Do Chocolate Cysts Cause Pain? Symptoms and Concerns

Can a chocolate cyst cause pain when it exerts pressure?

Hello Dr.
Tsao: Two years ago, I frequently experienced diarrhea, menstrual pain, and occasional discomfort in the anal area during my menstrual period.
In October of the previous year, an ultrasound revealed a 3.7 cm chocolate cyst in my right abdomen, and I have been undergoing regular follow-ups every six months since then.
However, since the end of last year, I have felt pain in the lower right abdomen when pressure is applied (for example, bending down to tie my shoes or squatting to use the restroom), and sometimes I also experience discomfort in the lower right abdomen outside of my menstrual period (though it is not extremely painful).
I mentioned this to my doctor during my follow-up visit, but the doctor did not provide much explanation, only advising me to monitor my weight (I have gained nearly 12 kg over the past two years, from 58 kg to 70 kg).

1.
Is it normal for the chocolate cyst to cause pain when pressure is applied to the abdomen or during non-menstrual periods?
2.
I have also been experiencing frequent gastrointestinal discomfort recently, and I plan to see a gastroenterologist for an examination.
However, I am concerned that my gynecological issues may be affecting my gastrointestinal health.
How can I differentiate between the two?

Niming, 20~29 year old female. Ask Date: 2017/03/24

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if you have a 3.7 cm chocolate cyst in your right abdomen, most patients generally do not exhibit symptoms.
However, if you are experiencing discomfort, it is advisable to consider consulting a gastroenterologist.
Wishing you good health.

Reply Date: 2017/03/24

More Info

Chocolate cysts, also known as endometriomas, are a type of ovarian cyst formed from endometrial tissue that grows outside the uterus. They are often associated with endometriosis, a condition where tissue similar to the lining inside the uterus grows outside it, leading to various symptoms including pelvic pain, painful periods, and sometimes gastrointestinal issues.

1. Pain Associated with Chocolate Cysts: It is not uncommon for individuals with chocolate cysts to experience pain, especially when pressure is applied to the abdomen. The pain you describe when bending over or squatting could be related to the presence of the cyst. As the cyst grows or if it becomes inflamed, it can exert pressure on surrounding structures, leading to discomfort or pain. This is particularly true if the cyst is located on the right ovary, as it may be in your case. Additionally, the hormonal fluctuations during your menstrual cycle can also exacerbate the pain associated with these cysts.

2. Gastrointestinal Symptoms: Your concerns about gastrointestinal discomfort are valid, especially since endometriosis can sometimes affect the intestines or other parts of the gastrointestinal tract. Symptoms such as bloating, cramping, or changes in bowel habits can occur in individuals with endometriosis. However, it is essential to differentiate between symptoms caused by the chocolate cyst and those stemming from a separate gastrointestinal issue.
To discern whether your gastrointestinal symptoms are related to the chocolate cyst or if they are due to another condition, consider the following:
- Timing of Symptoms: Pay attention to when your gastrointestinal symptoms occur. If they coincide with your menstrual cycle or are exacerbated during that time, they may be related to the endometriosis. On the other hand, if they occur independently of your menstrual cycle, they might be due to another gastrointestinal issue.

- Nature of Symptoms: Note the specific symptoms you are experiencing. For instance, if you are experiencing diarrhea, constipation, or significant abdominal pain that is not linked to your menstrual cycle, it may warrant further investigation by a gastroenterologist.

- Follow-Up with Your Healthcare Provider: Since you are already scheduled for a gastrointestinal evaluation, it is crucial to discuss all your symptoms with your healthcare provider. They may recommend imaging studies, such as an ultrasound or MRI, to assess the cyst and its potential impact on surrounding organs, including the intestines.

- Weight Management: Your physician's advice to monitor your weight is also significant. Weight gain can sometimes exacerbate symptoms of endometriosis and may contribute to increased abdominal pressure, which can worsen pain. Maintaining a healthy weight through a balanced diet and regular exercise can help manage symptoms.

In conclusion, while it is possible for chocolate cysts to cause pain, especially with pressure applied to the abdomen, it is essential to monitor your symptoms closely and communicate with your healthcare provider. They can help determine the cause of your discomfort and recommend appropriate treatment options. If your gastrointestinal symptoms persist or worsen, further evaluation may be necessary to rule out other conditions.

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