Ovarian Endometrioma or Endometriotic Cyst

Medically Reviewed by Dr Sravya, MBBS, MS

Introduction

Ovarian endometrioma or endometriotic cyst is a type of cyst that forms on or within the ovaries. They are often seen in women with endometriosis. They are also known as chocolate cysts or endometrioma cysts. Endometriosis affects approximately one in every ten women of childbearing age. However, it can affect even young girls. Experts prefer to treat ovarian endometriomas surgically, as they cause severe pelvic pain and infertility and also increase the risk of ovarian cancer. This blog will focus on decoding ovarian endometrioma, its causes, symptoms, diagnosis, and management.

In This Article

What is Endometriosis?

Since endometriotic cysts are part of a more severe and chronic condition called endometriosis, let us first try to understand what this is.

Endometriosis is a chronic and progressive condition where cells similar to the uterus lining (endometrium) start to grow outside the uterus. It is the same lining that sheds and bleeds every month during periods. So, the cells found outside the uterus also thicken, shed, and bleed with the changes in hormone levels.

This monthly phenomenon causes inflammation and scarring of tissue in the pelvic area, forming bands of fibrous tissue that stick to the surrounding organs in the abdomen, like the fallopian tubes, intestines, pelvic lining, etc.

Endometriosis commonly involves the ovaries forming cysts called ovarian endometriomas or endometriotic cysts.

Endometriosis causes severe pelvic pain, especially during periods. The adhesions around the fallopian tubes can prevent them from picking up the eggs released from the ovaries, leading to infertility.

What is an Ovarian Endometrioma?

Ovarianendometriomas are fluid-filled cysts that are found on the surface of the ovary or can be deep-seated within the ovary. They contain a chocolate-colored fluid and are hence called “chocolate cysts”.

They are seen in women with endometriosis, usually in the age group of 20–45. They may grow up to 4-6 inches in diameter.

The presence of endometriomas is diagnostic of endometriosis.

How are Endometriomas Caused?

The origin of ovarian endometriomas is not clear; there are many theories. However, most experts believe it occurs when some tissue during periods flows back into the pelvic cavity through the fallopian tubes.

These cells then attach to the ovaries or enter them. Since the cells are highly hormone-sensitive, they grow, shed, and bleed depending on hormone levels, just like the uterus wall.

We know that the blood and tissue shed from the uterus come out through the vagina. However, the blood released from the endometrial cells (seeded in the ovary) does not have an outlet and collects there, forming a cyst. Over time, the blood changes color and becomes dark reddish brown or chocolate-colored.

What are the Symptoms of Endometriomas?

Women may present with symptoms that are similar to those of endometriosis. The two main presenting features are pelvic pain and infertility.

1. Pain: Women with endometrioma cysts suffer severe pelvic pain (cramps), especially during periods (dysmenorrhea). The pain may start two or three days before the onset of periods and last a couple of days after the periods
have started.

They may experience a general feeling of heaviness in the pelvic area and a backache.
They may complain of pain during sex (dyspareunia), usually during deep penetration.
They may feel pain while using the toilet (dyschezia)
Severe cramps may lead to vomiting, nausea, and diarrhea.

2. Irregular periods: Some women experience heavy period flow or shorter than usual 28-day cycles.

3. Difficulty getting pregnant: This is another common symptom seen in women with endometriotic cysts. There are extensive records to prove the association of infertility with endometriosis; up to 50% of infertile women have endometriosis.

Eggs are produced in ovarian follicles. As the cyst grows, it compresses and destroys the healthy ovarian follicles, thus causing subfertility.

The thick bands of tissues formed around the fallopian tubes may prevent the uptake of eggs released by the ovaries, causing infertility.

How are Endometriomas Diagnosed?

Consult a healthcare professional if your symptoms are similar to those listed above.

Endometrioma cysts can be confirmed only after testing the cyst under a microscope. However, your healthcare provider can diagnose endometriosis and cysts by following the given steps:
Medical History: Your doctor will want to know your medical and family history. They will inquire about your periods, their duration, flow, etc., and also if women in your family have experienced endometriosis or ovarian cysts.
Physical Examination: Your healthcare provider will perform an abdominal and pelvic exam to check for abnormalities.
Imaging: Ultrasounds are an effective method of identifying an endometrioma. Most doctors will request a vaginal ultrasound to visualize the cyst and identify its type. During this process, the ultrasound probe is placed in the vagina.
In some cases, the doctor may request an MRI or CT scan.
Blood Tests: The doctor may order a few blood tests to confirm the diagnosis.

How are Endometriomas Managed?

You cannot prevent endometriomas, and there is no cure for them. Fortunately, many effective treatments are available.

The treatment will depend on whether your main complaint is pain or infertility. Other factors, like the severity of symptoms, the size of the cyst, your age, whether you are planning to get pregnant, etc., also play a vital role in deciding the management.

Based on the above factors, endometrioma cysts are managed medically or surgically.

1. Medical management with continuous hormonal therapy works by suppressing the functions of the ovary and ovulation. It prevents the activation of the endometrial lining of the cyst and may cause the cyst to shrink, thereby relieving the pain. These hormones include:

However, because these hormones also suppress ovulation, you will not conceive while on medical treatment. So, if your main concern is infertility, medical management may not be appropriate for you. Another issue with medical management is the recurrence and growth of cysts once the treatment stops.

Pain is managed with over-the-counter or prescription pain medications.

2. Surgical management is advisable in patients with

If the patient is unmarried or her main concern is infertility, only the cyst is removed and not the ovary. This procedure is called a cystectomy. Patients who are not trying to get pregnant are then advised to undergo medical management for at least six months so that there is no recurrence.

Women who do not plan to get pregnant in the future may opt for the complete removal of their affected ovary. This procedure is called an oophorectomy. This procedure is also advised for women with badly damaged ovaries.

Endometriomas are usually seen in severe cases of endometriosis, and most cases may need the removal of both ovaries, fallopian tubes, and the uterus. This procedure is called a hysterectomy.

All these procedures are done laparoscopically if the adhesions due to endometriosis permit it. Laparoscopy is a minimally invasive method that is performed through 5 cm-long incisions in the abdomen. The removed cyst or organs are sent to pathology for a confirmatory diagnosis as well as to be tested for cancer.

Conclusion

Ovarian endometriomas can be a challenging condition. However, with early diagnosis and appropriate treatment, many women can find relief from their symptoms and maintain their fertility.

If you suspect you may have endometriomas or are experiencing symptoms, do not hesitate to seek medical advice. Your healthcare provider can help you determine the best course of action to manage this condition and improve your quality of life.

Remember, knowledge is power, and by understanding endometriomas, you can take control of your health and make informed decisions about your care. Prioritize yourself and stay happy and healthy.