Chocolate cysts, the incidence of which has been increasing in recent years, especially among those who are infertile. Here is a good overview for those of you who are preparing for pregnancy.
How does chocolate grow on top of the ovaries?
First of all, it should be clarified that it is not the ovaries that give birth to chocolate, and it is not the chocolate cysts that grow only after eating too much chocolate. So, this “chocolate” is not to eat! The foodies can take a detour. Chocolate cysts are a common type of endometriosis, where the ectopic lining that has escaped the uterine cavity grows in the ovaries and forms cysts.
Since it is endometrium, even if it is not in the uterine cavity, it is affected by fluctuations in estrogen and progesterone during the menstrual cycle, and grows a little once you have a period. Then the shed endometrium cannot be excreted like menstruation, but stays in the cyst and accumulates more and more. This old bleeding resembles chocolate fluid, so it is commonly known as a chocolate cyst. In fact, the scientific name is “ovarian endometriosis cyst”, which is like a naughty child who runs away from home and stands on her own feet.
How does endometriosis occur?
This is more complicated, there are many kinds of statements, which specific cause, En brother can not say at once, later have the opportunity to again eight eight. The most classic theory is that menstrual blood flows backwards from the fallopian tubes to the pelvis, and individual active endothelial tissues take root and grow wherever they go. The most common site is, of course, the ovaries.
What are the possible cases of chocolate cysts?
How can we know if we have a “runaway child” in our belly? The first thing to look out for is those who may have endometriosis, as they are nearly half as likely to have chocolate cysts.
1. Be alert if you have dysmenorrhea, especially if it worsens from year to year, or if it comes from nothing; or if you have frequent pain in the lower abdomen, and if the pain is cyclical, then be more suspicious.
2. Patients who are infertile should also be careful. Nearly half of the patients with endometriosis will be infertile. This may be due to endometriosis causing pelvic adhesions and tubal adhesions leading to compromised tubal patency; chocolate cysts can also affect ovarian function and non-ovulation; they can also produce many inflammatory factors affecting normal pregnancy
3. Patients who are infertile should also be careful. Almost half of the patients with endometriosis will be infertile. It may be due to endometriosis causing pelvic adhesions and tubal adhesions resulting in the degree of tubal patency being affected; chocolate cysts can also affect ovarian function and non-ovulation; they can also produce many inflammatory factors affecting normal pregnancy
4. in some patients with endometriosis, stomach pain during sexual intercourse.
5. if the chocolate cyst affects ovarian function, it will cause menstrual disorders.
6. if the chocolate cyst grows to a certain extent, it may be found to rupture, with pain on one side of the lower abdomen, either mild or severe, requiring emergency surgery in severe cases.
When these situations occur, you have to go to rule out the presence of chocolate cysts. Of course, there are also some patients who usually have no obvious discomfort and may only be detected during routine physical examinations.
How can chocolate cysts be detected?
In addition to routine gynecological examination, ultrasound is the most valuable non-invasive examination method, how ultrasound also can not eat, you can consider MRI examination. Combined with a blood CA125 test, most chocolate cysts will be elevated to some extent. Of course, it needs to be differentiated from other types of ovarian cysts, and the most accurate one is of course surgery + pathological diagnosis, all other tests may have some errors.
Should I have surgery first or get pregnant first?
If the cyst is less than 4cm, the dysmenorrhea is mild, and there is no history of infertility, then you can try to conceive without surgery first. The ultrasound and the blood CA125 level should be reviewed regularly during the pregnancy trial. Once the pregnancy is successful, then it is the best treatment. Because, the progesterone in the body is significantly higher during pregnancy, it can inhibit the growth of ectopic endometrium and make it shrink. Therefore, chocolate cysts during pregnancy will basically not grow and even shrink in the later stages.
If you have a cesarean section, you can deal with the cysts incidentally. If you have a normal delivery, you can continue to follow up the ultrasound after delivery, and if it does not progress, you can also not operate, or use medication to control it and delay it. If you are breastfeeding for a longer time after delivery, you can delay the return of menstruation, which will also help to slow down the progress of the disease.
What should I do if I find out I have a chocolate cyst only after I am pregnant?
Of course, you should continue your pregnancy for the same reason as above. However, if the cyst is too large, you should be careful of rupture of the cyst during pregnancy, which may cause abdominal pain and, in severe cases, miscarriage.
Is there any medicine that can cure it?
Eunuch can say with certainty that there is no medicine that can cure endometriosis, including chocolate cysts. There are many different drugs available, but all of them can only inhibit the progression of the disease to a certain extent, there is no way to cure it. If there was a way to cure it, one drug would be enough and there would be no need for so many options.
Expensive drugs, such as GnRHa, have a better remission effect, with a shot every 28 days, but the side effects are also relatively large, and the duration of medication should not be too long, usually 3-6 months. The cheaper ones, such as birth control pills, have fewer side effects and can be used for years, but the relief effect is also much worse. All these drugs, during the use of the drug, have different degrees of suppression of the disease, but after stopping the drug, basically will continue to progress.
Moreover, all these drugs, during their use, have a contraceptive effect, which is not favorable for mothers-to-be who are preparing for pregnancy. Therefore, they are generally indicated for those who need surgery, and are applied in combination after surgery to suppress any ectopic endometrium that may remain. And most choose GnRHa, because studies have found that the combination of GnRHa after surgery has a much higher success rate of pregnancy than other drugs.
When do I need surgery?
If the cyst increases to 5cm, CA125 is significantly elevated, severe dysmenorrhea medication has not worked conservatively, or if you have been trying to conceive for 1 year without success. Then, surgery is needed. The best way of surgery is elective laparoscopic surgery, because it is minimally invasive.
During the surgery, the cysts can be removed and the pelvic endometriosis lesions that exist at the same time can be treated. If there are adhesions in the fallopian tubes, they can also be broken down at the same time, and a tubal lavage can be done to understand the patency.
A comprehensive evaluation of the fallopian tubes, ovaries and pelvis can also be done during the procedure, either by r-AFS or the Endometriosis Fertility Index. Those with low scores can try to get pregnant after surgery; those with high scores are directly advised to do IVF and not to waste time trying.
How long after surgery can I get pregnant?
Usually, after one or two periods after surgery, you can go to try to conceive. It is also possible to combine GnRHa shot treatment for 3-6 months after surgery to inhibit recurrence on one hand, and on the other hand, the success rate of pregnancy will be a little higher in the first 1-2 months after GnRHa discontinuation. The choice of these treatment modalities and the timing of trying to conceive depends on the specifics of the procedure and the patient’s requirements for the timing of fertility.
After an incision, how did it grow back!
After chocolate cyst debulking surgery, it is easy to recur. According to statistics, after conservative surgery, the 5-year recurrence rate is as high as 40%-50%, and the combined surgery + medication also has a 20% recurrence rate. If recurrence occurs and there is a requirement for fertility, then the first step is not to go back to surgery immediately, because repeated surgery will accelerate the decline of ovarian reserve function and reduce the success rate of pregnancy.
It is recommended to go to a fertility center first for an evaluation. If the cysts are not large and there are problems with tubal patency, IVF can be done directly. If the cyst is large, you can consider puncture to extract the cyst fluid and do IVF after 3-6 months of control with GnRHa; or laparoscopic surgery again after egg retrieval and embryo transfer after surgery.
If you are preparing for pregnancy, if you encounter chocolate cyst for the first time, it is relatively better to deal with it and the pregnancy success rate is higher. If you encounter recurrence, it is more difficult and you need to communicate well with your doctor for a successful pregnancy.