Chocolate cyst is a disorder that manifests itself with severe pain in the pelvic region that is not affected by painkillers, especially during sexual intercourse, menstruation or at any other time. Apart from this, it can often have infertility effects such as inability to conceive in women. Studies have determined that chocolate cysts have an important place among the causes of infertility in women. If women with these complaints go to the doctor, they can most likely be diagnosed with chocolate cysts with an ultrasound examination.
Since the cause of chocolate cyst formation has not yet been determined, there is no definitive treatment method for it. The aim of the applied treatments is to reduce the complaints of the patients and to ensure that the cyst is removed. It can be said that the most effective treatment for these cysts is surgical intervention.
How is treatment planned for chocolate cyst?
When planning the treatment of chocolate cyst patients, the aim is to first reduce the patient's complaints. These treatments are determined according to whether the patient wants to have children, their age, whether there is an infertility problem due to the cyst, and the stage of the cyst. For cysts in the first and second stages, which are mild and minimal, only monitoring of the cyst may be recommended. Because the cyst has not yet caused infertility or severe pain in the woman. If the cysts need to be treated, medical treatment or surgical treatment can be preferred. These treatments can also be used in combination. These are determined according to the condition of the patient and the cyst.
Treatment methods applied to chocolate cyst
The first recommendation of doctors on this issue is to try conservative treatment approaches for the patient. Surgery is preferred in the last stage for patients. Medication or closed surgery can be used in treatment. These approaches may vary depending on the severity of the findings and the woman's desire to become pregnant.
Painkillers
In order to reduce painful menstrual cramps in patients with chocolate cysts, the use of non-steroidal anti-inflammatory drugs, ibrufen or naproxen-type painkillers is recommended. If these drugs are used at the recommended dose and do not provide relief, other treatment methods are used.
Hormone Therapy
In women, externally administered hormones may have an effect in reducing or eliminating endometriosis. Due to differences in hormone levels during monthly menstrual cycles, endometrial tissue thickens, sheds and bleeds. Externally administered hormone medications can slow the growth of these tissues or prevent new formations. However, this approach to treatment does not provide a permanent solution for patients. After treatment is stopped, the disorders begin to recur.
Hormonal treatments used in the treatment of chocolate cysts (Endometriosis)
Hormonal contraceptives: Birth control pills, vaginal rings and patches used by patients can help control the hormones responsible for the accumulation of endometrial tissue on a monthly basis. In most patients using hormonal contraceptives, menstrual bleeding is light and shorter. They are especially effective in relieving and eliminating severe endometriosis pain.
Gonadotropin-releasing hormone (GnRH) agonists and antagonists: The use of these drugs is effective in reducing estrogen levels in patients and blocking menstrual cycle and ovarian stimulating hormones. This causes shrinkage in endometrial tissue. The GnRH agonists and antagonists used can force endometriosis into remission during treatment and years later. Since these drugs create an artificial menopause in women, low doses of estrogen and progesterone hormones should be given to women in addition to the drugs. These are important measures to prevent hot flashes, vaginal dryness, and osteoporosis in women. However, when the use of the drugs is stopped, the negative effects start again. In addition, the woman's ability to conceive and her menstrual cycles return.
Medroxyprogesterone (Depo Provera): This drug can be used by injection. It relieves the symptoms of endometriosis in the patient, can stop the growth of endometrial tissue and stop menstrual cycles. However, side effects such as weight gain, depressive mood and decreased bone production can occur.
Danazol: This drug blocks the production of hormones that stimulate the ovaries and can prevent the development of the endometrium. It prevents the menstrual cycle in women and prevents the symptoms of endometriosis. However, danazol is a drug that has serious side effects. Therefore, it should not be used immediately. It has properties that can harm the baby, especially in women who are pregnant.
Conservative surgery
In women with chocolate cysts, if the woman wants to get pregnant, a healthy pregnancy can be achieved by conservative surgery, by removing as much endometriosis tissue as possible from the uterus and ovaries. If the woman has severe pain due to the cyst, surgery may also be beneficial. However, there is a possibility that the cyst may recur later and the pain may recur again.
Depending on the patient's preference, the surgical procedure can be performed laparoscopically or, if necessary, as an open abdominal surgery. In laparoscopic surgery, the surgery is performed with a laparoscope, a device with a camera on its end, through thin incisions made in the groin or abdomen. The chocolate cyst is removed through these incisions.
Assisted reproductive methods
In order to help women conceive, assisted reproductive methods such as in vitro fertilization may be preferred over conservative surgery in some patients. This is usually the doctor's preference if conservative surgery is ineffective for the patient.
Uterine surgery (Hysterectomy)
If patients are severely affected by endometriosis, hysterectomy, which means removing the uterus and cervix and both ovaries, may be considered the best approach to treatment. However, hysterectomy alone is not an effective treatment. The estrogen hormone produced in the ovaries can cause pain in the remaining endometrial tissue in the body. Therefore, the ovaries may also need to be removed. However, hysterectomy is generally seen as a last resort for women of reproductive age. This is because it is not possible for women to become pregnant after this surgery.
Combined treatment application
During the treatment of chocolate cysts, if necessary, drug treatments can be applied to patients before or after surgery. This is done according to the severity of the patient's pain. If there is no response to such applied medical treatment, surgical intervention can be performed to open the adhesions in the organs, burn the foci of the disease or remove them, and thus, a significant improvement can be achieved in the patients. When patients do not respond positively to the applied drug treatment, the nerves going to the uterus or the nerves in front of the sacrum are cut to try to treat them. When these applications are insufficient for some patients, it may be necessary to remove the uterus and ovaries. In the application of these treatments, the decision is made by evaluating the patients' current health status, age and factors such as inability to conceive.
It is important for women with chocolate cysts to contact a doctor with whom they can feel comfortable during the examination and treatment phase, with whom they can talk and consult comfortably. In this way, they can help determine the most appropriate treatment option for them.
Lifestyle of patients and recommendations for home use in the treatment of chocolate cysts
While the treatment is ongoing or after the treatment, some precautions taken at home may be beneficial in reducing the discomfort that occurs due to the long-term effect of the treatment.
For women, a warm bath and a heated pad can help reduce cramping and pain and relax the pelvic muscles.
Non-steroidal anti-inflammatory drugs sold without a prescription can be used to relieve painful menstrual pain and cramps.
Regular exercise by women may be effective in relieving symptoms.
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