Endometriomas are cysts that can form when tissue from the lining of the uterus grows in the ovaries. They are part of a condition known as endometriosis. Endometriomas are also called "chocolate cysts" because they are filled with dark brown menstrual blood.
When you have endometriosis, endometrial tissue grows outside the uterus and into other areas of the abdomen/pelvic region.
This article explains the symptoms and causes of endometriomas. It also describes some of the possible complications and how these cysts are treated.
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What Causes Endometriomas?
The cause of endometrioma isn't known for sure, but research suggests some may form as a result of retrograde menstruation.
In retrograde menstruation, some of a woman’s menstrual blood flows back into her body during her period instead of out through the cervix and vagin*. The endometrial cells are carried backward through the fallopian tubes to the ovaries and pelvic cavity, where they implant and cause endometriosis.
Retrograde menstruation may also contribute to endometriosis. Ovarian endometriomas are found in up to 17% to 44% of women with endometriosis. With endometriomas, retrograde menstruation results in endometrial tissue being trapped in the cysts, causing inflammation.
Endometriomas are sometimes called "chocolate cysts" because they are filled with dark brown fluid consisting of old menstrual blood and tissue.
There is some evidence suggesting that an autoimmune response can contribute to endometriomas. In this case, the endometrial tissue that normally forms during menstruation would cause an inflammatory response that could lead to scarring and diseased tissue in the pelvis.
Symptoms of Endometriomas
Endometriomas may or may not cause symptoms. When symptoms do occur, they are the same as the symptoms of endometriosis.
These may include:
- Painful periods
- Pelvic pain, not related to monthly periods
- Irregular periods
- Heavy periods
- Pain during sexual intercourse
How Big Do Endometriomas Get?
Endometriomas don't usually grow larger than a few centimeters. However, it is possible for them to grow larger than that. Some can even become grapefruit-sized.
How Serious Is an Endometrioma?
Endometriomas are not typically dangerous, though they may cause complications. Potential complications of an endometrioma include:
- Infertility
- Ovarian cancer (very rare)
- Blockage of the urinary tract or bowel
- Chronic pelvic pain, which may be debilitating
- Ovarian torsion, leading to severe pain
Rupture is a serious complication of endometriomas. Signs of a ruptured cyst include:
- Pain with fever and vomiting
- Sudden, severe abdominal pain
- Faintness, dizziness, or weakness
- Rapid breathing
- Bleeding
If an ovarian endometrioma ruptures, you may experience severe, sudden abdominal and pelvic pain on the side where the cyst is located. If you have these symptoms or think you may have a ruptured cyst, seek medical attention immediately.
Is an Endometrioma Cancerous?
In rare cases, a cancerous tumor may be misdiagnosed as an endometrioma. For this reason, cysts that are larger than 4 cm and don't resolve on their own are usually removed surgically.
Endometriomas and Infertility
Endometriomas are considered a serious threat to fertility. Endometriosis is closely linked with infertility. As many as 50% of women with endometriosis and endometriomas have difficulty getting pregnant. Among women who are infertile, about 30% have endometriosis.
It is not known exactly how these conditions affect fertility, but experts think the increased risk may be due to:
- A decrease in the "ovarian reserve," or the number of eggs available for fertilization: This may be due to the hormonal effects of the cysts.
- Inflammation: It is believed that inflammation may interfere with the functions of the sperm and egg cells, making fertilization more difficult.
- Fluid in the cysts: This may result in embryos that are not viable.
In addition, treatments for endometriomas have the potential to destroy healthy ovarian tissues and can lead to premature ovarian failure and decreased ovarian function.Endometriomas can also interfere with fertility treatments and lead to additional complications.
Can You Get Pregnant With Endometriosis?
Diagnosis
Endometriomas are diagnosed and treated by a gynecologist, a doctor who specializes in women's reproductive health.
Your gynecologist may consider a diagnosis of endometrioma if you have endometriosis and are experiencing symptoms or have unexplained fertility. A cyst can sometimes be felt during a pelvic exam.
Ultrasound
Ultrasounds are good at identifying the presence of cysts, but they might not be able to determine the exact type of cyst you have.
There are several different types of ovarian cysts, including follicle cysts, corpus luteum cysts, dermoid cysts, and cystadenomas, most of which are more common than endometriomas.
How Is an Endometrioma Treated?
Your gynecologist will develop a treatment plan for endometriomas depending on several factors. These include your age, your symptoms, whether one or both ovaries are affected, and your plans for having children going forward.
Observation and Monitoring
Cysts that are not causing symptoms are usually not treated. Instead, your healthcare provider may take a watch-and-wait approach.
Birth Control Medications
Endometriosis responds to fluctuations in the hormones progesterone and estrogen.
For women who are not actively trying to conceive, hormonal forms of birth control, such as birth control pills, NuvaRing, or a hormonal birth control patch, can regulate hormone function, slow down cyst growth, and help reduce pain.
Surgery
Surgery to remove cysts—called ovarian cystectomy—is recommended for women who have painful symptoms, large cysts, cysts that might indicate cancer, or infertility.
This procedure involves making small incisions (cuts) in the belly and inserting a laparoscope—a thin, long tube with a camera and light. This helps the healthcare provider see and remove the cyst.
In women who are planning to conceive, the risks and benefits of an ovarian cystectomy have to be weighed carefully, because the procedure can potentially have a negative effect on ovarian function. Discuss the procedure with your healthcare provider in advance to understand any potential effects on fertility.
Complementary Therapies
While this area hasn't been studied extensively for women who have endometrioma, some complementary or alternative therapies have been found to help some women with endometriosis.
These include acupuncture, Chinese medicine, vitamins, and dietary supplements. Always talk to your healthcare provider before trying an alternative treatment.
Coping
In addition to medical approaches, you may find some relief from the symptoms and stress of an endometrioma by adjusting certain aspects of your lifestyle.
Diet
In recent years, there has been a lot of interest in the role of inflammation in many diseases. Diet can affect inflammation.
Studies have shown that consuming a diet consisting largely of fresh vegetables, fresh fruit, and foods high in omega-3 fatty acids (such as salmon, halibut, walnuts, and flaxseeds) can significantly reduce the risk of endometriosis.
Eating red meat on a regular basis increases the risk.
Exercise
Exercise may relieve the pain of endometrioma by encouraging healthy circulation, decreasing excessive estrogen production, relieving stress, and releasing pain-relieving endorphins in the brain.
Stress Management
The pain and potential infertility of an endometrioma can negatively affect all aspects of your life, including work, family, and relationships. Exercising, getting adequate sleep, and seeking individual talk therapy and/or a support group for women with endometriosis may all be effective ways to reduce stress.
Prognosis
Ovarian endometriomas can be difficult to treat. If ongoing symptoms of endometriomas are troubling, ask your gynecologist about treatment options.
Pelvic pain and painful periods associated with endometriomas are often managed with over-the-counter medications. Other treatments are available to relieve symptoms. However, even with successful treatment, it is possible for new endometriomas to form. One study found a 15% to 55% recurrence rate after treatment.
Endometriomas can also hinder your fertility and may interfere with assisted reproductive treatments.
Endometriosis and endometriomas are influenced by hormones and can continue throughout your childbearing years. Many women find menopause brings permanent relief from endometriosis and endometriomas.
Summary
Endometriomas are cysts that form on the ovaries when endometrial tissue grows on the ovaries. An endometrioma can form in women who have endometriosis.
Symptoms of an endometrioma include painful periods and heavy menstrual bleeding. While these cysts are rarely dangerous, they can cause fertility problems.
A Word From Verywell
Cysts associated with endometrioma can be painful and cause stress, especially for women who are planning to have children. Fortunately, there are many treatment options as well as lifestyle measures that can manage the pain and reduce the risk of complications.
Because endometriomas, as well as the surgery used to treat them in some cases, can significantly affect fertility, it's important to talk to your healthcare provider if you are trying to conceive.
