The size of the chocolate cyst is not a criterion for deciding on the surgery, but rather the patient’s clinical symptoms need to be taken into account. Surgery is mainly to control recurrent pain symptoms and avoid complications. Chocolate cyst is a recurrent bleeding lesion caused by endometriosis to the ovary, which can cause menstrual pain and other symptoms. Smaller chocolate cysts with fewer symptoms can be considered for regular checkups. In case of rupture and torsion of chocolate cysts, surgical removal of the cysts will be required under the supervision of the clinician. Chocolate cysts may recur after surgical removal, and require regular injections of medications (e.g., treprostinil, etc.) as prescribed by the doctor, and regular observation of the recovery of the adnexal region after surgery. If there are obvious symptoms of abdominal pain and discomfort, consult a doctor promptly for observation.