Chocolate cysts

　　Ovarian chocolate cysts are also known as endometriotic cysts, which is a type of endometriosis. It is caused by endometrium located in the ovary, which is affected by sex hormones and repeatedly sheds and bleeds with the menstrual cycle, causing the ovary to enlarge and form a cyst containing old blood clots. This old blood clot is brown, thick like paste, resembling chocolate, hence the name 'chocolate cyst'. This kind of cyst can gradually increase in size and sometimes rupture during or after menstruation.

　　After the blood accumulated in the pelvic cavity after the rupture of the cyst flows into the peritoneal cavity, it stimulates the peritoneum, causing severe abdominal pain and can cause adhesion of pelvic organs. Ovarian chocolate cysts can spontaneously rupture without any trigger, and rough or intense sexual intercourse, especially during the premenstrual period, is often an important trigger for cyst rupture.

　　Small ovarian chocolate cysts are usually not prone to rupture. The therapeutic effect of medication for chocolate cysts is poor, and it is difficult to eliminate the chocolate cyst. When the cyst grows to more than 3 centimeters, the risk of spontaneous rupture begins to appear and gradually increases. When it reaches a certain size, spontaneous rupture is often unavoidable. Therefore, it is indeed a 'bomb' hidden in the pelvic cavity, which may explode at any time.

　　Chocolate cysts mainly occur in middle-aged and young women between the ages of 30 and 40. They are mainly caused by endometrial fragments shed from the uterine wall during the menstrual period, which cannot be completely expelled from the vagina due to poor drainage, with a small amount flowing back to the pelvic cavity through the fallopian tubes. The etiology of ovarian chocolate cysts is not yet clear, and environmental factors, lifestyle, and mental state may all be related to the occurrence of ovarian cysts, but there is no relationship with being married or unmarried. Therefore, ovarian cysts can occur at any age, generally with a high incidence in women aged 20 to 50, and unmarried women should be vigilant when they find symptoms such as menstrual irregularity, decreased menstrual flow, or abdominal pain, and should seek timely medical examination, especially for overweight adolescent girls.

　　1. Tumor rupture: Approximately 3% of ovarian tumors may rupture, and ovarian tumor torsion can lead to rupture, which can be traumatic or spontaneous. Traumatic rupture often occurs due to abdominal blows, childbirth, sexual intercourse, gynecological examination, and puncture, while spontaneous rupture is often caused by rapid tumor growth, with most cases involving infiltrative growth of the tumor piercing the cyst wall. The severity of symptoms depends on the size of the rupture, the nature and quantity of the fluid that enters the peritoneal cavity. When small cysts or simple serous cystadenomas rupture, patients may only experience mild abdominal pain; after rupture of large cysts or mature teratomas, severe abdominal pain, nausea, and vomiting may occur, sometimes leading to internal bleeding, peritonitis, and shock.

　　Gynecological examination may reveal abdominal tenderness, muscle tension, or signs of ascites, with the original mass not palpable or felt to be smaller and deflated. Immediate laparotomy should be performed if tumor rupture is suspected. During the operation, the cyst fluid should be aspirated as much as possible, and a cytological examination should be performed on the smear. The peritoneal and pelvic cavities should be cleaned, and the specimen should be sent for pathological examination. Particular attention should be paid to whether there is malignant transformation at the edge of the rupture.

　　10. Pedicle torsion: Common, one of the gynecological acute abdomen conditions. About 10% of ovarian tumors are associated with pedicle torsion. It is more common in cystic tumors with long pedicles, medium size, high mobility, and a center of gravity偏向一侧, often occurring during sudden changes in body position, in the early stages of pregnancy, or after childbirth. The pedicle of the tumor consists of the infundibulopelvic ligament, the ovarian ligament, and the fallopian tube. After acute torsion, venous return is obstructed, leading to severe congestion within the tumor or vascular rupture, causing the tumor to rapidly increase in size, internal bleeding, and finally obstruction of arterial blood flow, resulting in necrosis of the tumor and turning purple-black. The tumor is prone to rupture and secondary infection.

　　The typical symptom is sudden severe pain in one side of the lower abdomen, often accompanied by nausea, vomiting, and even shock, caused by peritoneal traction and strangulation. Gynecological examination may reveal a mass with high tension and tenderness, most pronounced at the pedicle, and muscle tension. Sometimes the torsion may naturally复位, and the abdominal pain will subsequently subside. Once torsion is diagnosed, prompt laparotomy should be performed.

　　8. Infection: Rare, often caused by torsion or rupture of the tumor, or may come from adjacent organ infection foci such as appendiceal abscesses. Clinical manifestations include fever, abdominal pain, mass, abdominal tenderness, muscle tension, and increased white blood cells. Treatment should first be with antibiotics, followed by surgical removal of the tumor. If infection cannot be controlled within a short period of time, immediate surgery should be performed.

　　7. Malignant transformation: Malignant transformation of benign ovarian tumors often occurs in older individuals, especially postmenopausal women. The tumor rapidly increases in size in a short period of time, causing symptoms such as abdominal distension, loss of appetite, and a significantly increased, fixed tumor volume. There may be ascites. Those suspected of malignant transformation should be treated promptly.

　　1. Female infertility: Ovarian chocolate cysts can lead to an infertility rate of up to 50.9%. Women who have been married for many years without pregnancy must be highly vigilant. Among patients with unexplained infertility, about 70-80% have endometriosis. Patients often become infertile due to mechanical factors such as adhesions of pelvic organs, which obstruct the peristalsis of the fallopian tubes or cause tubal obstruction. It may also be related to factors such as incomplete ovarian function, enhanced autoimmune response, increased prostaglandins, and increased prolactin.

　　2. Abnormal dysmenorrhea: Dysmenorrhea is the most obvious symptom of endometriosis, yet it is the most easily overlooked precursor. Most women believe it to be normal dysmenorrhea and do not take it seriously. In fact, the ectopic endometrium is also controlled by hormones and can undergo periodic local bleeding, leading to inflammation of surrounding tissues and pain. Therefore, the characteristics of dysmenorrhea in endometriosis usually start from the premenstrual period or even the second half of the menstrual cycle, lasting throughout the menstrual period and disappearing several days after menstruation. The pain is usually located in the middle of the lower abdomen, or to one side, with the lesion extending to the uterus and rectum. Menorrhagia, with excessive menstrual blood volume, is also one of the common clinical symptoms, generally manifesting as excessive menstrual blood or prolonged menstrual bleeding.

　　3. Sexual pain : Due to uterine muscle contraction and pelvic adhesions, endometriosis in the uterovesical pouch, posterior fornix of the vagina, uterosacral ligament, and other parts can cause sexual pain, and it is often more obvious before the menstrual period. More than 50% of women will have significant pain during sexual intercourse.

　　4. Severe lower abdominal pain : Severe lower abdominal pain accounts for 71.3%, especially severe pain in the first few days of the menstrual period, which is also a clear signal that needs to be paid enough attention by women.

　　The etiology of ovarian chocolate cysts has not been clarified, but it is closely related to intrauterine cavity surgery mainly caused by induced abortion. It can be seen that the key to preventing chocolate cysts is how to avoid the occurrence of endometriosis. According to the 'risk factors' related to the onset of endometriosis, preventive measures should be taken from the following aspects:

　　Among them, pay attention to adjusting emotions, maintaining an optimistic and open mindset, so that the function of the body's immune system is normal. Pay attention to keeping warm, avoiding colds and chills.

　　Among them, avoid gynecological bimanual examination during the approach of the menstrual period to prevent the endometrium from being squeezed into the fallopian tubes, causing abdominal implantation. At the same time, all intense activities, sexual life, and heavy physical labor are prohibited during the menstrual period. Pay attention to self-care during the menstrual period, control one's emotions, do not get angry, otherwise it may lead to changes in endocrine secretion;

　　Among them, if endometriosis has been diagnosed, and the chocolate cyst is larger than 6cm, it is necessary to pay attention to maintaining emotional stability during the menstrual period or in the middle of the menstrual period, avoiding overwork. Once the tension inside the cyst cavity suddenly increases, the cyst wall may rupture, causing acute abdomen;

　　Among them, gynecological surgery should be avoided as much as possible during the menstrual period. If it is necessary to perform it, the operation should be gentle to avoid exerting pressure on the uterine body, otherwise it is possible to squeeze the endometrium into the fallopian tubes or abdominal cavity. Try to do fewer abortions and curettage, and do a good job of family planning;

　　Among them, timely correction of over-arching uterus and cervical canal stenosis should be made to ensure the unobstructed flow of menstrual blood and avoid stasis or retrograde flow;

　　Strictly master the operation procedures of fallopian tube patency test (aerating, irrigating) and造影, and do not perform it immediately after the menstrual period or directly during the scraping period of this cycle to avoid the pressure of endometrial fragments into the abdominal cavity through the fallopian tubes;

　　Among them, attention should be paid to preventing the overflow of uterine contents into the abdominal cavity during cesarean section and cesarean section delivery. When suturing the uterine incision, do not let the suture thread pass through the endometrial layer. Before suturing the abdominal wall incision, physiological saline should be used for flushing to prevent endometrial implantation;

　　Among them, women who marry late, especially those with dysmenorrhea, should give birth as soon as possible. If there is still no pregnancy after one year of marriage, they should go to the hospital for relevant examinations on infertility.

　　1. Physical examination: Most patients can feel lumps of varying sizes in the abdomen, such as those as large as a fist or a child's head, which are mostly cystic, movable, and benign tumors generally do not have ascites. However, fibroids and serous tumors may show signs of ascites.

　　2. Medical history and symptoms: Patients may report discomfort in the lower abdomen, abdominal pain, or palpable movable mass in the lower abdomen; or compression symptoms; irregular menstruation or amenorrhea; long course of disease, and the mass gradually grows larger.

　　3. B-ultrasonography: B-ultrasonography is an effective method for assisting in the diagnosis of endometriosis. It is mainly used to observe ovarian endometriotic cysts, and its sonogram characteristics are: cystic mass, clear or unclear boundaries. If the adhesions around the cyst are heavy, the boundaries are unclear; if the adhesions between the cyst and the uterus or surrounding tissues are few, the boundaries are clear. The cysts are mostly of medium size, and small granular echoes can be seen inside the cyst, indicating the viscosity of the cyst fluid. Sometimes, due to the condensation and organization of old blood clots, a more dense coarse speckle image appears, showing a mixed mass. The mass is often located on the posterior side of the uterus, and the accompanying symptoms of the cyst and uterus can be seen. When the cyst spontaneously ruptures, the sonogram shows a posterior depression, and the cyst is smaller than before.

　　4. Laparoscopic examination: Laparoscopic examination is the new standard for diagnosing endometriosis. Through laparoscopy, the pelvis can be directly visualized, and the ectopic lesions can be seen to make an accurate diagnosis, and clinical staging can be performed to determine the treatment plan.

　　5. Radiological examination: Radiological abdominal flat film is a commonly used examination method: if it is a mature ovarian cystic teratoma, it can show teeth and bone, the cyst wall is a dense calcified layer, and the cyst appears as a radiolucent shadow.

　　6. Tumor markers: Some ovarian tumors can produce and release antigens, hormones, and enzymes. These substances can be detected in the patient's serum by immunological and biochemical methods and become tumor markers. The detection of these markers can discover clinical pre-cancerous ovarian cancer and improve the effectiveness of treatment. Alpha-fetoprotein (AFP) is a good marker for endodermal sinus tumors, and the AFP value of immature teratoma also increases. Chorionic gonadotropin is a highly specific marker for trophoblastic disease, and lactate dehydrogenase (LDH) is the main enzyme in the metabolism of ovarian malignant tumors. The increase in these marker values indicates the presence of some kind of tumor in the body.

　　6. Cytological examination: Gynecological experts point out that the ovary is located in the pelvis, and the shed cells accumulate in the rectouterine凹陷. After the posterior fornix puncture aspiration of peritoneal fluid is performed for cytological examination, cancer cells can be found to help diagnose, especially for stage I patients, which is of certain significance for further determining the stage and treatment. Vaginal cytological examination can also be performed for suspected granulosa cell carcinoma to judge estrogen levels.

　　What should be paid attention to in the diet of chocolate cyst? It is recommended not to eat honey or soy milk powder, and the diet should be light and nutritious. Correct malnutrition and abnormal eating habits, and avoid eating刺激性 and seafood frequently. Below are some ovarian chocolate cyst diet methods for you:

　　Ovarian chocolate cyst diet methods - should

　　1. Diet for ovarian chocolate cyst should consume more foods with antitumor effects: horseshoe crab, sea horse, turtle, dragon pearl tea, hawthorn.

　　2. Diet for ovarian chocolate cyst with bleeding should include goat blood, snails, clam, cuttlefish, shepherd's purse, lotus root, mushrooms, malan head, stone ear, hickory nuts, persimmon cake.

　　3. Abdominal pain and bloating should consume pork kidneys, bayberries, hawthorn, tangerine cake, walnuts, chestnuts.

　　4. For the diet of infected ovarian chocolate cysts, it is recommended to eat eels, razor clams, water snakes, needlefish, carps,麒麟菜, celery, sesame seeds, buckwheat, brussels sprouts, scallions, red beans, mung beans, and soybeans.

　　Ovarian Chocolate Cyst Diet - Taboo

　　1. Avoid刺激性 foods such as scallions, garlic, peppers, and cassia bark.

　　2. Avoid smoking and drinking.

　　3. Avoid greasy, fried, moldy, and preserved foods.

　　4. Avoid warm and active blood foods such as mutton, dog meat, chives, and pepper for the diet of ovarian chocolate cysts.

　　5. Avoid excessive tension and mental stimulation, maintain an optimistic mood and adequate sleep.

　　Endometriosis is a benign lesion, but it cannot be cured. From a physiological point of view, when the menstrual period stops, the ectopic endometrium should no longer grow. As long as the ovaries are functional, chocolate cysts may recur at any time. Chocolate cysts growing in the ovaries are prone to cancer because they cause long-term chronic stimulation to the ovaries, which may trigger endometrioid cancer.

　　Symptomatic chocolate cysts can be treated by taking oral contraceptives to suppress endometrial growth, thereby alleviating symptoms. However, this method is not effective for chocolate cysts with a diameter larger than 5cm, and larger chocolate cysts must be treated by surgery.

　　The only way to cure it completely is to remove the uterus and ovaries, but this will make many women lose the right to be a mother. For young women who have not given birth, they can only undergo cystectomy.

　　Currently, laparoscopic surgery is widely used for the treatment of chocolate cysts, which can easily剥离 the cysts without damaging the ovaries and affecting future fertility. However, there is a prerequisite: only chocolate cysts no more than 5cm are suitable for this treatment method. It should be noted that patients should go to the hospital for a review once every two months after laparoscopic surgery. And women should get pregnant as soon as possible after surgery because as long as the ovaries are still there, there is always a possibility of recurrence.

　　In addition to surgical treatment, women have a natural self-treatment method, which is normal pregnancy. Because after pregnancy, at least one year allows these endometrial tissues to gradually regress due to the absence of estrogen and then be absorbed, so pregnancy is the best treatment.