What is a Chocolate Cyst?
Symptoms of Chocolate Cyst
Causes of Chocolate Cyst
Diagnosis of Chocolate Cysts
Treatment Options For Chocolate Cysts
Chocolate Cysts Effect on Fertility
Chocolate Cyst and In Vitro Fertilisation (IVF)
Preventing Chocolate Cysts
When to See a Doctor?
Conclusion
Frequently Asked Questions

Chocolate Cyst (Ovarian Endometrioma): Causes & Treatment

Fertility

Published Date: 15-07-2024 Updated Date: 07-10-2026

Written by Medicover Team

Medically reviewed by Dr V Sita Lakshmi, Senior Consultant Gynecologist

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A chocolate cyst is a type of ovarian cyst that forms when tissue similar to the lining of the uterus grows inside the ovary. This cyst is filled with old, dark blood that looks like chocolate, which is how it got its name.

Chocolate cysts are often linked to endometriosis, a condition that can cause pain and fertility problems. In this article, we will look at the symptoms, causes, and treatment options for chocolate cysts in simple and easy-to-understand language.

What is a Chocolate Cyst?

A chocolate cyst forms when endometrial tissue (tissue similar to the lining inside the uterus) grows on the ovary. Each month, during the menstrual cycle, this tissue bleeds just like the lining inside the uterus. But instead of leaving the body, the blood gets trapped inside the ovary, forming a cyst over time.

This condition is part of endometriosis, a common but often painful disorder that affects many women of reproductive age.

Symptoms of Chocolate Cyst

Some women may not experience any symptoms, especially if the cyst is small. However, as the cyst grows, the following symptoms may appear:

Pelvic pain, especially before or during periods
Painful periods (dysmenorrhea)
Pain during sex (dyspareunia)
Bloating or swelling in the lower abdomen
Painful bowel movements or urination (often during menstruation)
Irregular or heavy menstrual bleeding
Infertility or difficulty getting pregnant

These chocolate cyst symptoms are often similar to those of general endometriosis, making diagnosis more difficult without imaging or further testing.

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Causes of Chocolate Cyst

The chocolate cyst causes an endometrioma, which is still a debatable topic. According to researchers, there are several theories about its cause. One theory is that it forms due to retrograde menstruation.

During menses, endometrial tissue must be shed.
In women with chocolate cysts, menstrual blood flows back to the ovaries.
Remnant tissues and blood adhere to the ovaries, forming cysts.
One theory suggests immune system disorders contribute to endometriosis.
The immune system fails to detect and destroy endometrial tissue outside the uterus.
Another hypothesis suggests abdominal cells from the embryonic state can become endometrial cells.
Genetic and environmental factors influence this transformation.
Endometriosis may run in families, increasing the risk for daughters and sisters.

Diagnosis of Chocolate Cysts

A Chocolate cyst may be discovered during a routine gynaecological examination, either through a vaginal ultrasound or X-ray.
A Doctor might suggest a pelvic ultrasound if he or she feels a cyst during a routine pelvic examination.

If you are symptomatic for endometriosis or if you face Infertility issues, a Chocolate cyst can be detected on ultrasound (chocolate cyst USG). Still, the type of cyst cannot be identified.

A needle biopsy may be suggested, in which the liquid is extracted from the cyst and viewed under a microscope to ascertain the diagnosis of a chocolate cyst.

Treatment Options For Chocolate Cysts

It is necessary to consult a doctor and get treatment for a chocolate cyst once a diagnosis has been confirmed. If not treated in a timely manner, it can cause infertility.

The treatment plan is based on a woman’s age, symptoms, whether both ovaries are affected or not, and your reproductive status (if she wants to have children). After diagnosis, treatment is prescribed based on the patient's condition.

Medication

Analgesics and anti-inflammatories can relieve pelvic pain.
Sometimes, it is coupled with hormonal treatment to reduce bleeding.

Large Chocolate Cysts (over 4 cm)

It may cause pain, infertility, or rarely turn cancerous.
Ovarian cystectomy via laparoscopy is suggested to remove the cyst.
Laparoscopy removes endometrial growths, scar tissue, and adhesions.
There's a risk of removing healthy ovarian tissue, which can affect ovarian reserve and function.

Severe Endometriosis

If symptoms persist and cystectomy/adhesiolysis fails, a hysterectomy may be recommended.
Consider the woman's reproductive status and age.
Complete removal of ovaries and uterus is suggested for women over 35 with completed families.

Small, Asymptomatic, Benign Cysts

Follow up with imaging tests.

Postmenopausal Women

Ultrasonography and CA 125 values are used to determine the course of action.
Benign cysts with low CA 125 are monitored with scans every 3-6 months.
Surgery is recommended if there's doubt about the cyst's benign nature.

Chocolate Cysts Effect on Fertility

Small chocolate cysts usually don’t affect fertility, especially if there’s only one and it's a few millimetres in size. However, larger cysts (over 10 cm) can cause pain and reduce the chances of pregnancy.

They may:

Lower egg count and quality
Increase FSH levels, signalling ovarian problems
Cause scar tissue and blockages in the fallopian tubes
Raise the risk of ectopic pregnancy and miscarriage
Disrupt the normal function between the ovary and fallopian tube
Damage the ovaries or require removal, leading to infertility

Early diagnosis and treatment can help protect fertility.

Chocolate Cyst and In Vitro Fertilisation (IVF)

Before undergoing any treatment, and if you are facing difficulty in conceiving due to a chocolate cyst, it is advisable to visit an Infertility specialist. Based on your medical history and the severity of your cyst, she may recommend the best treatment plan for you.

IVF is an option if a woman is facing difficulty in conceiving, though it may possess some risks. However, here, a doctor's experience counts when performing any surgical intervention. The risks associated are:

It responds slowly to gonadotropins, which might increase the rate of IVF cancellation cycles.
The cyst's location plays a significant role, as it might interfere with egg retrieval.
The risk of the chocolate cyst being punctured during an egg retrieval remains, which can cause the cyst to rupture and lead to infection.
The fluid within the chocolate cyst may contaminate the follicular fluid, reducing the likelihood of blastocyst hatching and lowering the pregnancy rate.

Fertility Preservation should be considered for women who plan to undergo surgery for endometriomas because surgery may significantly decrease AMH (Anti-Mullerian Hormone) levels, cause inflammation and remove healthy ovarian tissue.

A woman is at risk of going into Premature Ovarian Failure, which might cause early menopause.

Preventing Chocolate Cysts

There is no guaranteed way to prevent chocolate cysts fully, but you can reduce the risk or manage their growth by:

Managing endometriosis early with medical advice and regular check-ups
Using hormonal birth control to regulate your menstrual cycle
Maintaining a healthy lifestyle, including a balanced diet and regular exercise
Reducing stress, which can impact hormone levels
Monitoring symptoms, like painful periods or pelvic pain, and seeking early treatment

Early detection and proper care can help prevent complications and protect your fertility.

When to See a Doctor?

You should see a doctor if you experience:

Severe or ongoing pelvic pain
Painful periods or pain during sex
Unusual or heavy menstrual bleeding
Bloating or swelling in the lower abdomen
Trouble getting pregnant
Pain during bowel movements or urination, especially during periods

Early diagnosis and treatment of chocolate cysts can prevent complications and help protect your fertility. Don’t ignore symptoms - timely medical help is important.

Conclusion

Chocolate cysts are not cancerous, but they can cause pain and may affect a woman’s ability to get pregnant. The good news is that with early diagnosis and proper treatment, they can be managed. Some women may only need medication, while others might require surgery or IVF to improve fertility.

It’s important to listen to your body. If you have symptoms like pelvic pain, heavy periods, or trouble getting pregnant, don’t ignore them. See a doctor as soon as possible. With the right care and regular check-ups, most women with chocolate cysts can live healthy lives and even have children.

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Frequently Asked Questions

1. Can a chocolate cyst be cancerous?

Chocolate cysts are typically benign (non-cancerous). However, in rare cases especially in older or postmenopausal women they may increase the risk of developing ovarian cancer.

2. Does a chocolate cyst goes away on its own?

No, chocolate cysts usually do not go away on their own. They may stay the same or grow larger over time. Treatment is often needed, especially if the cyst causes pain or fertility problems.

3. What are risk factors for ovarian endometrioma?

Risk factors include early menstruation, short cycles, heavy periods, never having been pregnant, family history of endometriosis, and immune system-related conditions.

4. What are the complications of endometriomas?

Endometriomas can cause severe pelvic pain, infertility, ovarian damage, cyst rupture, adhesions (scar tissue), and in rare cases, an increased risk of ovarian cancer.

5. What happens if you don’t remove an endometrioma?

If left untreated, an endometrioma can grow, rupture, cause pain, reduce ovarian function, lead to infertility, or cause scar tissue that may damage nearby organs.

6. Can ovarian endometriomas grow back?

Yes, even after surgery, endometriomas can recur, especially if endometriosis is active. Hormonal treatments and regular monitoring may help reduce the risk of recurrence.

7. What can I expect if I have an ovarian endometrioma?

You may have pelvic pain, painful periods, or trouble conceiving. Expect regular check-ups and treatments like hormonal therapy or surgery based on your condition and goals.