LITERATURE REVIEW

ENDOMETRIOMA
 Learning Objectives
 Describe the theories of endometrioma
 List the most common sites of endometriosis
 Describe the symptoms and physical exam
findings in a patient with endometrioma

 Describe the diagnosis and management of

endometrioma
 Introduction
20-40% of patients with
endometriosis

Ovarian endometriomas, also known as ‘chocolate cysts’, contain

thick, old blood that appears as a brown fluid.
 Introduction
• An endometrioma or chocolate cyst of
ovary is a condition related to endometriosis.
• Endometrioma is a type of cyst formed when
endometrial tissue grows in the ovaries.
• It affects women during the reproductive
years and may cause chronic pelvic pain
associated with menstruation
 Definition
• Endometriosis is a disease in which
endometrial glands and stroma implant and
grow in areas outside the uterine cavity and
wall.
 Sites of Occurrence

 Ovary (most common)

 Cul-de-sac
 Uterosacral ligaments
 Broad ligament
 Fallopian tubes
 Round ligaments
 Vagina
 Rectosigmoid
 Bowel
 appendix
 Urinary bladder and ureters
Hacker & Moore: Hacker and Moore's Essentials of Obstetrics and Gynecology,
5th edition (2009), Neville F Hacker, Joseph C Gambone, Calvin J Hobel, Chapter
25 (p299).
 The characteristic triad of symptoms:

1- dysmenorrhea.
2- dyspareunia.
3- dyschezia.
 Other symptoms:
• Female reproductive tract:
1- pre and postmenstrual spotting.
2- cyclic pelvic pain.
3- low sacral backpain (especially premenstually).
4- infertility.
5- diminished amount of menstrual flow.
6- ovulatory pain and mid-cycle vaginal bleeding.
 Other symptoms:

• If the Bladder is involved:

1- cyclic hematuria/ dysuria.
2- ureteric obstruction.

• If the rectosigmoid colon is involved;

1- premenstrual tensmus or diarrhea.
2- obstruction.
 Signs:
• Tenderness on bimanual examination.
• Tenderness or nodularity on the posterior vaginal
fornix.
• Uterosacral ligament tenderness or nodularity.
• Cystic ovarian enlargement.
• Fixation of adnexal structures.
• Retroflexed uterus.
• Episiotomy or cesarean section scars.
 Subtypes of endometriosis
• Depending mostly on location
– Ovarian endometriosis (ovarian endometriomas)
• Unilateral or bilateral
• Mostly < 5 cm in size
– Peritoneal endometriosis
– Deep infiltrating endometriosis (DIE)
• Rectovaginal
• Ovarian endometriomas is the most common
Normal Pelvic Structures