Chocolate Cyst


The layer that covers the inside of the uterus and is poured with menstruation.

called the endometrium. Endometriosis is the endometrium.

It is the development of tissue resembling the uterus in a place other than the uterus. General

limited to the pelvis and called the pelvis

It can be seen in any part of the body. Most

Common sites are the ovaries, peritoneum, and peritoneum.

in womb

are the sacrouterine ligaments. The outer surface of the uterus, tubes, intestines, and bladder

are places. Usually, endometriosis occurs in more than one place.

Causes of endometriosis

– Pregnancies that do not end in childbirth

– Maternal endometriosis

– Menstrual periods in which the bleeding duration is more than 8 days but less than 27 days

– Conditions that prevent the flow of menstrual blood (stenosis in the cervix, septum in the uterus)

– Being of white or yellow race

On the contrary, conditions that reduce the amount and frequency of menstruation (no menstruation-amenorrhea,

pregnancy and using birth control pills) reduce the risk of endometriosis.

The mechanism of formation of endometriosis is not fully known today. Many on this

Although the theory has been put forward, the most valid ones are;

– Backflow of menstrual blood, that is, into the abdomen. The most important condition that supports this theory is the uterus.

endometriosis is common in cases that prevent menstrual blood from flowing out in or in the mouth.

is to be seen.

– To other parts of the body through the blood or lymphatic vessels of the endometrial tissue


– Endometrial tissue that develops outside the uterus due to disruptions in the immune system

inability to grow and develop

– In the theory called celomic metaplasia, it is due to menstrual blood flowing into the abdomen or infections.


transformation into texture.

What are the symptoms of endometriosis?

It may be completely asymptomatic and the severity of the symptom is directly proportional to the extent of the disease.

may not be. eg; A woman with mild endometriosis may have severe groin pain. Again

In many women, severe groin pain is one of the most important symptoms of endometriosis. pain menstrual

It can happen before or during sex, as well as during or after sex. In addition, the intestine

If there are endometriosis foci on it, there may be pain with bowel movements, bloody stool

Premenstrual spotting, pain when urinating, or bloody urine may occur. painful period

vision may worsen over the years.

Endometrioma (Chocolate cyst)

These are large foci of endometriosis and are filled with chocolate-like blood. Generally

They are detected by ultrasound and the definitive diagnosis is made only after surgical removal.

Endometriosis is very rare before menarche (the first menstrual period in a woman’s life) and after menopause.

they are seen. If the woman has painful menstruation or has heavy bleeding

can be suspected. This should be confirmed by surgery. For a definitive diagnosis, a blood test or

imaging technique is not available.

Laparoscopy is the most commonly used method in the definitive diagnosis and treatment of endometriosis today.

or laparotomy. Both procedures can only be performed under operating room conditions. in surgery

Endometriosis foci can be seen as black, blue, pink or red. around them

adhesions or withdrawals may occur. The diagnosis is confirmed by biopsy to be performed from here.

Considering the size, depth and location of the Cearrah endometriosis focus, a

makes staging and plans the treatment accordingly.


– Observation (no treatment)

– Painkillers

– Birth control pills

– Hormonal therapy

– Surgery

– Combined therapy

In the planning of the treatment, the desire of the woman comes to the fore. female pain relief

may want or desire a child. Or there is a large mass in the abdomen and the surgeon can not directly

may decide on surgery.

Patients with minimal disease or close to menopause with non-severe symptoms

Patients may be kept under observation and no treatment may be given. Illness at the time of menopause

Since it will regress spontaneously, no treatment is given, in patients who are not married yet or if they are married.

To prevent the progression of the disease in women who do not want children and to prevent a possible pregnancy.

Birth control pills can be used to pass.

Endometriosis is a disease that progresses slowly and regresses with menopause. In most patients

Pains respond to pain medications, but some only get relief after surgery. in pregnancy

and no pain after menopause. Completed the number of children, not responding to painkillers

In women, removal of the ovaries and uterus may be considered as an option.

Endometriosis can be seen in 30-40% of couples who want to have children but cannot.

In these, surgical treatment or assisted reproductive techniques (in vitro fertilization) may give positive results.

Medical treatment or surgery can be used to relieve pain. Digestion of pain relievers

It should be kept in mind that it can cause pain, bleeding, kidney problems and

Caution should be exercised in those with high blood pressure.

Birth control pills cause endometriosis foci to shrink and shrink. Pregnancy

It is suitable for those with mild or minimal disease who have no desire. smokers and veins

It is not recommended for those with the disease.

Progesterone-containing drugs can be given to patients whose pain is not relieved by other drugs.

It can be given to patients who cannot use it (due to smoking).

GnRH agonists and drugs called danazol are due to the excess of side effects and discontinuation of the drugs.

Since it is not in use as much as before due to the re-exacerbation of endometriosis

will not be described in detail here.

Surgery is used in cases where medical treatment is insufficient or in severe endometriosis cases.

If the endometrioma (chocolate cyst) is larger than 3 cm, if there is bowel and bladder involvement

surgery is appropriate. About 80% of patients benefit from surgery and do not have side effects of drugs.

not exposed. Pregnancy within 1 year in patients who want to have a child with surgery

rates are approximately equal to assisted reproductive techniques. Endometriosis during the surgical procedure

Foci are burned or removed, ovaries and uterus in resistant cases without child will


Endometriosis and infertility

In cases of endometriosis, between the ovaries and the tubes or between the intestines and the tubes

Due to the adhesions formed, there may be difficulties in conceiving. The reason for these adhesions

Adhesive substances secreted from endometriosis foci and these are ovulation,

It can prevent fertilization and the attachment of the fertilized egg to the uterus.

As a result, if endometriosis is detected as a cause in a couple with infertility problems.

Treatment options include observation, surgery, vaccination or in vitro fertilization. Like this

There is no place for medical treatment in patients.

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