Should I Consider Surgery for My Chocolate Cysts and Adhesions?

Is surgery a better option for calcified chocolate cysts that also have adhesion issues?

Hello Doctor, two years ago during an examination, I discovered a 4.5 cm chocolate cyst on the left side and a 3 cm chocolate cyst on the right side.
Since I do not plan to get pregnant for the time being and the chocolate cysts have not caused any discomfort, my doctor advised me to have follow-up examinations every six months.
Over the past two years of follow-up, the sizes of both chocolate cysts have remained stable, but my CA-125 levels have been rising, from an initial value of 67 to a recent value of 118.
During the last examination, the doctor noted that the right chocolate cyst appeared to be hyperechoic, and subsequently referred me for a high-resolution gynecological ultrasound, which revealed calcification of the right chocolate cyst and adhesion issues.
Since I still do not plan to get pregnant, the doctor suggested that I continue to monitor the situation.
However, he mentioned that the adhesions could worsen over time.
I would like to ask if not getting pregnant and not taking "You Ru" will indeed lead to worsening adhesions? (I experienced severe side effects after taking "You Ru" for one month.) Given my situation, would it be better to consider surgery now? Thank you.

GIGI, 30~39 year old female. Ask Date: 2016/08/18

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, chocolate cysts generally tend to adhere to surrounding tissues.
If there are no discomforts and the sizes of the chocolate cysts on both sides have not changed, it is recommended to simply monitor them with follow-up examinations.
Wishing you good health.

Reply Date: 2016/08/18

More Info

When considering whether to undergo surgery for chocolate cysts (endometriomas) and adhesions, several factors must be taken into account, especially given your current situation. Chocolate cysts are a type of ovarian cyst that occurs in women with endometriosis, where endometrial tissue grows outside the uterus. These cysts can cause various symptoms, but in your case, you mentioned that you have not experienced significant discomfort and have been advised to monitor the cysts through regular check-ups.

Factors to Consider for Surgery
1. Size and Symptoms: The size of your cysts (4.5 cm on the left and 3 cm on the right) is significant, but the absence of symptoms is a crucial factor. Generally, surgery is recommended if the cysts are large, symptomatic, or if there is a suspicion of malignancy. Since you have not experienced discomfort, this may suggest that surgery is not immediately necessary.

2. CA-125 Levels: Your CA-125 levels have increased from 67 to 118. CA-125 is a protein that can be elevated in various conditions, including endometriosis and ovarian cancer. While elevated levels can indicate a problem, they are not definitive for malignancy. It is essential to discuss the implications of these results with your healthcare provider, as they may recommend further imaging or monitoring based on these levels.

3. Adhesions: The presence of adhesions can complicate your situation. Adhesions can cause pain and may affect fertility in the future. If your doctor has indicated that the adhesions are becoming more severe, this could be a reason to consider surgery sooner rather than later, especially if they are causing or may cause complications.

4. Future Fertility Plans: Since you mentioned that you are not currently planning to become pregnant, this may influence your decision. However, if you plan to conceive in the future, addressing the cysts and adhesions now could improve your chances of a successful pregnancy later on.

5. Risks of Surgery: Surgery, while often effective, carries risks such as infection, bleeding, and potential damage to surrounding organs. Additionally, if you have had severe side effects from medications like "佑汝" (likely referring to hormonal treatments), this may influence your decision regarding surgical intervention.

Recommendations
Given your current situation, it may be prudent to have a thorough discussion with your healthcare provider about the following:
- Monitoring vs. Surgery: If your cysts are stable and asymptomatic, continuing with regular monitoring may be a reasonable approach. However, if there are concerns about the increasing CA-125 levels or worsening adhesions, surgery may be warranted.

- Surgical Options: If surgery is recommended, discuss the type of surgery that would be best for you. Laparoscopic surgery is often preferred due to its minimally invasive nature and quicker recovery time compared to traditional open surgery.

- Consultation with a Specialist: If you have not already, consider consulting with a specialist in reproductive endocrinology or a gynecologist with expertise in endometriosis. They can provide tailored advice based on your specific circumstances.

In conclusion, while surgery may be beneficial in certain cases, it is essential to weigh the risks and benefits carefully, especially in light of your current health status and future fertility plans. Regular follow-ups and open communication with your healthcare provider will be key in making the best decision for your health.

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