Twenty-five percent of patients with endometriosis are asymptomatic and are often seen for a pelvic mass found on physical examination. However, some ovarian chocolate cysts are often combined with other sites of endometriosis, causing patients pain mainly in the form of chronic pelvic pain and infertility. (a) Chronic pelvic pain: 80% of patients have different degrees and different types of pelvic pain, which makes patients suffer from pain. (1) Dysmenorrhea: It is a common and prominent symptom. Some patients have menstrual abdominal pain, abdominal cramps, nausea and vomiting since the beginning of menarche, which is primary dysmenorrhea. Most patients have normal menstruation at the beginning of menstruation, and from a certain period, they have cyclic abdominal pain, low back pain and lower limb involvement pain during, before or after menstruation, which requires bed rest or medication for pain relief in severe cases and affects patients’ life, study and work. We call it secondary dysmenorrhea. (2) Acute abdominal pain: Ovarian chocolate cysts are prone to rupture when their volume increases especially during menstruation or late menstruation. Once ruptured, the fluid inside the cyst flows out into the pelvic abdominal cavity, stimulating the peritoneum and causing sudden onset of severe abdominal pain in the lower abdomen, accompanied by anal swelling. Although the rupture of ovarian chocolate cysts does not affect blood pressure and other vital signs, if not treated by surgery in time, it may easily cause secondary infection, fever, aggravate the adhesion of pelvic and abdominal organs and affect the reproductive function, and in serious cases, lead to intestinal obstruction. (3) Painful stool: Patients often feel painful when passing stool through the rectum during menstruation, which is a typical symptom of having utero-rectal fossa, vaginal rectal septum and rectal endorectal ectasia. If the lesion invades the rectum, it will cause narrowing of the intestinal lumen and symptoms of urgency, constipation and obstruction, and if the lesion invades the rectal mucosa, there will be menstrual blood in the stool. It is often misdiagnosed as rectal cancer. (4) Periodic painful urination, frequent urination, and blood in urination are symptoms of endocele. (5) Painful intercourse: If the endoheterosis lesion occurs in the posterior vaginal fornix and uterosacral ligament area, it will cause thickening of the sacral ligament, sclerosis and shortening, adhesion of the pelvic floor peritoneum to the surrounding tissues or involvement of the nerves, and pain will be felt during intercourse, which affects sexual life. (6) Endometriosis at the abdominal wall caesarean incision and perineal incision scars presents with periodic local mass enlargement and pain around the incision. (2) Infertility: Patients are concerned about infertility, so does chocolate cyst necessarily lead to infertility? Ovarian chocolate-like cysts do not absolutely cause infertility, but 40% of patients have primary infertility, and 80% of infertility patients have endometriosis. Infertility involves many aspects, firstly, ovarian chocolate-like cysts affect ovarian reserve function, with ovulation disorders in 17-27% of cases and luteal malfunction. Secondly, the dense adhesions of the pelvic and abdominal organs in endometriosis lead to incompetent or incompetent fallopian tubes that affect the picking up of oocytes; the increase of inflammatory factors in the pelvic cavity in endometriosis affects conception; the endometrium often has polyp-like changes that affect the implantation of pregnant eggs. Currently, no medication alone can improve the pregnancy rate. Even with IVF, the pregnancy rate is lower than that of infertility due to tubal factors. (iii) Menstrual disorders: 15%-30% of patients with endometriosis have symptoms of increased menstrual flow, prolonged periods and premenstrual spotting, which are related to cysts that destroy ovarian tissue, ovarian dysfunction or complications of uterine fibroids and adenomyosis, the latter two also being common conditions affecting women’s health.