Endometriosis cyst: symptoms, diagnosis, treatment of endometrioma

By Cristiano Antonino On Mar 23, 2023

An endometriosis cyst or endometrioma is a cyst formation filled with ‘old’ blood of endometrial origin, thus taking on a brownish colour

Their size varies between 2 and 5 centimetres in diameter, but they can grow up to 10-20 centimetres.

These cysts can be the cause of abdominal cramps, pelvic pain and a particularly painful menstrual cycle.

Although they are not dangerous in themselves, they can become very dangerous in the event of a rupture with bleeding from the vagina, fever, nausea and vomiting.

When such a complication occurs, endometriomas can be responsible for an emergency condition.

Depending on the severity and size of the cyst, treatment may vary and one may opt for pharmacological or surgical treatment.

What are endometriosis cysts?

An endometrioma is a non-cancerous, fluid-filled cyst – as we have seen, it is ‘old’ blood from the endometrium – that forms in the ovaries.

These typically dark-coloured cysts, brown in colour that can resemble tar or melted chocolate, can affect one or both ovaries and can occur singly or as clusters of cysts.

This condition affects between 20 and 40 per cent of women with endometriosis.

As the term suggests, endometriosis cysts are a typical manifestation of this disease that affects women

In reality, although they are often commonly called ‘ovarian cysts’, the term is a misnomer because they may also appear at the level of the fallopian tubes, in the last tract of the intestine or on portions of the peritoneum.

However, in about 80% of cases, the organ affected is the ovary.

What is endometriosis?

Endometriosis is an unfortunately rather common disease in which the inner lining of the uterus, known as the endometrium, grows on the outside of the uterus and on the ovaries, fallopian tubes and other areas of the reproductive tract.

Abnormal growth of this lining causes severe pain and sometimes infertility.

What are the symptoms of an endometriosis cyst?

Although there may be no particular manifestation, the symptoms are usually quite definite.

Caution: it is not the size of the cyst that dictates the severity or intensity of the symptoms: it is possible that a woman with a small cyst may experience very acute symptoms, while someone with a large cyst may be asymptomatic and arrive at the diagnosis by chance.

In any case, when they occur, the symptoms are similar to those of endometriosis.

Not necessarily all symptoms occur at the same time, it is possible that some are more pronounced than others or not at all, and include:

Menstrual cycle with intense pain and abdominal cramps.
Pelvic pain, also unrelated to the menstrual cycle, particularly during urination or defecation.
Irregular cycle.
Pain during sex.
In severe cases, difficulty conceiving and infertility.

As mentioned above, endomestriotic cysts may represent a medical emergency in the event of a rupture: in such cases, they may cause sudden severe abdominal pain on the side of the body where the cyst is located and bleeding from the genitals, as well as vomiting, diarrhoea and fever.

In such an eventuality, the best thing to do is to seek medical attention immediately or go to the emergency room.

What causes endometrioma?

There is much debate as to how and why these cysts form.

The most accepted theory is that they are a direct consequence of endometriosis.

In fact, the lining of these cysts acts much like the lining of the uterus: it grows and is then shed in response to the monthly rise and fall of female hormones.

In a normal condition, this tissue is expelled through the menstrual cycle; in a pathological condition, however, it remains trapped in the cyst cavity.

Here it can produce inflammation and ovarian disorders.

However, it is possible for ovarian cysts to form even in the absence of endometriosis: in this case, the origins are still rather mysterious.

How are endometriosis cysts diagnosed?

If you have the symptoms described above, you should book a gynaecological examination and talk to your doctor.

The specialist may recommend further instrumental investigations to confirm the suspected diagnosis.

In particular, he or she may prescribe a pelvic ultrasound if:

Perceives the presence of a cyst during a pelvic test.
She suspects that you have endometriosis based on your symptoms.
You are experiencing unexplained infertility.

An ultrasound scan, using an internal imaging process, can identify whether a cyst is present, although it cannot determine precisely what type of cyst it is.

For confirmation, therefore, it will be necessary to perform a biopsy: with a needle, the doctor will extract the material contained inside the cyst to analyse it under a microscope.

However, this procedure, as it is fraught with certain complications, is rarely performed.

How are endometriosis cysts treated?

Obviously, there is no single treatment for this type of cyst.

The treatment chosen will depend on several factors, including:

The age of the patient
The symptoms complained of
Location of the cyst
Desire for pregnancy

If the cyst is small and does not produce symptoms, the doctor may recommend a very cautious approach: the cyst will need to be checked a couple of times a year and its progress and possible growth assessed from time to time.

During this period, drugs that inhibit ovulation, such as the contraceptive pill, may be prescribed.

This can help control pain and can slow the growth of cysts, but cannot cure them.

Hormonal treatments based on gonandotropins or progesterone, which can suppress or limit oestrogen production, may also be prescribed.

In addition, non-steroidal anti-inflammatory drugs (NSAIDs) may be recommended to help women cope with pain – particularly during the menstrual cycle.

In more severe cases, decisive intervention becomes necessary; surgery will then be resorted to.

In particular, surgical treatment, called ovarian cystectomy, is often recommended for women who have:

Painful symptoms
Cysts larger than 4 cm
Infertility
A rather advanced age

In addition, it may be recommended for those who have already had children or who have no desire to become pregnant in order to intervene before the situation becomes complicated.

If the woman is already in menopause, the operation is almost routine and involves the removal of the entire ovary (ovariectomy).

The operation is generally performed using a laparoscope, i.e. a thin, long tube with a light and a camera at the end – which helps doctors perform the procedure – that is inserted through a small incision.

However, even when the surgeon is highly qualified, healthy ovarian tissue may be removed along with the cyst, which may adversely affect ovarian function.

On the other hand, the inflammation that an endometriosis cyst can produce may affect fertility more than the surgery itself.

This is why it is a good idea to discuss this carefully with your doctor and evaluate all possible and viable options in your individual case.

What effect does an endometriosis cyst have on fertility?

Endometriosis cysts can invade, damage and take over healthy ovarian tissue: this can pose a serious threat to fertility.

As just described, however, this type of cyst can be difficult to treat, and it should be noted that the same pelvic surgeries used to control or remove them, although generally minimally invasive, can lead to ovarian scarring and consequent reduced fertility.

Furthermore, it has been observed that women with this condition also tend to have:

A lower number of eggs;
Ovules that are less likely to mature;
Higher levels of follicle-stimulating hormone (FSH), which may suggest the presence of ovarian problems.

However, the presence of endometriosis cysts is not equivalent to infertility: in fact, there are many women who still manage to conceive naturally despite the presence of endometriosis cysts.

For women who experience fertility problems due to endometriosis cysts that cannot be resolved by medical or surgical treatment, in vitro fertilisation is another option.

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