Endometriosis (Chocolate Cyst)

Endometriosis is the name given to the abnormal extrauterine growth of the internal lining of the uterus called the endometrium, which normally lines the intrauterine cavity in the uterus. During menstruation, the endometriosis tissue grows abnormally into the abdominal cavity causing pain, inflammation and injury. Endometriosis is diagnosed in approximately 20-40% of all infertile women.

Although there is no certain evidence on how endometriosis occurs, some theories have been proposed;

• The flow of menstrual blood backwards through the uterine tubes causes the endometrial tissue to adhere to the structures in the abdominal cavity. If this is the case, there will be cervical narrowing (narrowing of the opening of the uterus) and the discharge of the menstrual blood will be hampered.
• The endometrial tissue (internal lining of the uterus) starts developing in abnormal areas instead of growing in the intrauterine cavity, where the baby will normally develop.
• Genetic Predisposition

Endometriosis can only be diagnosed by laparoscopy. In making the diagnosis of endometriosis; a variety of digestive problems prevail including lower abdominal pain, painful menstruation, cramps, premenstrual spotting, painful sexual intercourse, infertility, and diarrhea.

How does endometriosis (chocolate cyst) result in infertility?

• Abnormal tissue formation can disrupt the position and shape of the uterine tubes and/or ovaries.
• Mucus secreted from the endometrial tissue blocks the uterine tubes and prevents the transport of the egg.
• Endometrial Cyst (Chocolate Cyst) can invade the ovaries, damaging areas of egg development and inducing inflammation.
• The resulting inflammation causes an increase in the white blood cell count accompanied by a highly increased macrophage count attacking the egg cell and sperms as if they are foreign structures to be fought against.
• Endometriosis is also associated with low progesterone levels, resulting in problems with implantation.

For the treatment of endometriosis, removal of abnormal tissues from the abdominal cavity by laparoscopy or hormonal supplements that suppress the menstrual cycle such as birth control pills are recommended. However, for women who wish to become pregnant, supplements that suppress the menstrual cycle will also inhibit normal reproductive functions and result in ovulation suppression. Therefore, they are not a treatment option for this group of patients.