Endometriosis (Chocolate Cyst)

Endometriosis is the localization of the endometrial tissue (inner wall of the uterus) in extra-uterine areas. Endometriotic foci may cause inflammation (inflammation) where they are located, causing menstrual pain, pelvic pain, pain during intercourse and infertility (infertility).

Endometriotic foci are most common in the pelvis, and in the pelvis, the eggs are most common (67%). Uterosacral ligaments, which are the support of the uterus, can also be seen in the fossa ovalis, Douglas cavity (the space at the back of the uterus), bladder, vagina, cervix, large and small intestines, and ureters. However, extrapelvic diaphragm can also be detected in the pleural spaces. Endometriosis is generally accepted to occur with a frequency of 10% in women.

The frequency has increased in special populations. For example, it has been reported with a frequency of 40% in adolescents with genital anomalies, 50% in women with infertility complaints, and 70% in women and adolescents with pelvic pain.

Risk factors;

not have given birth

Long-term exposure to estrogen: menses start before 11-13 years of age
late menopause
Menstruating in cycles shorter than 27 days
heavy menstrual bleeding
Genital anomalies that disrupt the flow of menstrual blood
Being exposed to physical / sexual abuse during childhood-adolescence
low body mass index
High consumption of trans-unsaturated fat


Patients usually present with pelvic pain (menstrual pain or pain during intercourse), infertility, and mass in the ovum in the reproductive age. The patient’s symptom varies according to the location, number, and size of the endometriotic implant.

In vaginal examination, endometriotic foci can be observed sensitively. Adnexal masses can be palpated and the cervix and uterus can be felt as fixed. While endometriomas can be seen with ultrasound, MRI may be required to determine the distribution and depth of the disease. There is no specific laboratory test for endometriosis. The height of Ca-125 can be seen.

Definitive diagnosis is made by biopsy from endometriotic implants and histological confirmation. The treatment is planned individually.

Nonsteroidal anti-inflammatory drugs and birth control pills can be used in patients with mild and moderate pain.

Hormone suppression treatments can be applied to those with severe pain. In cases where there is no response, surgery can be planned. Surgery is planned according to the age of the patient, whether there is a pregnancy request, the depth and extent of the lesions.

If chocolate cysts are not treated, they may continue to grow and the patient’s pain may increase. In case of rupture of the cysts, severe pain is felt.

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