Can medications cure ovarian chocolate cysts? The cause of ovarian chocolate cysts is unclear and there are no medications to cure them. The main basis of drug treatment is that endometriosis is an estrogen-dependent disease. For those who have only mild dysmenorrhea without ovarian chocolate cysts, pain medication, oral contraceptives, and progestin therapy can be chosen. The aim of treatment is mainly to suppress ovarian function, inhibit estrogen secretion, cause a pseudo-pregnancy or pseudo-menopausal state, reduce the activity of the endometriosis lesion as well as reduce the formation of adhesions, and relieve pain. Laparoscopic surgery is performed in case of ineffectiveness. Postoperative drugs are applied to suppress residual lesions, prevent recurrence, shorten the interval between recurrences, and promote fertility. All these drugs have different side effects and cannot be taken for a long time. Once the drugs are discontinued, endometriosis will be at risk of recurrence as long as there are ovaries present and as long as there is sex hormone secretion, which is the fundamental reason why ovarian chocolate cysts affect women’s health. Surgery is preferred for patients with pelvic pain, ovarian chocolate cysts and infertility for a clear diagnosis. Long-term drug treatment without a clear diagnosis is not advocated. This is because there is a significant chance that ovarian chocolate cysts are combined with other types of ovarian tumors, and there is a 1% chance of malignancy, and they respond poorly to drug therapy. What are the treatment options for ovarian chocolate cysts? (1) For those who have no fertility requirements, are around 45 years old, have severe symptoms, have lesions involving important organs or have failed to respond to multiple treatments, total hysterectomy/bilateral adnexal resection is recommended for radical treatment. After bilateral oophorectomy, the ectopic lesions will atrophy and degenerate and disappear without hormonal support. However, the vast majority of patients in clinical practice are women of childbearing age or even have not completed childbirth, and radical surgery is not possible. (2) For young patients requiring fertility and infertile patients with other infertility factors ruled out by comprehensive examination, the first step should be to make a clear diagnosis under laparoscopy as early as possible, separate the pelvic adhesions, remove the lesions visible to the naked eye, and restore the normal anatomy. The uterus and ovaries are preserved. The surgery can clarify the diagnosis, exclude malignancy, relieve pain, improve quality of life, and significantly increase the rate of natural pregnancy in mild endometriosis. The second step medication suppresses the residual lesions of endometriosis, improves the immune environment of the pelvis, and suppresses estrogen levels. The third step recommends early and aggressive use of assisted reproductive technology to assist pregnancy in moderate to severe patients. Long-term expectancy or medication should not be used. The first surgery is very important, if the lesion is not completely removed it is prone to recurrence and treatment of another recurrence is exceptionally difficult. If the lesion is removed as completely as possible there is a risk that too much ovarian tissue will be lost and postoperative ovarian reserve function will decline, affecting fertility. It is very important to balance these two aspects of surgery. However, the severity of the patient’s condition varies, and sometimes balancing is difficult. (3) For younger patients without fertility requirements, laparoscopic surgery can be chosen to remove the lesion, preserve the ovaries and uterus, and place intrauterine Mannorrhoea, a progestin-containing intrauterine device, which can provide contraception, relieve dysmenorrhea and excessive menstrual flow, and prevent recurrence of endometriosis. Patients who do not have contraindications to oral contraceptives can also take the pill for a long time. What should I do if my ovarian chocolate cyst recurs after surgery? Any treatment that preserves the ovaries may recur. The recurrence rate is related to the severity of the disease, the thoroughness of the surgery, the use of postoperative medication, the length of follow-up, and whether adenomyosis is combined. The recurrence rate 5 years after removal of ovarian chocolate cysts is 30-40%, of which 12% require reoperation. Removal of the uterus and one ovary still has a recurrence rate of 5%. Treatment after recurrence is even more difficult, especially for women with fertility requirements. Re-operation not only increases the risk of damage to the rectum, bladder, ureter and other surrounding organs, but crucially, it can lead to decreased ovarian reserve function, little or no ovulation, and even premature ovarian failure. If the ovarian cyst is not large, ultrasound-guided aspiration can be used to assist in pregnancy, but there is a risk of secondary infection and recurrence. In rare cases, ovarian cysts are malignant and puncture can cause tumor spread. Radical or semi-radical surgery is an option for those without fertility requirements.