Posted by Chantel Martiromo, Article By Kyle J. Norton
Endometriomas - Chocolate Cysts are definition as a
health condition of endometrial cells forming in the outside of the
ovaries, leading to endometriosis on the surface of the ovaries. They
also react to hormone stimulation during the menstrual cycle, by building
up tissue, breaks it and eliminates it through menstrual period that
causes blood spilling over the abdominal cavity, causing menstrual
cramps and pain. Since chocolate cysts - endometriomas are filled with a thick chocolate-type material, they are called chocolate cysts.
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II. Causes of chocolate cysts - endometriomas
The causes of endometriomas are still unknown, here are some suggestions and theories.
1. Retrograde menstruation
retrograde menstruation theory suggests that during menstruation the
blood flows backward instead of outward causing menstrual blood to go
through the fallopian tubes to the pelvic and abdominal cavity,
resulting in blood embedding on the outside of the ovaries, causing
2. Weakening of immune system
the immune will destroy endometrial cells which are located outside
the uterus. If the immune system is weakened and no longer functions
normally, it will allow the endometrial cells that shed to attach and
grow on the surface of the ovaries.
3. Stress and emotion
stress and emotion, the adrenal glands produce cortisol which affects
the function of the body to cleanse toxins resulting in stimulating the
growth of endometriomas.
4. Embryonic theory
theory suggests during the embryonic stage, some endometrial cells
which normally grow in the uterus instead develops in the ovaries.
5. Hormone imbalance
happen during reproductive years of women when estrogen and
progesterone are most active. In each stage of the menstrual cycle,
estrogen and progesterone must be balanced for women to conceive. Any
imbalance of hormones during the menstrual cycle causes conversion of
estrogen into bad estrogen and over-production of prostaglandins,
leading the cervix to contract resulting in no escaping of the menstrual
period, causing menstrual cramps and endometriomas. Nutritional
deficiency is also one of the causes of hormone imbalance.
may be genetics passing through from generation to generation or it
may be resulted from genetic errors, causing some women to become more
likely than others to develop the condition. Study shows that women are
5 times more likely to develop endometriomas if her sister has it. It
is wise for these women to have children in their early reproductive
7. Toxic environment
shows that exposing our body to toxins found in pesticides and some
harmful waste products may have some hormonal and chemical influence,
causing activation of endometriomas at the time of menstrual cycle.
resulting in proliferating of endo-tissues to the ovaries/
of our body with certain chemicals causes a disruption of the body's
hormones as resulting of over-production of estrogen converting to
xenoestrogen to stimulate the growth of endometriomas.
9. Sex during menstruation.
intercourse during menstruation causes the endometriosis tissue to
travel into the fallopian tubes then into the ovary resulting in
developing ovarian endometriomas.
Since endometriosis is treatable and manageable by natural remedies and self help course, if you have endometroisis, please look at the bright side.
III. Symptoms of chocolate cysts - endometriomas
1. Progressively increasing dysmenorrhea (menstruation cramps and pain)
are caused by contractions of uterine muscles as resulting of over
production of certain hormones of the prostaglandins family from the
endometriomas, as her periods become more painful or that the pain
begins earlier or lasts longer.
2. Pain during intercourse
The penetration motion of the penis can produce pain in an ovary bound by endometrial implants or adhesion.
3. Severe period pain
normally happens with over-production of prostaglandins and
leukotrient causing the cervix to contract resulting in no escape for
the menstrual period.
4. Difficult to get pregnant
the cyst is presented in the ovary, it will respond to hormone changes
in the menstrual cycle causing the cysts to get large every month
blocking the normal function of ovaries resulting in infertility.
5. Pain elevate to ward the end of period.
Since the blood cannot escape, it retents in our body causing damage
to the organs or any part of the body hosting the endometriosis
resulting in severe pain toward the end of the period.
9. Pain in one side of pelvic
on one side of the pelvic during menstrual cycle may be caused by
endometrial implants or adhesion to that side of the ovary.
1. Physical Exam
Normally, during annual pelvic exam, if the mass of endometiomas are large enough, they can be detected.
is defined as a diagnostic imaging technique that uses high frequency
sound waves to create a picture of our body internal organs including
tendons, muscles, joints, vessels. Accuracy in diagnosing endometriomas
varies with the experience of the radiologist.
There are two types of ultrasonography diagnosis
a) Ultra sound
order to evaluate the abdominal including the uterus. You will be
lying down with a full bladder for the procedure then a high frequency
waves will pass through your body abdominal region with a medical
device move back and forth in the abdomen with a thin jellylike
substance applying to the skin on your abdomen to improve the contact
of your body.
After the image is taken, either the operator or the
doctor in the office will explain to you what have been seen. You will
be asked to either take the image to your doctor or they will send it.
there are endometriomas or chocolate cysts, they will be captured in
the image because of their darker shapes than other fluid filled cysts.
b) Trans vaginal ultrasound
vaginal ultrasound is defined as ultrasound taken with a transducer
inserted into the vagina ( if you are discomfort with this procedure,
you may ask the operator that you will do the insertion yourself to
decease your discomfort). The transvagina ultrasound works well for
measuring the thickness of the endomerium, endometrial hyperplasia,
endometriomas and cancer.
3 . Laparoscopy
suspect the disease if you complains of severe menstrual cramps or pain
with intercourse, he/she may suggest laparoscopy to look in side your
uterus and ovaries, so he/she can visually confirm the presence of the
endometriomas and gauge its extent and most of the time, a small piece
of tissue can be removed for biopsy.
1. Creating a continual pregnancy state
types of medication help to stop or reduce period with stimulating the
corpus luteun in ovary to continue producing progesterone such as
continuous dose of the Pill, Provera and Danazol.
2. Reducing the blood flow volume
the Pill as we mentioned above, progestogens are one of the
conventional medication that use in maintaining pregnancy. With high
progesterone in your body, it reduces blood flow in menstruation or
tricks your body to think that you are pregnant.
3. Create a menopausal state
is necessary for the surge of estrogen for woman's body to start the
menstrual cycle, estrogen inhibitors medication stop the production of
estrogen from the ovary resulting in tricking your brain that you are
now at menopausal state. Without surging of estrogen there is no
menstrual cycle. These types of medication include all GnRH agonist
range of drugs.
4. Stop the pain
Over producing of
prostaglandins that control the ovarian muscles contraction will cause
menstrual pain. These types of medication include prostaglandins
inhibitor medicines, the Pill, painkiller, etc.
5. Regulating hormone swing
types of medication are used to treat symptomsof endometriosis or pre
menstruation in menstrual cycle such as depression, anxiety. It
includes the Pill, anti depressants, etc.
B. Side effects and risks
In general, taking the above medication may cause the following side effects and risks.
1. Blood clots
2. Stroke and heart attacks
3. Weight gain
4. Hormonal imbalance
5. Long term loss of period after coming off the Pill in some women.
8. Breast tenderness
9. Male pattern hair growth and deepening of voice
1. If fertility is a concern then
Most laparoscopies are completed in a hospital and usually performed under general anesthesia.
laparoscopy is a medical instrument that is used by a doctor for
viewing and tissues removing in the operation table. Through a incision
at the abdominal wall, the thin instrument passes into the abdominal
cavity. Laparoscopic hysterectomy is an operation that involve in
removing the present of endometriomas during the course of the
laparoscopy. Today, many physicians insert a slightly larger telescope
through the umbilical port, which allows them to use a carbon dioxide
laser to destroy the endometriomas.
laparoscopy, laparostomy is a surgery performed through a larger
incision. You may be required to stay 1 to 3 days in the hospital
following the surgery. If exceedingly large ovarian cysts, ovarian cysts
are found and suspicious for cancer.
1. Bleeding caused by medical instrument during operation.
2. Injure to adjacent organs caused also by medical instrument during surgery.
4. Anesthesia risk.
2. If you are over 40 and fertility is not a concern
Then your gynecologists will recommend the removal of both ovaries by bilateral oophorectomy
General anesthesia is needed and the operation is done in the hospital.
Normally, bilateral oophorectomy is done with a laparoscopic surgery.
Laparoscope is a thin tube containing a tiny lens and light that
inserts through a small incision in the navel with a camera on the
other end that allows your doctor to see the abdominal cavity on a
video monitor. Both ovaries are removed though a small incision at the
top of the vagina.
b) Vertical incisions
give the doctor better view of of the abdominal cavity but it will
leave some notable scar. If cancer is detected, a vertical abdominal
incision is needed. After the incision the ovaries are removed.
c) Horizontal incision
If the ovaries are removed by horizontal incisions, it will leave a less notable scar.
d). Risk and side effects
i) Heavy blood loss caused by medical instrument used during surgery.
ii) Heaving bleeding during or after operation
iii) Infection of the incision area, may be caused by bacteria or medical instruments.
iv) Needed to stay to hospital for 2 - 5 days
v) Time to recover is longer. It may take 3- 6 weeks to return to normal activity.
VI. Endometriomas and Fertility
women with endomatriomas can conceive naturally, but unfortunately for
some, if the endometriomas grow large enough to block the extruding of
egg into the fallopian tube. It is evidence that endometriomas also
affect the quality of egg and impair ovulation in some women.
1. Treatment with medication
case of endometriosis interfere with production of the egg, fertility
medication may be required for production of many eggs, resulting in
increasing the chance of conception such as Clomid.
2. Treatment with artificial insemination
a) In vitro fertilisation (IVF)
IVF , sperm is introduced to the egg outside of women body, after
fertilization, it will be implanted back to the woman's uterus.
b) Intrauterine insemination (IUI)
IUI is a relatively simple infertility treatment. It places some selected sperms directly into the uterus.
c) Gamet Intrafallopian transfer (GIFT)
the endometriosis interferes with the with function of the ovary, GIFT
is helpful to assist reproductive treatment by placing the egg and
sperm cells into one of the fallopian tubes.
d) Intracytoplasmic sperm injection (ICSI)
For the same reason above, ICSI technologies inject one sperm cell directly into an egg, with a small, specialized needle.
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