Chocolate Cysts: Treatment Options and Fertility Concerns - Obstetrics and Gynecology

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Chocolate cyst


I underwent surgery for a chocolate cyst on January 4th of this year.
The cyst was 10 centimeters in size, and I had laparoscopic surgery.
However, once I was in the operating room and the surgery began, the doctor discovered that adhesions had enveloped my left ovary and fallopian tube quite severely.
As a result, the adhesions were not completely removed because the doctor mentioned that laparoscopic surgery could lead to significant bleeding.
I am currently taking a medication called Primolut-Nor 5mg, manufactured by Taiwan's Sinopharm Co., Ltd.
The doctor advised me to take it for 4 to 6 months.

I have a few questions: Is the purpose of this medication to lower estrogen levels in order to reduce the chances of developing chocolate cysts? Additionally, there is an injectable treatment that costs between 8,000 to 10,000 TWD, administered once every 28 days for six months, followed by taking birth control pills until I decide to conceive.
I would like to know what ingredients are in this injection and whether there are any side effects.
Some patients have mentioned that this injection is ineffective.

As I am unmarried and still studying, I am concerned about how these medications might affect my future ability to conceive.
I would also like to gain a deeper understanding of the causes of chocolate cyst formation.

vondas, 20~29 year old female. Ask Date: 2001/02/13

Dr. Xu Junzheng reply Obstetrics and Gynecology


Chocolate cysts are a type of endometriosis, formed by the accumulation of endometrial tissue in the ovaries.
The use of injections aims to induce a pseudomenopause through medication, with side effects that may include symptoms of menopause.
However, once the medication is discontinued, there is a high likelihood of recurrence.
Whether using oral medications or injections, there should be no impact on fertility after a period of discontinuation.
Thank you.

Reply Date: 2001/02/13

More Info


Chocolate cysts, also known as endometriomas, are a type of ovarian cyst formed when endometrial tissue, which normally lines the uterus, grows on the ovaries. This condition is often associated with endometriosis, a disorder in which tissue similar to the lining of the uterus grows outside the uterus. Understanding the implications of chocolate cysts on fertility and the available treatment options is crucial for women who wish to conceive in the future.


Impact on Fertility
Chocolate cysts can significantly affect fertility. The presence of these cysts may lead to adhesions, which are bands of scar tissue that can bind organs together. In your case, the severe adhesions that were found during your laparoscopic surgery indicate that your left ovary and fallopian tube were affected, potentially impacting their function. Adhesions can obstruct the fallopian tubes, preventing the egg from traveling to the uterus, which can hinder conception.

Moreover, the hormonal environment created by chocolate cysts can disrupt normal ovarian function. Elevated levels of CA-125, a protein that can be a marker for endometriosis, may indicate the severity of the condition. In your situation, a CA-125 level of 53 suggests a significant presence of endometriosis, which could further complicate your fertility prospects.


Treatment Options
1. Medication: The medication you are currently taking, Primolut-Nor (5 mg), is a progestin that helps regulate hormonal levels and can reduce the size of endometriomas. This medication is often prescribed to manage symptoms and prevent the growth of endometriosis. It is essential to follow your doctor's advice regarding the duration of this treatment, as it may help in stabilizing your condition before considering pregnancy.

2. Surgical Intervention: If medication does not yield satisfactory results, or if you are planning to conceive soon, surgical options may be considered. Laparoscopic surgery can be performed to remove chocolate cysts and any adhesions. However, as you experienced, there are risks associated with surgery, including potential damage to healthy ovarian tissue, which can affect egg reserve.

3. Hormonal Injections: The injections you mentioned, which cost between $8,000 to $10,000 and are administered every 28 days, are likely hormonal therapies designed to suppress ovarian function and reduce the growth of endometriosis. These injections can have side effects, including weight gain, mood changes, and potential impacts on bone density. The effectiveness of these injections can vary among individuals, and some may find them less beneficial.


Future Fertility Considerations
Given that you are currently unmarried and pursuing your studies, it is understandable to have concerns about how these treatments may affect your future fertility. Hormonal treatments, whether oral or injectable, are generally reversible, and many women successfully conceive after completing their treatment. However, it is essential to have open discussions with your healthcare provider about your long-term fertility goals and the best strategies to achieve them.


Causes of Chocolate Cysts
The exact cause of chocolate cysts is not fully understood, but several factors may contribute to their formation:
- Retrograde Menstruation: This theory suggests that menstrual blood flows backward through the fallopian tubes into the pelvic cavity instead of exiting the body, leading to the growth of endometrial tissue outside the uterus.

- Immune System Disorders: An impaired immune system may fail to recognize and destroy endometrial cells outside the uterus.

- Hormonal Factors: Estrogen may promote the growth of endometrial tissue, contributing to the development of chocolate cysts.

In summary, chocolate cysts can pose challenges to fertility, but with appropriate management and treatment, many women can still achieve their reproductive goals. It is crucial to work closely with your healthcare provider to monitor your condition and explore the best options for your individual circumstances.

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