Endometriomas - Chocolate Cysts - In Conventional Medicine Perspective

Posted by Chantel Martiromo,  Article By Kyle J. Norton 

I. Definition
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
The 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 endometriomas.

2. Weakening of immune system
Normally, 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
During 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
This theory suggests during the embryonic stage, some endometrial cells which normally grow in the uterus instead develops in the ovaries.

5. Hormone imbalance
Endometriomas 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.

6. Hereditary
Endometriomas 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 years.

7. Toxic environment
Study 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/

8. Xenoestrogen
Interaction 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.
Sexual 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)
They 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
It 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
If 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
Pain on one side of the pelvic during menstrual cycle may be caused by endometrial implants or adhesion to that side of the ovary.

IV. Diagnosis
1. Physical Exam
Normally, during annual pelvic exam, if the mass of endometiomas are large enough, they can be detected.

2. Ultrasonography
It 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
In 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.
If 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
Trans 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
Your physician 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.

V. Treatments
A. Medication
1. Creating a continual pregnancy state
These 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
Beside 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
It 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
These 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.
6. Nausea
7. Bloating
8. Breast tenderness
9. Male pattern hair growth and deepening of voice
10 Indigestion
11. Etc.


B. Surgery
1. If fertility is a concern then
a) Laparoscopy
Most laparoscopies are completed in a hospital and usually performed under general anesthesia.
A 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.

b) Laparotomy
Similar to 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.

c) Risks
1. Bleeding caused by medical instrument during operation.
2. Injure to adjacent organs caused also by medical instrument during surgery.
3. Infection
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.

a) 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
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
Some 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
In 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)
In 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)
If 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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