Brief Answer:
Further treatment depends upon the extent of the recurrence

Detailed Answer:
Dear xxxxxxxxxxxxxx,

Chocolate cyst of the ovary is ovarian endometriosis. Let me explain you this.

Endometrium is inner layer or the lining of the uterus. It periodically and cyclically undergoes changes in its structure and growth according to the levels of reproductory hormones - Oestrogen and Progesterone. When these hormones go to their lowest levels, the endometrium breaks and is thrown out of the body. This is what is seen as menstrual bleeding.

A variation of the site of endometrium is noted when it is present somewhere else than the uterine cavity. Such ectopic endometrium may be found any where in the body. Wherever it is present, it also undergo cyclical changes and bleeds at the time of menstruation. This condition is known as Endometriosis. If such cyclical bleeding is discontinued, the endometriosis will restrict by itself. Therefore, pregnancy is the best treatment for endometriosis.

The endometriosis of the ovaries causes bleeding within the ovarian substance. This blood with the endometrium gets trapped in the ovarian substance. When the blood becomes old, it gains chocolate colour. Hence they are known as chocolate cyst of the Ovary.

Because it is bleeding every month, it goes on increasing and gives pain. If the menstrual process is stopped, it will get restricted. While getting shed off, the basal layer of the endometrium is retained which further develops new endometrial tissue. Therefore when the chocolate cysts are removed, utmost care has to be taken for removal of the complete cyst, not leaving any layer or the cyst wall behind, otherwise, the endometrium will grow again and the chocolate cyst will recur again.

Whether your daughter requires a repeat surgery or a trial of hormonal medicines can be given will depend upon its size and location. Also, presence of any other lesions elsewhere also will have to be look for. Usually endometriosis is present at multiple sites.

How the recurrence of chocolate cyst has been diagnosed? Did she undergo follow up laparoscopy? Do you have any of the pictures of her original and recurrence lesions? If so, will you please upload them with the reports for my review? Also please provide me with her detailed history with all the reports of the investigations. What is her age? How many years ago and at what age did she get her first menstruation? With the more available medical information and reports of your daughter, I may be better equipped to guide you further.

Currently with whatever little information you have provided, I feel, she may need repeat surgery with all the due care to remove the cyst completely with the cyst wall. This can be performed laparoscopically also. She may be put on continuous birth control pills without any gap to prevent the menstruation. It is jus creating a false pregnancy like situation.

I feel, this much advise should give you some guidance. If you still want to have any more information, I am always available for you, xxxxxxxxxxxxxxxxxxxx. If you are satisfied with the information, you please post a review with 5 star rating for me.

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