Some patients with ovarian cysts detected by ultrasound must be clearly informed by the doctor at that time whether the cyst is benign or malignant and whether the diagnosis of ovarian chocolate cysts is unrealistic. ultrasound examination can clarify the presence of cysts in the pelvis, the location of the cysts, and the internal structure of the cysts, but it cannot confirm the diagnosis of endometriosis. This is because it is sometimes difficult to distinguish endoheterosis from ovarian malignancy, tuberculosis, and inflammatory masses. Depending on the patient’s condition, the doctor may recommend MRI, cystoscopy, proctoscopy, ultrasound of both kidneys and ureters, CA125, etc. MRI can clarify the presence and extent of invasion of the rectum, bladder, and ureter, and can help differentiate it from malignant tumors. Endoheterosis often invades or compresses the ureter, leading to hydronephrosis, even renal atrophy and chronic renal failure. Ultrasound of both ureters and CT of the urinary system can help to diagnose. Cystoscopy for those with periodic painful urination, frequent urination and blood in urine, and rectal colonoscopy for those with periodic blood in stool and painful defecation, can not only understand whether the bladder and rectal mucosa are involved but also biopsy to clarify the diagnosis. CA125 is not a specific indicator of cancer, but can be elevated in endometriosis, adenomyosis, inflammation and other diseases, as well as in menstruation, pregnancy and other physiological conditions. It cannot be used to diagnose endometriosis alone. The most effective method recognized for diagnosing endometriosis is laparoscopy. Not only can the diagnosis be made definitively, but the endo lesion can also be removed. Of course the most accurate diagnosis depends on postoperative pathology. In that case, is it possible to perform laparoscopic surgery directly without these tests? The above tests do not confirm the diagnosis of endo, but they can help the surgeon to rule out other diseases and narrow down the population that requires surgery. It helps the surgeon to assess the extent and degree of endo, and provides a basis for a reasonable surgical plan. Also do not refuse your doctor a gynecologic pelvic exam, as some deep nodal endografts are difficult to detect on imaging, and a pelvic exam can help with the diagnosis. Some patients ask if their chocolate cysts will disappear naturally. The answer is no. Ovarian chocolate cysts do not disappear spontaneously, even with medication. Most of those that do disappear spontaneously are physiologic cysts of the ovary. There are two common types of physiological cysts, one is called follicular cysts, which are mostly seen in the middle of menstruation, i.e. during ovulation. The other is luteal cysts, which are mostly seen in the second half of menstruation or luteal phase. Physiological cysts of the ovary are usually less than 5 cm in size, with no echoes as indicated by ultrasound (there are clinical exceptions), and are related to the cyclical changes of menstruation, and most of them will disappear naturally in 2-3 months without treatment. Therefore, regardless of whether the ovarian cyst is found for the first time during a gynecological examination with symptoms or a physical examination ultrasound, the doctor will advise the patient to observe the cyst for 2-3 months and then review the ultrasound to rule out the possibility of a physiological cyst. If the ovarian cyst does not disappear on its own in 3 months, the doctor will recommend further examination or suggest laparoscopic (open) surgery to clarify the diagnosis.