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Endometriosis (Chocolate Cyst)
Endometriosis (Chocolate Cyst)
22 April 2022
Endometriosis (Chocolate Cyst)
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What is Endometriosis?

Endometriosis is a disease seen in women of reproductive age. The disease takes its name from the "endometrium" tissue, which covers the inner layer of the uterus and thickens and sheds every month during the menstrual period.

Endometriosis, colloquially known as a chocolate cyst, is the glandular tissue that forms the inner part of the uterus and provides menstrual bleeding outside the uterus.

Wherever the inner membrane layer of the uterus is located, it holds the organ and causes complaints according to the organ it holds. Endometriosis can affect the ovaries, abdominal cavity, intestines, outer lining of the uterus, bladder, lungs, and even the brain.

What Causes Endometriosis (Chocolate Cyst)?

It is not known exactly what causes a chocolate cyst. Many theories have been put forward about how the chocolate cyst forms, but none of them has become clear. Regardless of the theory, the underlying genetic predisposition is seen as the most important risk factor.

Retrograde Menstruation

One of the most accepted theories is that the blood that needs to be thrown out during menstruation goes back to the tubes from the uterus and spreads from there to the abdominal cavity, intestines and ovaries. It is thought that the living endometrial cells in this blood settle in the organ where they go and continue to grow there.

More frequent endometriosis in patients with severe menstrual bleeding and prolonged frequent menstruation supports this theory.

Cecemic Epithelial Metaplasia

According to this theory, endometriosis suggests that epithelial organs in developing organs can self-replace (metaplase). However, the question of why this change is not in everyone was not answered.

Spread by Blood

The presence of endometriosis in the lungs and brain was tried to be explained by blood and lymphatic spread, but no consensus could be reached on this issue.

Spread via Lymph

Lymph circulation is a circulatory pathway that continues outside of the intravascular circulation and is thought to play a role in the transport of endometriosis cells.

Direct Spread of Endometrial Cells

Genetic predisposition

Perhaps the only consensus theory about how a chocolate cyst occurs is genetic predisposition.

Weak Immune System

Decreased immune system is counted among the causes of chocolate cyst. Even if there is reverse blood flow during menstruation, a woman with a normal immune system will destroy these endometrial cells that go out of the uterus by natural killer cells.

As a result, viable endometrial cells cannot survive in those areas and are destroyed. However, if the immune system is weak, endometriotic cells cannot be cleared by the body and continue to grow where they go.

Having Excess Estrogen and Prostaglandins in the Body

One of the mechanisms that play a key role in the development of endometriosis is the increase in estrogen level as a result of increased aromatase enzyme activity. Chocolate cyst is actually an estrogen dependent disease. Because endometriosis is not seen before puberty and after menopause. This supports this theory.

Endometriosis Symptoms

Endometriosis can often present with the following signs and symptoms:

  • Severe menstrual pain
  • Severe and long-standing abdominal pain outside of menstrual period
  • Painful intercourse
  • Painful tampon use or inability to use tampons
  • Painful defecation, voiding, blood in stool or urine
  • Infertility, pregnancy loss, preterm birth
  • Allergy and concomitant immunological diseases
  • Back and leg pain (in endometriosis involving the sciatic nerve)
  • Difficulty in breathing during the menstrual period and pain caused by breathing (endometriosis in the diaphragm muscle) may suggest.
  • Chronic fatigue, menstrual irregularities
  • Anxiety and depression

What are the Endometriosis Treatment Methods?

Chocolate cyst treatment is mostly done with drugs and surgery. The endometriosis treatment method to be determined by the patient and the doctor may vary depending on the severity of the symptoms and the desire of the person to be pregnant.

Drug (Hormone) Treatment

Hormone supplements can, in some cases, give a positive result in the treatment of pain caused by endometriosis. During the menstrual cycle, the fluctuations of hormones cause the uterine tissue outside the uterus to thicken and subsequently dissolve and bleed. With hormone therapy, endometrial tissue development can be slowed down and new foci formation can be prevented.

But hormone therapy is not a definitive treatment for endometriosis. Symptoms may reoccur after treatment is completed.

Progesterone Treatment

A cervical device, birth control injection or pill-like progesterone treatment can prevent menstrual bleeding and the development of endometrial foci. Thus, the pain and symptoms caused by endometriosis can be reduced.

Endometriosis Surgery

If you have endometriosis and you want to get pregnant, you can increase your chances of getting pregnant by treating your uterus and ovaries without damaging your uterus and ovaries with surgical operations that eliminate the disease.

Conservative Surgery

If you suffer from severe pain caused by the disease, surgery may be helpful. However, postoperative pain can still recur. Your doctor can start this operation laparoscopically or with an open operation for different conditions. In laparoscopic surgery, the specialist surgeon puts a visual device called laparoscope, which passes through the belly button with the help of a thin incision into the stomach cavity. Thus, it completes the treatment by removing the endometrial tissues from another small incision.

Hysterectomy

In severe cases, the last option is total hysterectomy. This operation is the best method to completely destroy the uterus, cervix and ovaries. However, hysterectomy operation, in which only the uterus is removed, may be ineffective because the ovaries still present in the body can trigger endometriosis tissue by producing estrogen. Thus, it can cause the pain to recur.

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