Chocolate Cyst (Ovarian Endometrioma):Symptoms, Effect on Fertility & Best Treatment Options
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Chocolate Cyst (Ovarian Endometrioma): Symptoms, Effect on Fertility & Best Treatment options

Sep 2, 2020

Also known as endometrioma, chocolate cyst is one of several types of cysts on ovaries. A chocolate cyst is a sac or pouch growing on the ovary that contains fluids and sometimes semi-solid material too, in which case it may be referred to as a complex ovarian cyst. In simple words, a chocolate cyst is a blood-filled cyst found in the ovaries.

Many women are affected by chocolate cyst at some point in their lives usually before menopause. Endometrioma is one of the estrogen-dependent gynecological diseases affecting about 5% to 10% of women of reproductive age in the United States of America.

Chocolate Cyst: How Does It Form?

A chocolate cyst forms when an endometrial tissue (tissue from the inside surface of your uterus) abnormally attaches and grows in the ovaries, as it can with endometriosis. These patches of endometrial cells may form small cysts that multiply into even more cysts when stimulated by menstrual hormones. In the event of no pregnancy, the endometrial tissue usually breaks up from the body during menstrual bleeding. However, in the case of endometriosis, this doesn’t happen and instead, the blood accumulates and irritates the surrounding tissue.

Why Is It Called Chocolate Cyst?

The endometrial tissue inside the ovarian cyst responds to monthly hormones. This tissue bleeds and fills the interior of these cysts with un-clotted blood. Chocolate cysts get their name from dark old blood which is black, tarry and thick, grossly resembling chocolate. Other names for chocolate cyst are endometrial cyst, endometrioma cyst, and chocolate ovarian cyst.

Symptoms Of Chocolate Cyst Or Endometrioma

The symptoms of chocolate cyst are similar to those of endometriosis since the underlying disease is the same, but all cases are individual. As with most conditions, we all react differently. With cysts, some women, regardless of how long the cysts have been present, will have severe symptoms while other women will have little or no symptoms at all. Thus, the extent and severity of symptoms do not always correlate with how far endometrioma has progressed.

Some of the most common symptoms of endometrioma are:

  • Abdominal cramping/swelling during the menstrual cycle
  • Abnormal bleeding/spotting
  • Painful periods
  • Excessive vaginal bleeding
  • Dark-coloured vaginal discharge
  • Pain when going to the toilet—both urinating and emptying the bowels
  • Pain during sexual intercourse and
  • Pain during exercises, such as bending and stretching

Intense, sharp pain may indicate that the cyst has pressed on the ovary and this has caused it to twist and cut off the blood supply.

Chocolate cyst rupture can also be a source of severe pain. If a chocolate cyst ruptures, the contents may spill out onto the ovaries and other organs of the pelvis. This can lead to complications such as adhesions (scarring), infection, and intense pelvic pain. A ruptured ovarian cyst can be a serious medical emergency. You should consult an expert immediately if you have symptoms like excessive bleeding, fever, vomiting or severe pain.

Some other conditions that mimic this disease include ovarian cysts, Polycystic ovary syndrome (PCOS), and ectopic pregnancy. Ectopic pregnancy or tubal pregnancy is a complication when the pregnancy grows outside of your uterus.

How Does Chocolate Cyst Impact Fertility?

Chocolate cysts affect an astounding 5-10% of all women and not all of them have fertility problems. Many women are interested in knowing if a chocolate cyst will prevent or interfere with pregnancy. It is possible for a woman to still get pregnant even without removing the cyst. The odds of being fertile are very good if there is only one chocolate cyst and it is small in size. The answer is not so clearcut in more advanced cases in which multiple chocolate cysts are present and some are larger than a few inches in diameter. Here are some ways in which chocolate cysts can affect fertility:

  • Chocolate cyst growing on the ovary can prevent the ovary from forming eggs, which are to be fertilized.
  • In some cases, eggs may release from the ovary of a woman with chocolate cyst, but sperm cannot penetrate the walls of these released eggs.
  • Due to the presence of chocolate cyst, the fallopian tubes may develop scarring. This, in turn, may interfere with the transport of the egg and the sperm.
  • Apart from this, chocolate cyst can also cause a greater risk of ectopic or tubal pregnancy in affected women.
  • Moreover, there may also some other substances present in chocolate cysts that may prevent fertilization of the egg.
  • Chocolate cysts are affected by reproductive hormones and thus there may be an imbalance of these reproductive hormones. This, in turn, can prevent a fertilized egg from implanting into the uterine wall and may cause miscarriage.

How Is Endometrioma Diagnosed?

If you have any of the symptoms of endometrioma or chocolate cyst, your gynecologist may diagnose the condition by looking at your medical records, enquiring about your symptoms, and by performing a pelvic exam. While some cysts are large enough to be felt on pelvic examination, many are small and cannot be detected by clinical examination. Sometimes a transvaginal ultrasound, x-ray, or blood test may be done as well.

Ultrasound scanning is an excellent way of diagnosing chocolate cysts as it can pick up very small cysts as well. However, it’s not possible to make a definitive diagnosis of endometriosis on ultrasound scanning, as many other conditions can also produce cysts in the ovary.

The diagnosis can be confirmed either by aspirating the cyst under ultrasound guidance (and finding the typical dark old blood which is diagnostic of endometriosis); or by doing a laparoscopy. Some women do not have any symptoms so diagnosis could be made by other types of examinations.

Why Is It Important To Identify Chocolate Cyst On Time?

The most common incidents of infertility in women with chocolate cyst occur in women in the age group of 25 to 40 years. The sooner they begin treatment for chocolate cyst, the greater are their chances of having childbirth. Early removal of chocolate cyst by surgery can contribute to a lower risk of progression, relief of symptoms, and a better quality of life. Early-stage treatment of chocolate cyst will result in less damage to the ovary caused by the disease itself and by a less invasive surgical procedure.

Can Ovarian Function Be Preserved After Surgery?

After the removal of a chocolate cyst, there is a massive destruction of ovarian tissue and a reduction in ovarian reserve. Surgical removal may worsen ovarian function by removing healthy ovarian tissue or compromising blood flow to the ovary. With proper adherence to techniques using microsurgical principles and following the strict guidelines of not using any electricity during ovarian surgery, one can separate the cyst meticulously from the ovarian blood vessels. Using sutures rather than bipolar (electric) coagulation can reduce the occurrence of loss of ovarian function by not damaging the remaining follicles with electric coagulation.

Is It Necessary To Remove Ovaries To Treat Endometrioma?

The removal of ovaries (oopherectomy) is needed very rarely in the removal of ovarian chocolate cysts, or any form of endometrioma for that matter. This option should be considered only if there is a suspicion of cancer or persistence of disease despite multiple previous cyst removals.

Treatment Options For Chocolate Cyst

Conventional Treatment Of Chocolate Cyst

chocolate cyst
Conventional Treatment Of Chocolate Cyst

As mentioned above, an accumulation of menstrual blood leads to the development of cyst and other health conditions. Stopping menstruation can reduce the size of the cysts and symptoms of these types of diseases. Different hormones are used for this purpose. Oral contraceptive pills (OCPs), injection progesterone, Danazol and GnRH analogs are used to stop menstruation. Among all OCP is the cheapest and convenient drug. GnRH analogs are the most effective and expensive drug. Long continued use of GnRH analogs causes menopausal symptoms like hot flush.

In case of a big cyst and severe symptoms, surgery in the form of adhesiolysis and cystectomy is the treatment of choice. Surgery can be done by laparoscopy or laparotomy. Laparoscopy is the gold standard treatment for endometriosis and it needs expertise. In severe endometriosis, even conservative surgery like adhesiolysis and cystectomy may not cure the disease. So if the family is complete and patient’s age is more than 35, removal of ovaries and uterus can cure the disease completely. Because the source of development of cyst (ovaries) are removed all symptoms also revert.

Natural Remedies For Chocolate Cyst

chocolate cyst
Natural Remedies For Chocolate Cyst

Chocolate cysts are triggered by an imbalance in the immune and reproductive systems. Natural therapies are a good choice for cysts that are small and do not threaten the health of the ovary. Here are the top ten natural remedies for ovarian cysts. Also, do consult an expert for proper diagnosis and treatment.


Heat is said to be quite effective in reducing muscle cramps or pain in the abdomen due to ovarian cysts.

Castor Oil Pack

Castor oil packs are an age-old remedy for ovarian cysts. Castor oil clears the body of excess tissues and toxins. It also stimulates the lymphatic and circulatory systems, which helps in reducing and dissolving ovarian cysts.
Note: Do not use castor oil packs during menstruation. If you are trying to conceive then do not use this remedy after ovulation.

Epsom Salt Bath

An Epsom salt bath will also greatly help reduce the pain and other symptoms associated with ovarian cysts. The high magnesium sulfate content in Epsom salt works as a muscle relaxant that in turn eases pain.

Chamomile Tea

Herbal tea like chamomile tea is also considered as a good remedy for treating ovarian cysts and the associated pain and discomfort. The gentle sedative effect of chamomile tea will reduce pain and help you in relaxing. Also, the warm nature of this tea helps in normalizing irregular periods by stimulating blood flow to the pelvic area and uterus.

Apple Cider Vinegar

Apple cider vinegar can help shrink and dissolve ovarian cysts caused by potassium deficiency. It is high in potassium and recommended by many health experts.

This remedy will also help with the symptoms of excessive menstrual bleeding as well as bloating and cramping throughout periods.


Beetroot contains a compound known as betacyanin that boosts the liver’s ability to remove toxins out of your system. Plus, the alkaline nature of beetroot helps in balancing acidity in your body. This, in turn, reduces the severity of many symptoms of ovarian cysts.

Try An Antimicrobial Herbal Formula

Some herbs can help reduce inflammation and support normal reproductive function. Goldenseal (Hydrastis canadensis), Jamaican Dogwood (Piscidia erythrina), Red Raspberry (Rubus idaeus), Wild Yam (Dioscorea villosa) are some herbs that can help.

Balance Excess Estrogen With DIM

DIM (diindolylmethane) can help your body eliminate excess estrogen that fuels the growth of endometriosis. Here’s the general dosage of DIM: 100-400mg daily with meals.


Yoga and aromatherapy serve as excellent home remedies for ovarian cysts. These alternative therapies are useful in improving hormonal imbalance and easing the pain caused by chocolate cyst.

Increase fluid intake

When suffering from ovarian cysts, it is essential to increase your fluid intake. Your best option is water. Try to drink alkaline as well as filtered water at regular intervals. You can also add a dash of lemon juice to water before drinking it. Water will flush out harmful toxins from your system.This, in turn, will reduce your pain and alleviate swelling in your abdomen.

Along with water, you can drink coconut water and green vegetable juice. Avoid coffee, soda, and alcoholic beverages.

Dealing with the severe health problems due to PCOD can feel overwhelming, but the good news is that the condition can be reversed naturally using a holistic approach, with Sepalika’s 5-Petal PCOD Programme. Our personalised protocols help treat PCOD at the root through diet, nutrition, exercise, Ayurveda and magnet acutherapy.

Dr. Manthan Mehta
is a research-physician by profession. He believes that drugs, though necessary, are not the only way to prevent or cure a disease. A holistic approach is the best way to eliminate an ailment from your system. He, however, advises to try well-researched modalities that have passed the rigors of scientific testing.