FAQs About Endometriomas

Women with endometriosis often also have endometriomas. In fact, the prevalence of endometriomas in women with a confirmed diagnosis of endometriosis can be as high as 17-40%. Here are some frequently asked questions faq about endometriomas.
Why are ovarian endometriomas called chocolate cysts?
Ovarian endometriomas have a dark brown appearance due to the accumulation of old blood and other menstrual debris, which gives them a chocolatey appearance. These cysts contain retained blood fragments and inflammatory enzymes, which can stick to nearby organs if they rupture.
Are ovarian endometriomas related to hemorrhagic cysts?
Hemorrhagic cysts are a natural occurrence due to monthly ovulation cycles and shrink on their own in about 60 days. While most hemorrhagic cysts are asymptomatic, there is considerable symptom overlap between endometriomas and large hemorrhagic cysts that rupture.
Can conventional imaging techniques effectively diagnose endometriomas?
Conventional imaging techniques like magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound may be useful for the preliminary diagnosis of endometriomas. However, they may not be able to properly distinguish between ovarian endometriomas and other more severe diseases like ovarian cancer.
Laparoscopic cold excision surgery followed by a histological examination of the sample is the gold standard to confirm the presence of ovarian endometriomas.
What is the recommended strategy for endometrioma treatment?
Treatment methods vary from patient to patient. Laparoscopic cystectomy can help in preserving ovarian function, but it needs a lot of microsurgery expertise.
Merely draining the endometrioma is not recommended as there is a high risk of recurrence. Ideally, the number of oocytes remains unchanged before and after meticulous laparoscopic cystectomy. However, some follicle loss is inevitable.

Dr. Seckin avoids techniques like electrocautery or heat ablation to stop bleeding, as they can harm oocyte health. Instead, he carefully stitches back and repair the disrupted ovary.
Finally, Dr. Seckin advises against oophorectomy unless the disease is in an advanced stage with no recourse and only with the full understanding of the patient about the consequences of the operation. The endeavor is always to preserve the patient’s fertility and ovarian function and avoid surgical interventions as much as possible.
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Further reading
You may also wish to explore the latest literature available on Endonews for further insights:
- Post Surgery Endometrioma Recurrence
- Ovarian endometriomas revisited
- Endometriomas and the Severity of Endometriosis
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