Ovarian Endometrioma (Chocolate cysts)

What are ovarian endometriomas (Chocolate cysts)?

Ovarian endometriomas are highly common and may be present in up to 30-40% of women with the disease. Endometriomas are large, fluid-filled cysts that form on, and may even encapsulate, the ovaries.

How do Endometriomas form?

Retrograde menstruation is one of the believed causes of ovarian endometrioma formation. According to this theory, in cases of endometriosis women will have a higher rate of menstrual backflow, causing an accumulation of blood to flow into the ovaries, and can ultimately form an endometrioma.

As the mature egg is released from the ovaries into the fallopian tubes during ovulation, menstruation occurs. However, some of this blood enters back into the uterus, through the fallopian tubes and into the ovaries. As more and more of this blood flows in, an endometrioma begins to form and develops until it is large enough to leak out of the ovary.

Why are Endometriomas called "chocolate cysts?"

These sizable cystic masses are comprised of menstrual debris, including fragments of endometrial tissue, thickened blood, and inflammatory enzymes. These so-called "chocolate cysts", aptly named for the appearance of the "old" blood they contain, may acutely rupture, causing spillage and adherence of their contents to the walls and nearby organs within the abdominal cavity.

Endomtrioma forms, chocolate cyst
This image depicts a typical ovarian endometrioma, with old blood and debris giving the cyst its “chocolate” appearance. As you can see in the bottom left corner, this endometrioma has gotten large enough to the point that it is leaking, which often goes on to spill and adhere to the wall and organs of the abdominal and pelvic cavities.

What kind of symptoms can ovarian endometrioma lead to?

They can cause excruciating abdomino pelvic pain. All forms of endometriosis can be associated with significant pain, infertility and interruption of a woman or young girl’s ability to go about her normal routine.

Why is it so important to identify ovarian endometriomas?

Early intervention is the key to effectively resolving this disease. Usually, in patients with an ovarian endometrioma, the patient's symptoms and sonographic findings are dismissed by general practitioners, in that their symptoms are simply from a cyst. Ovarian endometriomas are probably the most clinically important stage of endometriosis since it is usually confused with hemorrhagic ovarian cysts and due to the presence of prolonged asymptomatic stage (showing no symptoms), the disease is often diagnosed late.

How is ovarian endometrioma treated?

Treatment for ovarian endometrioma is laparoscopic cystectomy (surgical removal of an ovarian cyst), involving the process of removing the lining of the endometrioma cyst and performing ovarian reconstruction and temporary ovarian suspension. The ovary is suspended temporarily in the peritoneum so that it does not adhere to the pelvic sidewalls for 4-8 hrs post-operatively. The removal of the ovarian cyst must be done with precision without compromising the ovarian vascular supply. However, It is widely known that after ovarian cystectomy for endometriosis, patients are prone to have diminished ovarian function due to loss of ovarian follicles.

Is it possible to preserve ovarian function after having surgery?

With proper adherence to meticulous techniques using microsurgical principles, we follow the strict guidelines of not using any electricity during ovarian surgery (we don't want to cook the eggs) and separate the cyst meticulously from the ovarian blood vessels. Using sutures rather than bipolar (electric) coagulation, we can reduce the occurrence of loss of ovarian function by not damaging the remaining follicles with electric coagulation.

Is it necessary to have my ovaries removed?

Rarely, is removal of the ovaries (oopherectomy) ever needed in removal of ovarian endometrioma, or any form of endometriomas for that matter. An oopherectomy should be considered only if there is a suspicion of cancer, persistence of disease despite multiple previous cystectomies, and severe adhesions with deeply infiltrating pelvic sidewall disease causing neuropathy.

Our office is located on 872 Fifth Avenue New York, NY 10065.
You may call us at 212-988-1444 or have your case reviewed by clicking here.

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Patient Reviews

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  • Angela Aro

    I have struggled with endometriosis and adenomyosis since first starting my period at 13. I was diagnosed at 21 and what followed was a series of unsuccessful surgeries and treatments. My case was very aggressive and involved my urinary tract system and my intestines. After exhausting all of my local doctors I was lucky enough to find Dr. Seckin. We…

  • Emi O

    Seckin and Dr. Goldstein changed my life!

  • Kristin Sands

    Like so many women who have tirelessly sought a correct diagnosis and proper, thorough medical treatment for endometriosis, I found myself 26 years into this unwanted journey without clear answers or help from four previous gynecological doctors and two emergency laparoscopic surgeries. I desperately wanted to avoid the ER again; a CT scan for appendicitis also revealed a likely endometrioma…

  • Wilfredo Reyes

    Dr. Seckin literally gave my wife her life back. I am eternally grateful to him for his generous, determined spirit to see that Melanie finally live free from the prison bonds of Endometriosis.

  • Carla

    I am so grateful to Dr Seckin and Dr. Goldstein. My experience was nothing short of amazing. I was misdiagnosed with the location of my fibroids and have had a history of endometriosis. Dr. Seckin was the one who accurately diagnosed me. Dr Seckin and Dr. Goldstein really care about their patients and it shows. They listened to my concerns,…

  • Melissa Boudreau

    When I think of Dr. Seckin these are the words that come to mind. Gratitude, grateful, life-changing, a heart of gold. I feel compelled to give you a bit of background so you can understand the significance of this surgery for me. I am passionate about Endometriosis because it has affected me most of my life and I have a…

  • Jaclyn Harte

    Dr. Seckin and Dr. Goldstein radically changed my quality of life. They treat their patients with dignity & respect that I've personally never seen in the literally 25+ doctors I've seen for endometriosis. This summer, I had a surgery with Dr. Seckin & Goldstein. It was my first with them, but my 5th endo surgery. I couldn't believe the difference,…

  • Megan Rafael Moreno

    I was in pain for 2 years. I was getting no answers, and because dr Goldstein and dr seckins were willing to see and treat me I'm finally feeling almost back to normal. They were very down to earth and helpful in my time of need. Dr Goldstein was easy to talk to and caring, she took care of me…

  • Nancy Costa

    Dr. Seckin is one of the best endometriosis surgeon. Every time I go to the office, he really listens to me and is always concerned about my issues. Dr Seckin's office staff are a delight and they always work with me. I feel I can leave everything to them and they will take care of it. Thank you to the…

  • Rebecca Black

    Fast forward 5 years to find out incidentally I had a failing kidney. My left kidney was only functioning at 18%. During this time, I was preparing all my documents to send to Dr. Seckin to review. However, with this new information I put everything on hold and went to a urologist. After a few months, no one could figure…

  • Monique Roberts

    I'll never stop praising Dr. Seckin and his team. He literally gave me back my life.

  • Erin Brehm

    I had a wonderful experience working with Dr. Seckin and his team before, during and after my surgery. I came to Dr. Seckin having already had laparoscopic surgery for endometriosis 5 years prior, with a different surgeon. My symptoms and pain had returned, making my life truly challenging and my menstrual cycle unbearable. Dr. Seckin was quick to validate my…

  • Anita Schillhorn

    I came to Dr. Seckin after years of dealing with endometriosis and doctors who didn't fully understand the disease. He quickly ascertained what needed to be done, laid out the options along with his recommendation and gave me the time to make the right decision for me. My surgery went without a hitch and I'm healing very well. He and…

  • Nicholette Sadé

    Dr. Seckin brought me back to life! I am now 3 weeks into my recovery after my laparoscopy surgery, and I feel like a new and improved woman! Being diagnosed with Endometriosis, then 25yrs old in 2015, and discovering the severity of my case being stage 4, made me devastated. Dr. Seckin's vast knowledge of the disease, sincere empathy, and…