Treatment of chocolate cysts in endometriosis

For many female friends, the most troublesome thing is gynecological diseases. Severe gynecological diseases affect women's physical and mental health. Some gynecological diseases can even lead to infertility, which causes great mental harm to women. Among them, endometriosis chocolate cyst is a relatively serious gynecological disease, so its treatment is also crucial. Let us learn about the treatment of endometriosis chocolate cyst.

What is endometriosis?

Endometrial tissue (glands and stroma) with growth function appears in other parts of the uterine cavity outside the endometrium and uterine body muscle layer. The tissue is benign, but it has malignant behaviors such as proliferation, infiltration, metastasis and recurrence. It is one of the most common diseases in women of childbearing age. Ectopic endometrium can invade any part of the body, but most of them are located in the pelvis.

What is an ovarian chocolate cyst?

It's ovarian endometriosis. The ectopic endometrium grows in the ovarian cortex and bleeds periodically, forming one or more cysts. The typical old blood in the cyst forms a brown viscous liquid that resembles chocolate. The final diagnosis must be confirmed by histopathology. About 80% of patients with ovarian chocolate cysts have lesions involving one ovary, and 50% of patients have lesions involving both ovaries.

Treatment of chocolate cysts in endometriosis

(1) Surgery to preserve fertility function: The ectopic endometrial lesions are completely removed and destroyed, but the uterus, bilateral or unilateral ovaries, or at least part of the ovarian tissue is preserved. It is suitable for young patients who want to have children, especially those who have not responded to drug treatment. The recurrence rate after this procedure is about 40%. Early pregnancy or additional drug treatment after surgery can help reduce the recurrence rate. Currently, most scholars recommend using GnRHa for three courses after surgery, and starting to try to get pregnant after menstruation resumes. For details about the mechanism of action and side effects of GnRHa, please refer to the adenomyosis section.

(2) Ovarian function-preserving surgery: also known as semi-radical surgery, which involves removing the pelvic lesions and uterus, retaining at least one ovary or part of the ovary to maintain the endocrine function of the ovary. Suitable for critically ill patients under the age of 45 who have no fertility requirements. The recurrence rate after this procedure is approximately 5%.

(3) Radical surgery:

1) Castration: surgery to remove both sides of the adnexa and preserve the uterus. After bilateral oophorectomy, there is no hormonal effect and the ectopic endometrium atrophies and degenerates spontaneously and disappears. It is suitable for patients who are near menopause, have obvious symptoms but normal uterus and cervix. It is also suitable for patients who have normal uterus and cervix after surgery for colon or breast malignant tumors but have symptoms of pelvic ectopic disease. This operation should usually be performed under laparoscopy, and open surgery is rarely considered.

2) Total hysterectomy, bilateral adnexa and all ectopic lesions in the pelvis: Suitable for patients over 45 years old with severe pelvic adhesions.

(4) Surgery to relieve pain: Uterine sacral neurectomy and presacral neurectomy can be performed, which are suitable for patients with severe central pelvic pain that is not responsive to drug treatment. The recent pain relief rate is high, but the recurrence rate is as high as 50%.

With the continuous progress of society, many diseases can be well treated, but we must master the correct and scientific methods. The above is an introduction to the treatment of endometriosis chocolate cysts. We know that its treatment also requires a certain process. During the treatment, we must also actively cooperate with the doctor's treatment and not rush for quick results.