Chocolate Cysts

Ask our experts your questions about endometriosis here.

Moderator: talkhealth

2 posts
Posts: 1
Joined: Wed Mar 21, 2012 9:20 pm

by mcc1980 on Wed Mar 21, 2012 9:43 pm

Chocolate Cysts

I had my right ovary removed during a laporoscopy to remove a large chocolate cyst (11+cm)in Feb 2011. I was then discharged from the hospital back to my gp who gave me 3 months of prostap and then the contraceptive pill to try to control my endo. After feeling progressivly more tired and increasing pelvic pain it was discovered I have a 3cm chocolate cyst on my left ovary and I was referred back to the hospital.The consultant said they would not want to operate as yet due to the higher risk of damage to my bowel and bladder and the risk of me losing my remaining ovary. I am due another scan in 2 weeks and another appointment in 6 weeks. More prostap injections was mentioned as an option but will this shrink the cyst? Do I have any other options as I do not want to lose my ovary as I am still in my early thirties.

User avatar
Mr. Hugh Byrne, MRCOG
Posts: 186
Joined: Fri Mar 16, 2012 12:21 pm

by Mr. Hugh Byrne, MRCOG on Wed Mar 21, 2012 11:59 pm

Re: Chocolate Cysts

Hi MCC - what an ordeal and to loose an ovary to endometriosis too!

Firstly, any hormonal treatment wears off after you stop taking it. I would advise the combined pill (maybe 3 packs run together) to keep the endometriosis suppressed (provided you have no problems with the pill), and I would only prescribe the GnRH analogue (prostap in your case) if we needed to achieve something in particular - such as shrinking dense endometriotic lesions in advance of a major endometriosis operation. Furthermore, only 6 months of prostap is advisable in your lifetime, because of effects on bone after longer durations of treatments.

This brings me to the bowel injury issue: did your surgeons see evidence of severe adhesions ('internal scar tissue') at the time of you laparoscopy? If not, your risk of such injury may not be as high as is feared. Perhaps at that time the endometrioma on the right ovay was so large that it compressed all normal tissue and the entire ovary had to go. What other endometriosis did they see around your pelvis? if confined to the ovary I think that you may be OK for further laparoscopic surgery.

If you have symptoms, and it's over a year since your first laparoscopy, it may be worth doing what we call a 'second look' laparoscopy. If you are really afraid of loosing the remaining ovary, although it is a small risk, then you may decide to stay on the pill and observe the endometrioma by transvaginal ultrasound every 6 months or so. If the pain is intolerable, then removal of the cyst is possible but I would advise caution in stripping the cyst from it's capsule, and I would urge your surgeon not to use unnecessary electrocautery on the ovary as normal ovarian tissue surrounding the cyst may suffer reduced function as a result of thermal damage. Ask for a dye test of your tubes to test their patency during the laparoscopy too if fertility is an issue. If you opt to observe the cyst over a few months/years, bear in mind that if you then decide you need or want IVF at a later stage, the IVF team may require you to undergo removal of the cyst before treatment anyway.

Adhesions are difficult to diagnose pre-op but one investigation you could have is an MRI of your pelvis to outrule any disease between the rectum and vagina, and to see of the remainign ovary is adherent to another structure like the bowel etc. This might help you make the decision too. I hope this helps!
Mr Hugh Byrne
Consultant in Obstetrics and Gynaecology
St Georges Hospital

2 posts