Chocolate Cyst in Young Girls

Endometriosis can start in young girls with their first period. In this case, raising the awareness of young women is important for early diagnosis. Although chocolate cyst is not a condition without treatment or remedy, because of the area it affects and in which it emerges, it is among the conditions that can be taboo. Especially for young women who have their period for the first time, this change in their bodies is as difficult as it can be.

The first menstrual cycle, which causes both physical and psychological changes to be experienced, is at the same time a situation so unfamiliar that the person has nothing to compare it with. While women who menstruate regularly can easily tell that there is some problem or difference, young women who have their period for the first time cannot tell what is normal or abnormal because of their inexperience. For this reason it is very important to have informative conversations about sexual health.

Pelvic pain and menstrual cramps are common complaints in girls of a young age. The first step in the treatment of young girls with pelvic pain is NSAID (non-steroidal anti-inflammatory) drugs. In young girls whose pain is resistant to drugs, chocolate cyst should definitely come to mind.

While in adult women chocolate cysts produce findings during the menstrual period, in young girls they can cause pelvic pain both during and outside the menstrual period. Because of this pain they may frequently have difficulty in going to school and taking part in sporting and social activities.

Young people who have painful, heavy and irregular menstrual periods should definitely talk to their families and see a specialist doctor. Although menstrual pain is a normal process, pain that drags quality of life down to the bottom, that does not subside with painkillers and that is severe enough to prevent the person from getting out of bed should not be perceived as normal. Pain when going to the toilet, constant tiredness and severe pelvic pain between menstrual periods may be giving you signals about endometriosis.

When you receive these signals there is no need at all to worry and be afraid. Because this condition, which according to research carried out worldwide emerges in general in 1 in every 10 women, can be treated and brought under control, there is no need whatsoever for you to worry. Do not forget that there are women who have been diagnosed with a chocolate cyst and who continue their lives happily, energetically and without problems.

Pain that does not respond to painkillers both throughout the menstrual period and outside it, back and lower back pain, bloating, irregular periods, heavy menstrual bleeding, bleeding between periods and difficulty in going to the toilet are the other findings of chocolate cyst.

Endometriosis is a disease with a genetic predisposition, and for this reason young girls who have endometriosis in their family (mothers, sisters and aunts) have a higher risk of having a chocolate cyst. But its presence in close relatives does not necessarily mean that that person will have a chocolate cyst. Apart from this, young girls who start menstruating at an early age, who menstruate frequently and heavily and who have a congenital uterine anomaly are at risk in terms of chocolate cyst.

After a detailed history, the physical examination is carried out. Although in the examination the ovaries, the uterus and the vagina in the pelvis (the inside of the pelvic bone) are examined, the rectum, the urinary tract and the bladder (the urine sac) are also included in the examination. Because in young girls who are not sexually active this examination cannot be performed vaginally, rectal examination (through the anus) and,  for the purpose of good imaging, transrectal ultrasound can be used.

In addition to this, in disease that is not limited to the ovaries alone, in situations where involvement of a neighbouring organ (especially the bowel) is suspected (Deep Infiltrating Endometriosis), and in situations that cannot be clearly distinguished with ultrasonography (cancer?), MRI is used. In bowel involvement, if it is suspected that the lesion involves the inner side of the bowel, rectoscopy should be performed.

The definite diagnosis of endometriosis is made by seeing the lesions laparoscopically and by the pathological examination of tissue samples taken from these lesions. In the same session both the presence and the extent (stage) of the disease are assessed, and thanks to the tissue sample a definite diagnosis can also be made. But today laparoscopy (Diagnostic Laparoscopy) is not performed only to diagnose the disease. Laparoscopy is performed if surgical treatment is also to be carried out.

Painkillers (Non-steroidal anti-inflammatory drugs)

Painkillers such as ibuprofen or naproxen sodium are frequently used to help relieve pelvic pain and menstrual cramps. These painkillers have no effect on endometriotic implants (foci of chocolate cyst that settle on the organs or on the lining of the bowel) or on the progression of endometriosis. At the same time, they reduce the production of the prostaglandins that cause pain, and therefore they may also reduce the pain.

Birth Control Pills (Oral contraceptive pills, OC)

The combination of oestrogen and progesterone  is also used in the treatment of endometriosis. They are used in particular to act on pain. Another area of use is their use after surgery in order to reduce the risk of the disease recurring.

Progestins

Progestins (for example, dienogest, medroxyprogesterone acetate, norethindrone acetate, norgestrel acetate) are used in treatment. Dienogest, which is licensed specifically for endometriosis, is widely used in symptomatic patients (patients who have complaints) both worldwide and in our country. In young girls its most common side effects (although they are not very common) are; weight loss, swelling in the abdomen, acne, emotional instability, headache and menstrual irregularity. They can also be preferred in patients who cannot tolerate continuous combined hormone treatment (oral contraceptive pills) or in whom its use is contraindicated. While OCs were frequently used in previous years, today progesterones licensed specifically for this disease are used quite widely.

Artificial (Temporary) Menopause Injections (GnRH analogues)

They are used effectively to reduce pain and to shrink the size of endometriosis implants (foci). These drugs suppress the production of oestrogen by the ovaries by preventing the release from the pituitary gland of the hormones that stimulate the ovaries. As a result, after treatment the menstrual periods stop, imitating the menopause. But the use of GnRH agonists is not recommended in young girls under the age of 18.

Danazol

It is a synthetic drug that prevents the effect of oestrogen on egg production and ovulation by creating a hormonal environment of high androgens (the dominant hormones present at high levels in men, the male hormones) and low oestrogen. But because of its serious side-effect profile it is a drug that we do not prefer in young girls.

Surgical treatment

In the treatment of endometriosis, if the patient’s complaints are very severe, if these complaints do not respond adequately to medical treatment or if an obstruction has occurred in the bowel and urinary tract, surgery is the preferred treatment method. Because young girls will want to have children in the future, the conservative method in which the uterine and ovarian tissue is preserved (only the surgical removal of the endometriotic tissue, maximal preservation of the ovaries) should be applied.

The most important point in endometriosis surgery is that the doctor performing this surgery having the necessary knowledge and experience is essential for a successful result. If this operation is performed by a doctor who does not have sufficient experience, it will be accompanied by a high rate of complications during the operation (bleeding, vascular injury, injury to the urinary tract and the bowel and fistula) and by recurrence of the disease at an early stage after the operation. With successful surgery, the ability to conceive spontaneously when desired, a pain-free life and a low rate of recurrence of the disease will be seen. Especially in advanced-stage disease, in Deep Infiltrating Endometriosis, it is very important for successful surgical treatment that the doctor has previously performed these operations a great many times.

Endometriosis is a condition that occurs when the tissue located in the inner wall of the uterus forms outside the uterus. These cells break down every month with the menstrual cycle, because there is no other way for the blood that needs to be expelled to leave the body. In this case you may experience a process that you could confuse with your normal menstrual period. However, at the slightest feeling of abnormality, the healthiest decision will be to talk to your family and make an appointment with a specialist doctor. In the period before you go to the doctor, by keeping a pain and symptom diary for yourself you can make your patient history help with the diagnosis.