Endometriomas are pelvic masses or cysts that arise from the ovary. They are often blood filled and have a thick dark chocolate consistency, hence their name “chocolate cyst.” They are made up of abberent endometrial cells that bleed during the monthly cycle, as a result of hormone changes. These cysts are often seen in conjunction with surrounding endometriosis. If left untreated they can become quite large and engulf or overtake the ovary. Symptoms include pelvic pain, and painful periods. Surgery for removal is the treatment of choice.
Many physicians currently advocate hysterectomy as the best form of treatment for
endometriosis. I disagree. Once endometrial cells have implanted within the pelvis,
removing the uterus has no effect on the current condition. Implants need to be destroyed to reduce pain and
cramping…..as long as the patient still has her ovaries, monthly flow of estrogen will fuel
the spread of the existing pelvic implants. Diagnosing and some treatment can be performed via a minimally invasive laparoscope that puts a camera in the abdomen near the belly button. This technique can be effective for treating early stages of Endo. Unfortunately, my practice often sees women with much more severe and advanced cases and the scope has too limited a field of view. An open surgery allows the entire abdomen and pelvis to be examined with laser treatment of all areas, not just those limited with the scope. The best course of treatment in advanced stages is an open surgery, not laparoscopy, with aggressive laser therapy.