Chocolate Cysts: Symptoms, Diagnosis, and Fertility Concerns

Examination

During my last routine ultrasound examination, the doctor mentioned that there were no issues with my uterus or ovaries.
1) I would like to ask if a routine ultrasound can detect the presence of endometriomas (chocolate cysts)? For the past year, I have experienced chocolate-colored discharge two days before my period and two days after, along with noticeable dull pain on both sides of my ovaries before my period.
Can this be used as an indicator? What symptoms are associated with endometriomas? 2) If further examination is needed, when would be the most appropriate time to do it, either before or after my period? Can it be done simultaneously with progesterone testing? 3) Additionally, I would like to inquire if breast tenderness three weeks before my period could be a sign of elevated prolactin levels? 4) Lastly, we have been married for a year and a half without conceiving.
The doctor simply mentioned that we need to check for any blockages in the fallopian tubes.
Does a blockage in the fallopian tubes prevent ovulation, and under what circumstances can the fallopian tubes become blocked? I apologize for the lengthy questions, but I am currently abroad and having some communication difficulties with the local doctors, so I hope you can help clarify these concerns.
Thank you.

Xiao Ying, 20~29 year old female. Ask Date: 2004/12/23

Dr. Lin Zhaopei reply Obstetrics and Gynecology

1.
Chocolate cysts are not related to chocolate secretions.
When endometriosis leads to the formation of cysts on the ovaries, these are referred to as chocolate cysts.
The symptoms include 1.
dysmenorrhea, 2.
infertility, and 3.
dyspareunia.
2.
The timing of ultrasound examinations is related to the menstrual cycle, with different tests performed on different days.
If the examination is for chocolate cysts, the timing is not relevant.
For blood tests measuring general hormones, it is more accurate to test between days 3 to 5 of the menstrual cycle, while progesterone should be tested on day 21 of the cycle.
3.
Elevated prolactin levels are usually associated with prolonged menstrual cycles or milk secretion and are often related to psychiatric medications, brain tumors, or unknown causes.
Generally, breast tenderness in young women is mostly due to hormonal stimulation leading to breast swelling.
4.
To determine if there is a blockage in the fallopian tubes, a hysterosalpingography can be arranged, which is unrelated to ovulation.
Generally, causes of infertility include: a.
ovulation and luteal function b.
inflammation or blockage of the fallopian tubes c.
implantation issues within the uterine cavity and cervical antibodies d.
male factors.
If a woman has experienced pelvic inflammatory disease three times or more, the likelihood of fallopian tube blockage significantly increases.

Reply Date: 2004/12/23

More Info

Understanding chocolate cysts, also known as endometriomas, is essential for women experiencing symptoms related to their reproductive health. Chocolate cysts 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 where endometrial-like tissue grows outside the uterus, leading to various symptoms and complications.

1. Diagnosis through Ultrasound: A standard ultrasound can indeed help in identifying chocolate cysts. These cysts typically appear as dark, fluid-filled sacs on imaging studies. The presence of chocolate-colored fluid within the cyst is a characteristic feature. However, while ultrasound is a useful diagnostic tool, it may not provide a definitive diagnosis. In some cases, a laparoscopy, a minimally invasive surgical procedure, may be required for a conclusive diagnosis. Symptoms such as premenstrual pain, chocolate-colored discharge, and discomfort in the pelvic area can suggest the presence of chocolate cysts, but they are not definitive indicators on their own.

2. Timing of the Examination: The timing of the ultrasound in relation to your menstrual cycle can influence the results. Generally, it is recommended to perform the ultrasound during the follicular phase (the first half of the menstrual cycle) for better visualization of the ovaries and any cysts. Blood tests for hormones, including progesterone, can also be conducted, with the best time for testing progesterone being about a week after ovulation (around day 21 of a typical cycle). This timing allows for a clearer understanding of your hormonal status and any potential issues related to ovulation.

3. Breast Tenderness and Prolactin Levels: Breast tenderness in the weeks leading up to menstruation is common and often related to hormonal fluctuations, particularly estrogen and progesterone. Elevated prolactin levels can also cause breast tenderness and may be associated with other symptoms such as irregular menstrual cycles or galactorrhea (milk production). If you suspect high prolactin levels, a blood test can confirm this, and further evaluation may be necessary to determine the underlying cause.

4. Fertility Concerns and Tubal Obstruction: If you have been trying to conceive for over a year without success, it is reasonable for your doctor to investigate potential causes of infertility, including tubal obstruction. Blocked fallopian tubes can prevent the egg from meeting the sperm, thus hindering conception. Tubal obstruction can occur due to various reasons, including pelvic inflammatory disease (PID), endometriosis, or previous surgeries. It is important to note that tubal blockage does not directly affect ovulation; women can still ovulate normally even if their tubes are blocked. However, if you have a history of PID or other risk factors, it may increase the likelihood of tubal issues.

In conclusion, if you are experiencing symptoms that suggest the presence of chocolate cysts or other reproductive health issues, it is crucial to follow up with your healthcare provider for appropriate testing and management. Understanding the symptoms, timing of examinations, and potential implications for fertility can empower you to make informed decisions about your health. If communication with your current healthcare provider is challenging, consider seeking a second opinion or consulting a specialist in reproductive health or endocrinology for further evaluation and guidance.

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