During the menstrual period, which usually starts between the ages of 11 and 14 and continues until women enter the menopause, blood and mucosal tissue from the endometrium layer of the uterus (the innermost layer of the uterus) are expelled in cycles of about one month, if pregnancy does not occur. Although noticing clots in menstrual blood sometimes causes worry, this is usually a normal situation.
During menstrual bleeding the endometrial cells covering the inner wall of the uterus are shed and leave the body. At the same time the body releases proteins that cause the blood in the uterus to clot. This clotting prevents the blood vessels in the inner wall of the uterus from continuing to bleed.
The blood that leaves the woman’s body also contains these clotting proteins. At times when the flow is heaviest, the clotting proteins in the blood starting to gather together can cause clots in the menstrual blood. This usually occurs when the menstrual blood collects in the uterus or the vagina before being expelled from the body.
In addition, in endometriosis and adenomyosis, conditions women frequently experience, abnormal bleeding and blood clots can be seen. Among the diseases that arise from the growth of uterine tissue in an area other than the inner wall of the uterus, in endometriosis the endometrium tissue develops abnormally outside the uterus, while in adenomyosis it develops inside the muscle of the uterus.
Endometriosis Is a Chronic Condition That Must Be Treated
In patients with endometriosis the intensity of the symptoms can vary. Among the classic symptoms of endometriosis are pain, pain during or after sexual intercourse, infertility and painful bowel movements. Because these symptoms can also be signs of other conditions, a specialist must certainly be consulted. In some cases endometriosis shows no sign at all and can be diagnosed by chance during a medical examination.
In the treatment of endometriosis, drug or surgical options can be used, or patients without a clinically significant complaint can simply be observed. Although the chocolate cyst can shrink with drug treatment, it does not disappear or vanish. What is mostly aimed at is a certain reduction in its diameter, at the very least that it does not grow, and more importantly that the patient’s complaints clinically pass or decrease enough not to affect her life. Drug treatment aims to prevent recurrence and to reduce complaints. Sometimes drug treatment can also be given before the surgical procedure in order to shrink the cyst and make the operation easier.
The surgical procedure is generally performed as closed surgery (robotic surgery or laparoscopic surgery). Today, apart from very exceptional situations, open surgery is not used in endometriosis surgery. Because of its structure, the chocolate cyst attaches to the ovary far more strongly than an ordinary cyst.
If too much force is applied, a situation such as the removal of ovarian tissue can be faced. Therefore, in endoscopic surgery it is very important to separate the chocolate cyst gently from the healthy ovarian tissue and to protect the remaining healthy tissue well.