Table of ContentsView AllTable of ContentsCausesSymptomsConcernsInfertilityDiagnosisTreatmentCopingPrognosis
Table of ContentsView All
View All
Table of Contents
Causes
Symptoms
Concerns
Infertility
Diagnosis
Treatment
Coping
Prognosis
Endometriomasare cysts that can form when tissue from the lining of theuterusgrows in theovaries. They are part of a condition known asendometriosis. Endometriomas are also called “chocolate cysts” because they are filled with dark brown menstrual blood.
When you have endometriosis, endometrial tissue grows outside the uterus and into other areas of the abdomen/pelvic region.
This article explains the symptoms and causes of endometriomas. It also describes some of the possible complications and how these cysts are treated.
Ozgurcankaya / Getty Images
What Causes Endometriomas?
The cause of endometrioma isn’t known for sure, but research suggests some may form as a result ofretrograde menstruation.
In retrograde menstruation, some of a woman’s menstrual blood flows back into her body during her period instead of out through the cervix and vagina. The endometrial cells are carried backward through thefallopian tubesto the ovaries and pelvic cavity, where they implant and cause endometriosis.
Retrograde menstruation may also contribute to endometriosis. Ovarian endometriomas are found in up to 17% to 44% of women with endometriosis. With endometriomas, retrograde menstruation results in endometrial tissue being trapped in the cysts, causing inflammation.
Endometriomas are sometimes called “chocolate cysts” because they are filled with dark brown fluid consisting of old menstrual blood and tissue.
There is some evidence suggesting that anautoimmune responsecan contribute to endometriomas. In this case, the endometrial tissue that normally forms during menstruation would cause an inflammatory response that could lead to scarring and diseased tissue in the pelvis.
Symptoms of Endometriomas
Endometriomas may or may not cause symptoms. When symptoms do occur, they are the same as the symptoms of endometriosis.
These may include:
How Big Do Endometriomas Get?Endometriomas don’t usually grow larger than a few centimeters. However, it is possible for them to grow larger than that. Some can even become grapefruit-sized.
How Big Do Endometriomas Get?
Endometriomas don’t usually grow larger than a few centimeters. However, it is possible for them to grow larger than that. Some can even become grapefruit-sized.
How Serious Is an Endometrioma?
Endometriomas are not typically dangerous, though they may cause complications. Potential complications of an endometrioma include:
Rupture is a serious complication of endometriomas. Signs of aruptured cystinclude:
If an ovarian endometrioma ruptures, you may experience severe, sudden abdominal and pelvic pain on the side where the cyst is located. If you have these symptoms or think you may have a ruptured cyst, seek medical attention immediately.
Is an Endometrioma Cancerous?In rare cases, a cancerous tumor may be misdiagnosed as an endometrioma. For this reason, cysts that are larger than 4 cm and don’t resolve on their own are usually removed surgically.
Is an Endometrioma Cancerous?
In rare cases, a cancerous tumor may be misdiagnosed as an endometrioma. For this reason, cysts that are larger than 4 cm and don’t resolve on their own are usually removed surgically.
Endometriomas and Infertility
Endometriomas are considered a serious threat to fertility.Endometriosis is closely linked with infertility. As many as 50% of women with endometriosis and endometriomas have difficulty getting pregnant. Among women who are infertile, about 30% have endometriosis.
It is not known exactly how these conditions affect fertility, but experts think the increased risk may be due to:
In addition, treatments for endometriomas have the potential to destroy healthy ovarian tissues and can lead to premature ovarian failure and decreased ovarian function. Endometriomas can also interfere with fertility treatments and lead to additional complications.
Can You Get Pregnant With Endometriosis?
Your gynecologist may consider a diagnosis of endometrioma if you have endometriosis and are experiencing symptoms or have unexplained fertility. A cyst can sometimes be felt during apelvic exam.
Ultrasound
Ultrasounds are good at identifying the presence of cysts, but they might not be able to determine the exact type of cyst you have.
There are several different types ofovarian cysts, including follicle cysts, corpus luteum cysts, dermoid cysts, and cystadenomas, most of which are more common than endometriomas.
How Is an Endometrioma Treated?
Your gynecologist will develop a treatment plan for endometriomas depending on several factors. These include your age, your symptoms, whether one or both ovaries are affected, and your plans for having children going forward.
Observation and Monitoring
Cysts that are not causing symptoms are usually not treated. Instead, your healthcare provider may take a watch-and-wait approach.
Birth Control Medications
Endometriosis responds to fluctuations in the hormones progesterone and estrogen.
For women who are not actively trying to conceive, hormonal forms of birth control, such asbirth control pills,NuvaRing, or ahormonal birth control patch, can regulate hormone function, slow down cyst growth, and help reduce pain.
Surgery
Surgery to remove cysts—called ovarian cystectomy—is recommended for women who have painful symptoms, large cysts, cysts that might indicate cancer, or infertility.
This procedure involves making small incisions (cuts) in the belly and inserting alaparoscope—a thin, long tube with a camera and light. This helps the healthcare provider see and remove the cyst.
In women who are planning to conceive, the risks and benefits of an ovarian cystectomy have to be weighed carefully, because the procedure can potentially have a negative effect on ovarian function. Discuss the procedure with your healthcare provider in advance to understand any potential effects on fertility.
Complementary Therapies
While this area hasn’t been studied extensively for women who have endometrioma, some complementary or alternative therapies have been found to help some women with endometriosis.
These includeacupuncture, Chinese medicine, vitamins, and dietary supplements.Always talk to your healthcare provider before trying an alternative treatment.
Diet
In recent years, there has been a lot of interest in the role of inflammation in many diseases. Diet can affect inflammation.
Studies have shown that consuming a diet consisting largely of fresh vegetables, fresh fruit, and foods high in omega-3 fatty acids (such as salmon, halibut, walnuts, and flaxseeds) can significantly reduce the risk of endometriosis.
Eating red meat on a regular basis increases the risk.
Exercise
Stress Management
The pain and potential infertility of an endometrioma can negatively affect all aspects of your life, including work, family, and relationships. Exercising, getting adequate sleep, and seeking individual talk therapy and/or a support group for women with endometriosis may all be effective ways to reduce stress.
Ovarian endometriomas can be difficult to treat. If ongoing symptoms of endometriomas are troubling, ask your gynecologist about treatment options.
Pelvic pain and painful periods associated with endometriomas are often managed with over-the-counter medications. Other treatments are available to relieve symptoms. However, even with successful treatment, it is possible for new endometriomas to form. One study found a 15% to 55% recurrence rate after treatment.
Endometriomas can also hinder your fertility and may interfere with assisted reproductive treatments.
Summary
Endometriomas are cysts that form on the ovaries when endometrial tissue grows on the ovaries. An endometrioma can form in women who have endometriosis.
Symptoms of an endometrioma include painful periods and heavy menstrual bleeding. While these cysts are rarely dangerous, they can cause fertility problems.
A Word From Verywell
Cysts associated with endometrioma can be painful and cause stress, especially for women who are planning to have children. Fortunately, there are many treatment options as well as lifestyle measures that can manage the pain and reduce the risk of complications.
Because endometriomas, as well as the surgery used to treat them in some cases, can significantly affect fertility, it’s important to talk to your healthcare provider if you are trying to conceive.
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jayaprakasan K, Becker C, Mittal M, on behalf of the Royal College of Obstetricians and Gynaecologists.The effect of surgery for endometriomas on fertility. Scientific Impact Paper No. 55.BJOG2018; 125: e19– e28. doi:10.1111/1471-0528.14834Endometriosis Foundation of America.Sampson’s theory of retrograde menstruation.Brigham and Women’s Hospital.Deep ovarian endometriosis (endometriomas).Shigesi N, Kvaskoff M, Kirtley S, et al.The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis.Hum Reprod Update. 2019 Jul 1;25(4):486-503. doi: 10.1093/humupd/dmz014Endometriosis Foundation of America.Endometriomas and fertility.Office on Women’s Health.Ovarian cysts.Brigham and Women’s Hospital.Deep ovarian endometriosis (endometriomas).Brigham and Women’s Hospital.Medical treatment for endometriosis.Buggio L, Barbara G, Facchin F, Frattaruolo MP, Aimi G, Berlanda N.Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care.Int J Womens Health. 2017;9:281-293. doi:10.2147/IJWH.S119724Moscarini M, Milazzo GN, Assorgi C, Pacchiarotti A, Caserta D.Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate.Arch Gynecol Obstet. 2014;290(1):163–7. doi:10.1007/s00404-014-3158-z
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Jayaprakasan K, Becker C, Mittal M, on behalf of the Royal College of Obstetricians and Gynaecologists.The effect of surgery for endometriomas on fertility. Scientific Impact Paper No. 55.BJOG2018; 125: e19– e28. doi:10.1111/1471-0528.14834Endometriosis Foundation of America.Sampson’s theory of retrograde menstruation.Brigham and Women’s Hospital.Deep ovarian endometriosis (endometriomas).Shigesi N, Kvaskoff M, Kirtley S, et al.The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis.Hum Reprod Update. 2019 Jul 1;25(4):486-503. doi: 10.1093/humupd/dmz014Endometriosis Foundation of America.Endometriomas and fertility.Office on Women’s Health.Ovarian cysts.Brigham and Women’s Hospital.Deep ovarian endometriosis (endometriomas).Brigham and Women’s Hospital.Medical treatment for endometriosis.Buggio L, Barbara G, Facchin F, Frattaruolo MP, Aimi G, Berlanda N.Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care.Int J Womens Health. 2017;9:281-293. doi:10.2147/IJWH.S119724Moscarini M, Milazzo GN, Assorgi C, Pacchiarotti A, Caserta D.Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate.Arch Gynecol Obstet. 2014;290(1):163–7. doi:10.1007/s00404-014-3158-z
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Jayaprakasan K, Becker C, Mittal M, on behalf of the Royal College of Obstetricians and Gynaecologists.The effect of surgery for endometriomas on fertility. Scientific Impact Paper No. 55.BJOG2018; 125: e19– e28. doi:10.1111/1471-0528.14834Endometriosis Foundation of America.Sampson’s theory of retrograde menstruation.Brigham and Women’s Hospital.Deep ovarian endometriosis (endometriomas).Shigesi N, Kvaskoff M, Kirtley S, et al.The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis.Hum Reprod Update. 2019 Jul 1;25(4):486-503. doi: 10.1093/humupd/dmz014Endometriosis Foundation of America.Endometriomas and fertility.Office on Women’s Health.Ovarian cysts.Brigham and Women’s Hospital.Deep ovarian endometriosis (endometriomas).Brigham and Women’s Hospital.Medical treatment for endometriosis.Buggio L, Barbara G, Facchin F, Frattaruolo MP, Aimi G, Berlanda N.Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care.Int J Womens Health. 2017;9:281-293. doi:10.2147/IJWH.S119724Moscarini M, Milazzo GN, Assorgi C, Pacchiarotti A, Caserta D.Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate.Arch Gynecol Obstet. 2014;290(1):163–7. doi:10.1007/s00404-014-3158-z
Jayaprakasan K, Becker C, Mittal M, on behalf of the Royal College of Obstetricians and Gynaecologists.The effect of surgery for endometriomas on fertility. Scientific Impact Paper No. 55.BJOG2018; 125: e19– e28. doi:10.1111/1471-0528.14834
Endometriosis Foundation of America.Sampson’s theory of retrograde menstruation.
Brigham and Women’s Hospital.Deep ovarian endometriosis (endometriomas).
Shigesi N, Kvaskoff M, Kirtley S, et al.The association between endometriosis and autoimmune diseases: a systematic review and meta-analysis.Hum Reprod Update. 2019 Jul 1;25(4):486-503. doi: 10.1093/humupd/dmz014
Endometriosis Foundation of America.Endometriomas and fertility.
Office on Women’s Health.Ovarian cysts.
Brigham and Women’s Hospital.Deep ovarian endometriosis (endometriomas).
Brigham and Women’s Hospital.Medical treatment for endometriosis.
Buggio L, Barbara G, Facchin F, Frattaruolo MP, Aimi G, Berlanda N.Self-management and psychological-sexological interventions in patients with endometriosis: strategies, outcomes, and integration into clinical care.Int J Womens Health. 2017;9:281-293. doi:10.2147/IJWH.S119724
Moscarini M, Milazzo GN, Assorgi C, Pacchiarotti A, Caserta D.Ovarian stripping versus cystectomy: recurrence of endometriosis and pregnancy rate.Arch Gynecol Obstet. 2014;290(1):163–7. doi:10.1007/s00404-014-3158-z
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