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Chocolate Cyst: What is It, Its Symptoms, Is It Treatable without a Surgery?


Endometriosis is one of the leading triggers for hysterectomy. However, according to the Endometriosis Foundation of America, around 20-40% of endometriosis patients suffer from chocolate cysts.

Also termed ovarian endometriomas, chocolate cysts are non-cancerous, fluid-filled cysts composed of old blood and tissues. They are typically benign but, if left untreated, can lead to fertility concerns.

This article will explore more about chocolate cysts, what it entails and how to treat them with or without surgery.

Also Read: Women with Undiagnosed Endometriosis Face Difficulty in Getting Pregnant, Research Says

What are Chocolate Cysts?

As mentioned, chocolate cysts are non-cancerous, ovarian cyst outgrowths that are often a consequence of endometriosis. They have a deep brown and tar-like appearance filled with old blood.

Typically, these ovarian cysts are full of old period blood and dead tissues that form into cysts, affecting either the ovaries. They are alternatively known as endometriomas.

Chocolate cysts are a more severe subset of endometriosis that inflict more severe complications in the body, inadvertently affecting one’s fertility too.

What are the Causes of Chocolate Cysts?

Although modern medicine suggests that endometriosis is the primary cause behind chocolate cysts, there are still debates around it.

In patients with endometriosis, the endometrial lining grows outside the uterus in other reproductive organs like the ovaries, fallopian tubes, and even the urinary bladder. These lead to painful periods, severe cramps, and heavy bleeding during menstruation.

Chocolate cysts likely develop in endometriosis patients who get proper and timely treatment. The exterior endometrial lining tissue attaches itself to the ovaries and accumulates old period blood months and months. These hamper the ovarian function gravely.

While endometriosis directly connects with the development of chocolate cysts, doctors and researchers are still trying to pinpoint the exact cause behind endometriosis itself.

Some studies correlate excessive estrogen production with endometriosis, while others identify genetic predisposition as a contributing factor. External injuries and trauma or autoimmune disorders are also considered possible causes.

What are the Symptoms of Chocolate Cysts?

Chocolate cysts form in an advanced stage of endometriosis. However, the worst part of this condition is that some patients experience terrible symptoms while others experience nothing.

The size of the chocolate cysts can range between 2-20 cm in diameter. However, the size doesn’t directly comprehend the degree of symptoms one would experience. The reason why chocolate cysts are very complex to diagnose is because of similar symptoms like endometriosis.

Some of the most notable symptoms include:

  • Experiencing painful cramps during menstruation
  • Abdominal or pelvic pain and inflammation
  • Irregular menstrual cycle
  • Heavy bleeding during menstruation
  • Gastrointestinal issues
  • Experiencing pain during sexual intercourse
  • Infertility

The condition can often go undiagnosed until it has reached extreme severity. If a chocolate cyst ruptures due to lack of treatment, the same can lead to severe abdominal pain, discomfort, and inflammation. Since the cysts are full of old blood, dead tissues, etc., the exposure of the contents in the bloodstream can lead to infections and other complications. Immediate medical attention is advised in that case.

Chocolate Cysts – Diagnosis

The diagnosis of chocolate cysts from just the symptoms is difficult. Since the symptoms coincide with endometriosis, your doctor will likely suspect that you have endometriosis and not chocolate cysts.

Ideally, the diagnosis starts with an initial consultation with the gynecologist. They will first sit down, discuss the symptoms, and ascertain a possible diagnosis. However, since symptoms aren’t a proper diagnostic tool, an ultrasound is prescribed to get a clear picture of the situation.

An ultrasound can ascertain:

  • Whether the patient has one or multiple cysts in the ovary
  • Find signs of endometriomas in the reproductive anatomy of the patient
  • Look for blockages in the fallopian tubes to explain possible reasons for infertility

If you are suffering from ovarian cysts or endometriosis, an ultrasound will identify the issue. Once the doctor determines the presence of cysts, the cysts then go for further testing.

Fluid and tissue samples are collected from the cysts and sent for further testing to determine whether the patient has chocolate cysts or not. A needle biopsy is the safest choice of diagnosis in this case.

What are the Treatment options for Chocolate Cysts? Is Surgery Mandatory?

The treatment of chocolate cyst depends on the severity of the condition. If the cysts are very small and a few, the gynecologist will suggest waiting. In severe cases where the spread is profound or if one of the cysts has ruptured, in such cases, surgery is a must.

Here’s a quick breakdown of the treatment options:

Treatment Option When to Consider? What is done?
Medication -Cysts are small (less than 3 cm)- Not producing severe symptoms -Watch and wait- Medications that restrict ovulation, like birth control pills- Can inhibit the growth of the cysts and treat them without further deterioration.
Surgery -Severe symptoms like painful periods- Cysts are larger (more than 4 cm)- Malignancy in the cysts- Experiencing infertility due to the cysts – Ovarian cystectomy is done.

It is less than 1% of cases that the ovarian cysts turn cancerous or malignant. However, since chocolate cysts progress very quickly and alter one’s fertility, too, getting the proper treatment at the right time is crucial for one’s overall well-being.



If you are diagnosed with endometriosis, get further screening for chocolate cysts. Early diagnosis ensures quicker treatments, sometimes even just with medication. However, if not diagnosed on time, the condition might need surgical interventions.

The worst part of the surgical removal is that the condition is recurrent. Studies have found that chocolate cysts return in 30% of patients who have undergone surgeries. So, if you are experiencing discomfort, pain during your periods, talk to your doctor and get the correct treatment before it takes a turn for the worse.


1- Overview | Endofound

2- What are the Causes of Chocolate Cysts? | NCBI

3- Treatment Options for Chocolate Cysts | RSNA

This content has been reviewed by Srujana Mohanty who is working in scientific & medical writing and editing since 2018. She is also associated with the quality assurance team of scientific journal editing.

Somapika Dutta (B.Sc Physiology, Honours)
Somapikar holds Bachelors Degree in Physiology from University of Culcutta. She has 6+ years of experience writing in different niches, including health, tech and lifestyle. An animal enthusiast and a raging foodie, experiencing life - one day at a time.


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