Chocolate Cyst: Symptoms, Causes, and Treatment Options

Understanding what a chocolate cyst is and how it affects the body is crucial for those experiencing or learning about this medical condition.

Key takeaways:

  • Chocolate cysts are ovarian cysts filled with old blood.
  • They are linked to endometriosis and can cause pelvic pain.
  • Symptoms may include menstrual irregularities and infertility.
  • Diagnosis involves pelvic exams and imaging techniques.
  • Treatment options include medication, surgery, and lifestyle changes.



chocolate cyst

A chocolate cyst, medically known as an endometrioma, is a type of ovarian cyst filled with old blood, resembling chocolate syrup.

It is linked with endometriosis, a condition where tissue similar to the lining inside the uterus grows outside it.

Chocolate cysts result from endometrial tissue attaching to the ovaries and forming a cyst, which fills with menstrual blood.

These cysts can range in size and often lead to pelvic pain and can affect fertility.

Their management is crucial in alleviating discomfort and preventing potential complications.


Endometriosis, a condition where tissue similar to the lining inside the uterus grows outside of it, is often the catalyst for these benign ovarian masses. During menstruation, the tissue inside the cyst bleeds, resulting in the accumulation of old blood that resembles chocolate, hence the name “chocolate cyst“. Factors increasing one’s risk of developing such cysts include genetic predisposition, having a low body mass index, and experiencing menarchal cycles at a young age.

Hormonal imbalances also play a role, as they can encourage the development and persistence of endometrial tissue outside the uterus. Environmental toxins, such as dioxin, have been suggested to influence the occurrence of endometriosis, potentially affecting the formation of these cysts.


Individuals with chocolate cysts may not always experience symptoms, especially in the early stages. However, when symptoms do occur, they can include:

  • Pelvic pain: This discomfort may be constant or occur during menstruation or sexual intercourse.
  • Menstrual irregularities: Periods may become heavy, irregular, or more painful than usual.
  • Bloating and abdominal pressure: The growth of the cyst can cause a sensation of fullness or pressure in the abdomen.
  • Urinary or bowel discomfort: If the cyst presses against the bladder or bowel, it may lead to increased frequency of urination or pain during bowel movements.
  • Infertility: In some cases, these cysts can affect ovulation or lead to complications with fertility.

It is important to note that these symptoms can be similar to other conditions, making accurate diagnosis crucial.


Identifying a chocolate cyst typically involves a combination of patient history, physical exams, and imaging techniques. A pelvic exam may reveal cysts on the ovaries, but for more precise information, ultrasound is the tool most commonly used. It allows the healthcare provider to visualize the cysts’ size, location, and characteristics.

In some cases, MRI can provide additional details, especially if the ultrasound results are inconclusive. This imaging method gives a clearer view of the endometriomas and can differentiate them from other types of ovarian cysts.

For definitive diagnosis, laparoscopy, a minimally invasive surgery, may be performed. This not only confirms the presence of chocolate cysts but also provides an opportunity for immediate treatment. Biopsy, the removal of a small tissue sample during laparoscopy, can verify the cyst’s nature by analyzing the type of tissue present.


Management of chocolate cysts often involves a multi-faceted approach:

  • Medication: Hormonal treatments can regulate the menstrual cycle, reduce or eliminate the growth of endometrial tissue, and alleviate pain. Pain relievers may also be prescribed for immediate relief.

Surgery: Laparoscopy, a minimally invasive surgical procedure, may be recommended to remove cysts and improve fertility. In severe cases, more extensive surgery may be necessary.

Watchful waiting: Small, asymptomatic cysts may only require regular monitoring without immediate intervention.

Lifestyle changes: Regular exercise and a balanced diet can improve symptoms. Stress reduction techniques may also benefit overall well-being.

Fertility treatments: If chocolate cysts are affecting fertility, assisted reproductive technologies such as in vitro fertilization (IVF) may be considered.

Each treatment plan is tailored to the individual’s symptoms, cyst size, location, and personal family planning goals. Regular follow-ups with a healthcare provider are essential to monitor the condition and adjust treatment as necessary.