What Is Endometrioma?

According to data from recent research, at least half of women with endometriosis may have an endometrioma at some point in their life.
What Is Endometrioma?

Last update: 13 September, 2021

Endometrioma is also called a chocolate cyst because some of its characteristics are reminiscent of this food. However, it should be noted that its appearance has nothing to do with the consumption of chocolate. Actually, endometrioma or an endometriotic cyst is one of the most common consequences of endometriosis.

According to a study on the matter carried out by Dr. José Negrón Rodríguez, 17 to 44% of women have this disease, although in others the percentage is at least 50%. For this reason, it can be associated with dysmenorrhea, chronic pelvic pain and difficulties in achieving pregnancy.

It is a benign cyst that can appear in either or both ovaries. It is made up of endometrial tissue, surrounded by epithelium and, inside, it contains a thick, blackish material that may somewhat resemble chocolate.

Although it’s a type of injury that can cause some complications, it doesn’t pose a high risk of ovarian cancer. According to several specialized sources, the risk of this happening is low.


Endometrioma symptoms include severe pain
Like what happens in endometriosis, abdominal or pelvic pain is one of the main symptoms of endometrioma.

Dr. Gustavo A. Restrepo explains that endometriomas are “solid, cystic, compound pelvic masses that contain blood, fluids, and menstrual waste.” Likewise, he indicates that some of the symptoms and alterations that it can produce are the following:

  • Fever
  • Abdominal pain
  • High levels of leukocytes in the blood

When symptoms are experienced on the right side of the abdomen, they can be mistaken for acute appendicitis.

Additionally, the endometrioma is capable of causing other manifestations, which are very similar to those of endometriosis. Among them, pelvic pain predominates (both during menstruation and the rest of the menstrual cycle).

Other associated symptoms are pain during sexual intercourse, menstrual irregularity and, in some cases, impaired reproductive function (infertility).


According to the review carried out by Dr. José Negrón Rodríguez:

  • There are authors who consider that the cause of ovarian endometrioma is “the metaplasia of the invaginate coelomic epithelium, their main argument being the presence of epithelial invagination in continuity with endometrial tissue”.
  • Other authors consider that endometrioma could be a consequence of an imbalance of the enzymes that metabolize estrogens.
  • Studies prior to 2019 often used to point out that the pathogenesis of endometrioma was unknown.


One of the most used methods to reach the diagnosis of the chocolate cyst is the transvaginal ultrasound. This imaging test has proven to be effective in more than 88% of cases, according to the studies already cited above.

Laparoscopy is also a common diagnostic measure. It’s a procedure that allows you to see the inside of the pelvis and abdomen.


Endometrioma treatment varies depending on the case. In some mild cases, prescription of some medications in combination with some over-the-counter drugs may be sufficient to control symptoms.

However, there are many cases in which this type of measure is insufficient, which makes surgical treatment necessary. It should be noted that surgery is also often considered when the endometrioma is larger than one centimeter.

Endometrioma removal is not a curative treatment. Recurrences have been observed, even when the procedure has been successful at the time. For this reason, a post-surgical treatment is necessary and, of course, a periodic medical follow-up.

If the woman has fertility problems and wishes to have children, fertility treatment will be considered. In this sense, the studies already mentioned above indicate that in vitro fertilization has been successful.

Adjuvant treatment

Endometrioma can be controlled with some habits
Maintaining a healthy lifestyle only brings benefits. For this reason, although a good diet or regular exercise don’t resolve the endometrioma, they do help you cope with the disease.

There’s consensus on the importance of maintaining good lifestyle habits as an adjunctive treatment for endometriomas. Especially in regards to aspects such as healthy eating, an exercise routine and proper stress management.

It is important to bear in mind that lifestyle habits can always be realistically improved and adapted in the medical consultation. For this reason, if at any time there is any difficulty with the exercises, for example, it isn’t necessary to stick to a specific strategy.

In other words, it isn’t necessary to impose a specific strategy on yourself and try to follow it to the letter. If at any point it doesn’t work or is difficult to maintain, it can always be modified. The idea is to ensure well-being in a pleasant way, and not to make your day-to-day life more difficult.

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