Chocolate cyst (Endometriosis) is a serious disease that affects one out of every ten women today. It occurs when the tissue in the uterus, called the endometrium, settles outside the uterine cavity. Since these tissues can grow into cysts and their contents are chocolate-colored, the disease is also known as chocolate cyst among the people. 

What is Chocolate Cyst (Endometriosis)? 

Chocolate cyst occurs when the tissue in the uterus settles in another tissue outside the uterus. The uterine tissue prepares itself every month so that the egg can grow after fertilization. When the egg is not fertilized, the tissue is excreted from the body, that is, menstruation occurs. In the disease, which occurs when this tissue attaches to a region outside the uterus and develops there, symptoms begin to appear in the person. The places where the tissue is often attached to the body;Fallopian TubesOvariesPelvic CavityBowelUrine BagThis tissue, like the uterine tissue, bleeds every month in the region where the woman clings during the menstrual period and becomes a cyst in the ovaries.

Since there is no system for evacuation of blood in these areas, the person suffers from severe pain. According to the region where the tissue is attached, the disease is divided into 3 categories;Peritoneal endometriosis is attached to the organ membranes together with the peritoneum. Endometrioma attachment to the ovary. Deep Infiltrative Endometriosis is the attachment of the peritoneum deeper than 5 mm, that is, the bowel, urinary tract, bladder and uterus. 

What are the Causes? 

The causes of chocolate cyst are not known exactly, only some estimates can be made on this subject. It has been observed that genetic factors may be effective. The incidence of the disease is also higher in mothers or other relatives of patients with chocolate cysts. There are ideas that the immune system of the person creates the conditions suitable for this situation. 

In connection with hormones, it is thought that cells in the developmental stage can transform into endomerium cells.The condition called retrograde menstrual bleeding is also thought to be one of the causes of the disease. The tissue that needs to be expelled with blood goes back through the fallopian tubes and is poured into the pelvic cavity. 

Thus, it has the chance to cling to any place on the tissue path. From time to time, it can go out of the pelvic cavity and attach to the abdomen. During abdominal surgeries such as cesarean section, endomerium cells may have a chance to settle outside of the uterus. 

What are the symptoms? 

Chocolate Cyst is actually a very obvious disease, except in rare cases, because it causes severe pain. Interpreting these pains as ordinary menstrual pain or low back pain may delay diagnosis and treatment. Chocolate cyst formation also increases the symptoms of endometriosis. Symptoms can be categorized as pain and infertility. Whether there is pain and infertility, and if so in what form, depends entirely on where the tissue attaches.

Chocolate Cyst symptoms are as follows;Painful Menstrual Period (Dysmenorrhea)More than normal bleeding during menstrual periodsFatigue during menstrual periodsBloating during menstrual periodsConstipation or diarrhea during menstrual periodsNausea during menstrual periodspain during sexual intercoursePain after sexual intercourseInfertilityChocolate Cyst TreatmentChocolate cyst treatment is possible and the earlier it is diagnosed, the less damage the treatment will cause to the body. If chocolate cyst is diagnosed in the early period, it is possible to keep it under control with medication. If the chocolate cysts are widespread and the patient is over 35 years old, surgery is preferred. 

Chocolate cyst surgery can be performed with the open method as well as preferably with the laparoscopic (closed surgery) method. Certain criteria are taken into account when making a decision for chocolate cyst treatment. Conditions such as the severity of pain, the size of the cyst, and the age of the patient are evaluated. Surgery is not usually the first choice. Medication is tried.The aim of drug treatment is to imitate the pregnancy and menopause periods when this disease is not seen in the body hormonally. 

Therefore, injections that cause menopause or birth control pills are among the drugs used for the treatment of chocolate cyst. It is decided by looking at the age of the patient whether to use the menopausal injection or the birth control pill. Painkillers can be used to reduce pain periodically. Chocolate cyst surgery, on the other hand, is considered as the second option when drug treatment fails, the cyst is large and the pain is very severe. 

Here, primarily the laparoscopic method (closed surgery) is preferred. The goal is to completely remove the cysts. The area where the cysts are located is completely cleaned by separating it from the organ where it is located. After the operation, drug treatment is continued, although there is a possibility of recurrence of the cysts. Chocolate cyst surgery should be designed to cause the least damage to the woman’s fertility.