Endometriosis and Chocolate Cysts..

During my first ever ultrasound session, Dr. G had discovered that I had endometriosis, so in this post I will explain in brief what endometriosis is all about. Since I am not an expert, I had taken the information from Obstetrical & Gynaecological Society of Malaysia's website to help you guys understand better.

What is endometriosis?

The dictionary will tell you that endometriosis is "the presence of functioning endometrial tissue where it does not belong". Endometrium is the name of the tissue that lines the uterus. Every few weeks the endometrium thickens to form a comfortable nestling place for the foetus. Normally this is shed during your period and recreates itself again in the next cycle. Sometimes, endometrial cells grow on the outside of the uterus. The body responds by covering these rogue cells with scar tissue. These cells still react to hormones released during the menstrual cycle, so when menstrual bleeding begins, the scar tissue surrounding the cells becomes red and swollen, resulting in intense pain.

Where does it grow?

Common sites for endometrial growth - called implants or lesions - include the ovaries, the fallopian tubes and the bladder as well. In fact, endometrial lesions can be found anywhere in the pelvic cavity, and sometimes in the bowel, intestines, colon, appendix, rectum and on Caesarean and laparoscopy scars as well. In rare cases, endometriosis has been found inside the vagina, on the skin, even in the lung, spine and brain.

Who gets it?

Endometriosis used to be called "the career woman’s disease" because it was most often found in professional women who delayed childbearing but further research has shown that endometriosis can affect any woman during the menstruating years. Symptoms can start with or after the first menstruation, but the disease is rarely found after menopause. Overall, as many as 5-15% of reproductive-age women have endometriosis. Overall, as many as 5-15% of reproductive-age women have endometriosis.

How Common Is Endometriosis?

The actual number of women who have endometriosis is unknown because many women do not display symptoms.However, endometriosis is seen in more than half of teenagers who have menstrual periods that are painful enough to be evaluated further. By and large, endometriosis is very rare before puberty and symptoms of endometriosis usually disappear after menopause.

What causes it? 

The cause of endometriosis remains unknown although several different hypotheses have been put forward. Endometrial cells may be carried up through the uterus into the pelvis during menstruation, or they could have travelled to other parts of the body through the circulatory system. No theory has ever been entirely proven but most experts agree that endometriosis is exacerbated by the hormone oestrogen

Is there a cure for endometriosis?  

No, but the symptoms can be managed through a combination of treatments. Basically you can have either surgical treatment or hormone therapy or both. Hormone therapy works by manipulating the hormones that control menstruation and the swelling of your endometrium and endometrial lesions. The medication can be taken orally or through an injection. Treatment varies depending on whether you are treating pain or infertility. Treatment may include medication to shrink the implants, laparoscopy to destroy implants, or surgery to remove the uterus and ovaries.

What are the symptoms?

The most common symptom of endometriosis is recent worsening of period and pelvic pains which often - but not always - correlate to the menstrual cycle. Pain may be felt before, during or after menstruation, during ovulation, in the bowel during menstruation, when passing urine, during or after sexual intercourse and in the lower back region. Other symptoms, usually during period, may include diarrhoea or constipation, abdominal bloating, heavy or irregular bleeding and fatigue.

Symptoms may remain stable, decrease without treatment or suddenly increase. Symptoms may resolve with treatment and then return later. Often symptoms decrease during pregnancy.

The other well known symptom associated with endometriosis is infertility. It is estimated that 30-40% of women with endometriosis may have difficulties in becoming pregnant. Endometriosis is thought to be responsible for up to 10% of infertility problems.

How is it diagnosed?

An experienced gynaecologist should be able to recognise symptoms suggestive of endometriosis if you are honest about the history and pattern of your symptoms. Ultrasounds, MRI scans, and gynaecological examinations may be performed but the only reliable way to definitively diagnose endometriosis is by performing a laparoscopy and to take a biopsy of the tissue.

Is endometriosis cancer?

Although endometrial lesions are sometimes referred to as "benign tumours" because they "behave" similarly to cancer, endometriosis is not cancer.

Is endometriosis sexually transmitted or infectious?

Endometriosis cannot be transferred from one human being to another. The cause of endometriosis is not yet known but it is not an infectious disease.

Is endometriosis inherited?

The cause for endometriosis is not yet known but research does show that first-degree relatives of women with this disease are more likely to develop endometriosis.

What are some natural ways to manage the pain?

Try a hot bath or heating pad to relieve the pain. Relaxation and breathing techniques often help. Your partner can also play a role in making you feel better, whether it is a lower back massage, leaving you alone for a while or experimenting with different and more comfortable positions for intercourse.

What should I do if I suspect I have endometriosis?

Although there is no cure, health care providers can teach you how to manage endometriosis and live a comfortable and active life. The earlier you detect the disease, the less risk there is to your fertility and reproductive organs as well. The most important thing you can do if you suffer from the symptoms of endometriosis is to consult and seek professional advice from your gynaecologist.

Since my doctor had diagnosed me with Chocolate Cyst, so here's some information on the subject from Women-health-info.com's website for your information.

Chocolate cysts are a particular type of ovarian cyst linked to endometriosis. So called “Chocolate cysts” are well known also as Endometriomas - these are cysts in the ovaries formed by endometrial tissue (tissue similar to the lining of the uterus). Actually the chocolate cyst is the cyst of the ovary with intracavitary hemorrhage and formation of a hematoma containing old brown blood.  The term chocolate cysts come from the physical appearance as these growths are usually comprised of dried blood making them brown in appearance. Chocolate cysts are formed when endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) grows in the ovaries. Chocolate cysts are usually filled with old, dark, reddish-brown, sludgy-brown blood, hence their moniker. Chocolate cysts can vary between 0.5 and 8 inches (1.5-20cm) in diameter, and are not necessarily a cause for concern. However, if they rupture, their contents can spill into the ovaries and the pelvic cavity. This can be very painful and can also cause some of the organs in the pelvis to bind together. If this happens with the fallopian tubes and ovaries, it can result in infertility.

Chocolate Cysts
Chocolate cysts are affecting women during their reproductive period and may cause chronic pelvic pain associated with menstrual periods (menstrual cramps, endometriosis).

Chocolate cysts (Ovarian endometriosis) probably start as a surface lesion. This process becomes invasive and the endometriotic lesion internalizes into the ovarian tissue. Once the menstrual flow and debris collect at the site of endometriosis in the ovaries, chocolate cysts form that are filled with chocolate-colored liquid. Actually it is a cyst which represent debris from prolonged cyclic menstruation in an enclosed area (inside of ovary). Chocolate cysts could sometimes attain impressive size, with some documented as large as a baseball or grapefruit that completely obliterate the normal ovary. However, usually there is a well-demarcated separation between the cyst wall and the normal adjacent ovarian tissue.

On a monthly basis, endometrial tissue is produced when a hormonal signal is released preparing the uterus to receive a fertilized egg. When pregnancy does not occur the tissue is shed in the form of a menstrual cycle. Another hormonal release signals this shed of tissue which is effectively released from the body through muscular contractions.

When tissue has grown outside of the uterus this shed is not possible and causes an accumulation of tissue and thus cyst endometriosis occurs.

In general chocolate cysts are not life threatening, they can become such if no action is taken. Chocolate cysts’ rupture could be life threatening and is not something to ignore. In these cases emergency medical service is required.

When a rupture occurs, the contents of the chocolate cyst are released into the body and pelvic cavity. Besides being quite painful (it cannot be unnoticed - could be very strong not-bearable pain) it can lead to further health complications, as the cysts have blood in them and are in the pelvic region.

Chocolate Cysts' Symptoms
Most typical symptoms of chocolate cysts are:

• Painful periods- often starting a few days before, and then lasting for the whole of the period;
• Painful sex (Dispareunia)- typically the pain is felt deep inside and lasts for a few hours after sex.
• Pain in the lower abdomen and pelvic area;
• Infertility - as the passage of the egg from the ovary to the fallopian tube may be blocked.

Chocolate Cysts' Diagnosis
Chocolate cysts can be diagnosed with x-rays or trans-vaginal ultrasounds. Positive results on a blood test called CA125 can also indicate the presence of a chocolate cyst, although ovarian cancer will also give a positive result, so this could be cause for concern. In these cases, exploratory surgery may be necessary to determine the nature of the problem.

Chocolate Cysts' Treatment
When chocolate cysts become a problem, causing pain or infertility, the cyst may be surgically removed. In most cases the chocolate cysts can be removed during laparoscopy - with a small incision and a wand shaped tool minimizing the incision size.  In cases where the cyst is very large occasionally the entire ovary can be removed. Sometimes the cystectomy, or removal of only the cyst could be enough. In other cases, if the cyst is very large, poorly located, or if there are multiple cysts involved, a procedure called an oopherectomy, or removal of the ovary, could be required.

Surgery is not generally considered risky however infection is always a factor and therefore doctors may prescribe antibiotics after the procedure. The point here is that while endometriosis is usually treated by preventing the menstrual, there should also be treatment that restores balance to the hormones, as this can be the root cause.

Some specialists suggest that the permanent cure for chocolate ovarian cysts can be done by natural holistic approach. This works on the assumption that all ovarian cysts are an indication of underlying problems within the body. The solution therefore is not to attack the cysts, but to address these underlying problems and restore the body's natural balance.

Well, I hope the information above was beneficial to you guys especially for those couple out there facing the same problem as I am. I do hope that this wall we stumbled upon will be resolved and we will be on our way again on our journey of trying to conceive.