Ovarian chocolate cysts are cysts in women’s ovaries that resemble chocolate, hence the name “chocolate cysts”. Chocolate is a symbol of sweetness, but ovarian chocolate cysts are the devil that causes women to suffer for the rest of their lives. What does endometriosis mean? Endometriosis, as the name implies, is a disease in which the lining of the uterus, which is supposed to grow in the uterine cavity, “runs” to other parts of the uterus and grows outside the cavity. Originally, the endometrium is a layer of epithelium inside the uterine cavity with strong regenerative and transformative powers that undergoes cyclical changes under the regulation of estrogen and progesterone. It is either shed periodically and mixed with menstrual blood and excreted from the body, or it becomes a breeding ground for the development of fertilized eggs. Some of the “rebellious” endometrial cells escape from the uterine cavity headquarters and set up camp in the pelvic peritoneum, ovaries, uterine surface, uterosacral ligament, intestines, bladder, ureter, cesarean section and lateral perineal incision wounds, etc., resulting in pelvic pain, infertility, pelvic and abdominal masses, abnormal uterine bleeding and corresponding symptoms in the affected organs. This is collectively referred to as endometriosis (endometriosis). Clinically, endometriosis is classified according to the location and severity of the endometriosis: peritoneal, ovarian, and deep nodular. These three types often coexist, with the ovary being the most common site of endometriosis, accounting for 20% to 40% of cases. Therefore, when endometriosis is mentioned, the first thing that comes to mind is ovarian chocolate cysts. At what age do ovarian chocolate cysts tend to occur? About 10%-15% of women of childbearing age suffer from endometriosis, which is common in women aged 25-45 years, especially in women who have few or late children, 20-40% of whom have ovarian chocolate cysts. Women who experience dysmenorrhea at menarche may be at increased risk of developing endometriosis later in life. Since endometriosis is not popular enough for women’s health and quality of life, and the lack of knowledge of patients about the disease leads to an average delay in diagnosis and treatment of about 5-6 years, young women are advised not to take dysmenorrhea lightly. Women of childbearing age should have routine medical checkups for early detection, diagnosis and treatment. How do ovarian chocolate cysts form? Why does the endometrium become ectopic where it shouldn’t go? The reason for this is not clear. The main idea is that the endometrial cells of the uterine cavity act like seeds during menstruation and flow backwards into the pelvic cavity through the fallopian tubes with menstrual blood, which is normally destroyed and cleared by pelvic immune cells. However, in a few cases, pelvic immune cells are unable to recognize or attack the refluxed endometrial cells. Ectopic endometrium planted onto the pelvis and ovaries repeatedly bleeds periodically under the influence of hormones, and stale blood accumulates in the ovarian cortex forming ovarian chocolate cysts and nuisance lesions over time. The endometrium may also spread to distant organs through the venous or lymphatic system or implant directly onto the abdominal wall incision and perineal incision. The ability of the ectopic endometrium to later form foci in a new environment is also related to the immune deficiency, endocrine disorders and genetic factors of the patient’s organism. Endometriosis tends to run in families and is most likely a polygenic disease. Can ovarian chocolate cysts become malignant? Although endometriosis is characterized by behavioral features of malignancy such as invasion into surrounding tissues, distant metastasis and easy recurrence after treatment. However, it is pathologically an uncompromisingly benign lesion. This benign lesion can also become malignant under the action of some factors, and the malignancy rate is about l%. If ovarian cysts are found in the body during physical examination or ultrasound for 3 months and do not disappear, imaging suggests ovarian chocolate cysts should not be taken lightly. It is very important to monitor changes in ovarian masses during regular physical examinations because the ovaries live deep in the pelvis and the masses often grow silently, many without clinical symptoms. If serum CA125 is significantly elevated, one should be alert to the possibility of malignant transformation. Early treatment of suspected ovarian tumors is necessary to avoid malignant transformation of ovarian masses. What is the difference between ovarian chocolate cysts and ovarian cysts? Although small in size, ovary is the organ with the most types of tumors occurring in the whole female body. According to the World Health Organization’s histological classification, ovarian tumors are divided into nine categories, the common ones being epithelial tumors, germ cell tumors, interstitial tumors of the sex cords and metastatic tumors. These tumors are subdivided into malignant, benign, and junctional between benign and malignant. All of them can be manifested as ovarian cysts, so the scope of ovarian cysts is large, and there are also physiological and pathological cysts. Ovarian chocolate cysts are only one type of ovarian cysts. They are cysts containing old blood that are formed when the endometrium growing in the uterine cavity migrates to the ovaries and under the influence of sex hormones, periodic bleeding occurs. It is a tumor-like lesion, not an ovarian tumor. Can endometriosis be prevented? Although the cause of endometriosis is not fully understood and therefore cannot be effectively prevented. However, there are some risk factors that have been clinically found to prevent and avoid the development of endometriosis if attention is paid to them. These risk factors include congenital malformations or dysplastic diseases of the female genital tract such as hymenal atresia, vaginal atresia, vaginal stenosis, cervical adhesion, cervical stenosis, uterine malformations (especially stumpy uterus), and extreme retroflexion of the uterus, which can cause poor drainage or retention of menstrual blood, resulting in retrograde flow of menstrual blood into the pelvis. Therefore, women who do not have normal menstruation or have primary dysmenorrhea at puberty should consult a doctor early for relevant examinations to exclude abnormalities of the reproductive tract, and to diagnose and treat these diseases early to avoid the development of serious endometriosis. Poor drainage of menstrual blood The reflux of menstrual blood can also be caused by acquired diseases, such as cervical lesions due to HPV infection, possible narrowing of the cervical canal after cervical conization, and cervical adhesions due to multiple abortions. In addition, early menarche, short menstrual cycle, heavy menstrual flow, strenuous activities during menstruation, late childbirth and few children are also risk factors for the development of the disease. Women of childbearing age are forbidden to engage in strenuous sports and heavy physical labor during menstruation, and avoid overexertion. Sexual intercourse must be eliminated during menstruation. Avoid unnecessary vaginal examinations. Do family planning, take oral contraceptives and avoid abortion and scraping as much as possible to reduce the chance of menstrual blood reflux. Gynecological examinations and surgical operations such as tubal lavage, hysterosalpingography and cervical surgery should be chosen to be performed within 3-7 days after menstruation to avoid causing endometrial implantation. Pay attention to adjust your emotions, maintain an optimistic and cheerful state of mind, pay attention to your own warmth, avoid catching a cold, and keep the function of the immune system and endocrine system of the body normal. The incidence of endometriosis will decrease.