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Chocolate Cysts: Symptoms, Causes, Risk Factors, Diagnosis, and Treatment Options

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Chocolate Cysts: Symptoms, Causes, Risk Factors, Diagnosis, and Treatment Options

Obstetrics and Gynaecology | Posted on 07/11/2024 by Dr. Tripti Dadhich

Chocolate cysts, also called ovarian endometriomas are fluid-filled cysts that usually develop deep within the female ovaries. The name chocolate is given because of its tar-like appearance which is brown and looks like melted chocolate affecting one or both ovaries. This condition occurs from old menstrual blood and tissue filling the cavity of the cyst. It arises in 20-40 per cent of females dealing with endometriosis, one of the common disorders in which the uterus lining develops outside the uterus and on the ovaries, fallopian tubes, and other reproductive areas. Understanding the nature, symptoms, causes, risk factors, diagnosis, and treatment options for chocolate cysts is crucial for managing this condition effectively. If you experience heavy menstrual bleeding, pelvic pain, etc. book your appointment with one of the best gynaecologists in Jaipur at CK Birla Hospitals for proper diagnosis and treatment solutions that are suitable for your condition. However, please note that this write-up is for informative purposes only and does not replace the importance of a professional consultation. If you are facing any problems or issues related to this, make sure to visit a gynecologist.

What are Chocolate Cysts?

Chocolate cysts, also referred to as ovarian endometriomas, are fluid-filled sacs that form on the ovaries due to endometriosis in which tissue similar to the uterine lining develops outside the uterus. Females with a family history of endometriosis or those who have never given birth are prone to developing chocolate cysts. Their colour looks like chocolate because they include blood that is old and dark brown. These sacs may impair fertility, causing pelvic pain, mainly during periods. Medications to control symptoms and surgery to eliminate the sacs are primary treatment options to treat this condition. Early diagnosis and treatment play a pivotal role in reducing symptoms and maintaining ovarian function. Chocolate cysts, specifically affect females of reproductive age, usually who are between 20- 40 years old. 

What Are the Symptoms of Chocolate Cyst?

In certain cases, some females may not experience any symptoms of chocolate cysts and are only detected during a routine pelvic examination or ultrasound. The symptoms of chocolate cysts might differ depending on an individual but here are common symptoms: 

Symptoms of Chocolate Cysts 

Pelvic pain during periods 

Infertility or facing issues when trying to conceive 

Heavy periods 

Feeling the urge to pee often

Irregular periods

Discomfort during urination

Bloating and abdominal discomfort 

Pain during sexual intercourse

What Are the Causes of a Chocolate Cyst?

Chocolate cysts are mainly linked to endometriosis according to the theory of experts, while their precise cause is unknown. Endometrial cells may spread via the bloodstream or lymphatic system, or pass through the fallopian tubes and implant in the ovaries. However, it is also believed that chocolate cysts are also associated with a family history of endometriosis. 

What Are the Risk Factors of a Chocolate Cyst?

Several factors can increase the risk of developing chocolate cysts, including:

Risk factors 


Family history 

Women who have a history of endometriosis are vulnerable to develop chocolate cysts 


Females of reproductive age, especially those between 20-40 are prone to this condition 

Menstrual history 

Heavy menstrual cycles or short cycles are contributing factors to chocolate cysts 

Hormonal imbalances 

High estrogen levels increase the risk of developing chocolate cysts 

Lifestyle factors 

Involves a lack of exercise, poor dietary habits, stress, etc. 

How are Chocolate Cysts Diagnosed?

The diagnosis of chocolate involves a combination of tests such as: 

  • Pelvic Exam: Involved to check for anomalies in the reproductive system of a female. 
  • Ultrasound: Involves using sound waves to capture an image of the ovaries to identify the presence of cysts.
  • MRI: This test helps obtain detailed pictures of the cysts including surrounding tissues.
  • Laparoscopy: In this minimally invasive surgical procedure, a camera is inserted by making a small incision into the abdomen to view the cysts directly and take a biopsy if required. 

What Are the Options Available for Chocolate Cyst Treatment?

Treatment for chocolate cysts involves considering certain factors such as the size, location, and severity of the cysts also whether or not fertility is a problem. Depending on the analysis, healthcare providers often recommend the following treatment options: 

  • Medications: Involves painkillers and hormonal therapy, such as progestins, GnRH agonists, and birth control tablets, which can help control chocolate cyst symptoms and shrink them.
  • Laparoscopic surgery: A viable option for cyst removal while securing the ovarian tissue. 
  • Oophorectomy: Also, known as hysterectomy, the removal of the ovaries, might be needed in severe cases.
  • Lifestyle modifications: A healthy diet, regular exercise, and stress reduction are some of the most important lifestyle changes that assist in reducing symptoms and improving overall well-being.


Chocolate cysts can substantially affect a woman's quality of life, particularly if it is not treated on time. Initial diagnosis and proper treatment are crucial to manage symptoms and prevent the possibility of complications. If you notice any symptoms of chocolate cysts, seek medical assistance to ensure adequate diagnosis and an individualised treatment plan. Understanding the nature and management of chocolate cysts can help you take proactive steps to maintain your reproductive health.

Faq - 


Is chocolate cyst dangerous?

Chocolate cysts aren’t harmful as they often dissolve on their own. But if the cysts are developing continuously filled with fluid and old blood, then it might turn into something serious. 

Can chocolate cysts shrink?

No, they don’t shrink on their own because endometriosis leads to permanent issues when the condition is in its advanced stage. Regular monitoring by a healthcare expert is crucial for suitable management.

Can I get pregnant with a chocolate cyst?

Yes, most women can get pregnant easily even if they have a chocolate cyst, but women suffering from endometriosis, might experience problems when trying to conceive as it is linked with infertility. 

Can chocolate cysts be cancerous?

Chocolate cysts are benign, but they can put females dealing with endometriosis at risk of developing cancer. However, the risk is still very low, so, seeking medical assistance on time is helpful.

Do chocolate cysts cause infertility?

Yes, Chocolate cysts, linked to endometriosis, can cause infertility by interfering with regular ovarian functionality, deforming pelvic anatomy, and causing complications during egg fertilisation and implantation.