestingly, nearly all women have some degree of retrograde menstruation, but only a few women will develop a chocolate cyst. This can also be due to differences in the woman’s immune system. Also, if a close relative has the disease, the risk is even greater. Therefore, this condition is likely to be genetic.

Relationship with pain

If a woman with endometriosis has a menstrual cycle, she may bleed not only in cells and tissues inside the uterus, but also in cells and tissues outside the uterus. Blood can cause inflammation and irritation, especially when it comes into contact with other organs in the abdomen, and can sometimes cause abdominal pain after intercourse.

Relationship with infertility

Between 20 and 40% of women with infertility problems have a chocolate cyst. This disease appears to impair fertility in several ways. First, they are unable to retrieve the egg after intercourse because it causes the fallopian tubes to malfunction. The second is inflammation of the ovary, which can negatively affect the function of the egg tubes.

What are the symptoms of endometriosis (chocolate cyst)?

A chocolate cyst may go unnoticed. Some women have only mild symptoms, others are more affected by the disease.

There is no direct relationship between the degree of disease and the severity of symptoms. Very small endometrial foci may cause very obvious problems, large ones may remain asymptomatic or vice versa.

Possible signs of endometriosis include:

  • Severe, often cramp-like pain during menstruation
  • Recurrent pain in the lower abdomen, especially in the second half of the monthly cycle
  • Bleeding between menstrual periods
  • Abdominal and back pain that may radiate to the legs
  • Pain during or after sexual intercourse
  • Pain during gynecological examinations
  • Pain when defecating or urinating
  • blood in the urine
  • bloating, diarrhea or constipation

However, all these symptoms may have other causes. Symptoms can vary depending on where mucous membrane cells are mistakenly located.

The characteristic sign of the disease is recurrent abdominal pain . The intensity of pain typically fluctuates throughout the monthly cycle.

Symptoms initially worsen maximally just before or during the menstrual period. Then they get better again.

How is endometriosis (chocolate cyst) diagnosed?

First, the doctor will ask about your symptoms and medical history . He also asks if close relatives (mother, sister, grandmother) have had endometriosis, as a family tendency is an indicator.

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After these, a gynecological examination is performed. The doctor examines the vagina, abdominal wall, and rectum.

An ultrasound scan can possibly detect large endometrial areas. Smaller areas are usually not visible. If symptoms are present, an ultrasound scan of the abdomen may be appropriate.

The doctor checks whether the endometrial foci are pressing on the ureters and causing urinary obstruction in the kidney. Sometimes an MRI scan is also used.

In case of blood coming from the bowel or bladder, these organs can be examined with the help of a mirror ( endoscopy ) to exclude other diseases.

Chocolate cyst can usually only be reliably diagnosed with laparoscopy , and this is a minor procedure. An individual decision must be made whether it is necessary to initiate treatment or whether the suspicion of endometriosis is sufficient.

However, tummy mirroring is often necessary. During mirroring, the doctor inserts thin optical instruments into the abdominal cavity through several small skin incisions. With their help, the doctor can look into the abdominal cavity and examine the organs located there for endometrial foci. With tissue samples examined under the microscope. the diagnosis of the disease can be reliably confirmed.

How is endometriosis (chocolate cyst) treated?

Unless the chocolate cyst is causing problems and is not getting worse, treatment is not usually necessary. However, close medical check-ups are recommended.

The cause of endometriosis is unknown. Therefore, there is still no clear targeted therapy that can cure the disease. However, there are different treatment options. Which treatment or combination of treatments is most appropriate should be individually decided.

Here the answer to the questions of the woman’s age, the end of family planning or whether she wants to have a child plays an important role.

Surgical treatment

Abdominal mirroring (laparoscopy), usually a minor operation, is required to confirm the diagnosis (more details in the diagnosis section). This intervention also offers the possibility of treatment.

Surgical removal or obliteration (eg, electrical or laser removal) of the affected areas is the preferred method, especially in the case of extensive chocolate cysts. Surgery is also necessary if tissue presses on the ureter and causes urine to accumulate in the kidney.

If this problem is not resolved, the kidney may be damaged . There is also evidence that removing endometriosis tissue will prevent infertility and increase the likelihood of pregnancy after the procedure.

Depending on the location of the endometrial focus, vaginal surgery is also possible. Sometimes a more extensive surgical procedure with an abdominal incision (laparotomy) is required. This is especially necessary in the case of extensive disease involving the bladder, bowel or other structures.

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This process should be well planned in advance. If possible, the operating doctor should have a lot of experience in the treatment of endometriosis, for example at a certified endometriosis center or with doctors from other relevant specialties.

The patient should talk in detail with the doctor beforehand about the possible advantages and disadvantages of the procedure. Even after surgery, the disease can reoccur and cause problems again.

If family planning is completed, removal of both the fallopian tubes and ovaries or removal of the uterus may be an option, depending on the situation. However, this step must be carefully thought through, planned. It can then be considered as a last option.


Different drugs are used for endometriosis. Antispasmodic medications for pain can relieve stressors if needed. However, it can also have side effects. This should be discussed with the doctor.

The doctor may prescribe hormonal contraceptives or hormone preparations that reduce the effect of female sex hormones on endometriosis cells or suppress the menstrual period . Of course, the disease calms down for a while. The hope will be regression of endometriosis tissue at this stage.

However, the desired effect is usually only short and the disease returns as soon as treatment is discontinued. Side effects such as hot flashes or mood swings may also occur.

For women with extensive chocolate cysts and those wishing to have children, medication alone is often not a permanent solution.

Women who become pregnant despite endometriosis (for example, through artificial insemination) can hope that the disease will resolve after pregnancy. Because pregnancy can dry out the cyst and it becomes less active.

Some women test complementary therapies, such as relaxation methods , or change their diet. Whether this can alleviate the symptoms of the disease has not been scientifically proven. At least one study suggests that acupuncture may help with pain.

It is not always possible to alleviate all complaints. Unfortunately, most endometriosis patients who want to have children will not be able to get pregnant. Interaction with other affected people can help to better cope with the disease.

Remember, your doctor will decide which medicine to take and how.

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