What is an Endometrioma?

With the onset of my last period, something horrible happened. Only a few hours after I had begun bleeding, I started to experience a sharp, stabbing pain in my low right side that was very severe. It would come and go in waves though, like a contraction. This started in the early evening around 6 or 7pm. Finally, around 3am, I called my boyfriend and said we needed to go to the ER.

This pain was different

Now, I've been menstruating for about three decades, and though they've always been awful, I've only ever gone to the ER with them a few times, mostly in my early 20s in the lead-up to my endo diagnosis and first and only lap. But this time was different. My periods usually consist of excruciating cramps that engulf my entire abdomen, whereas this was very central and small in the area impacted. It felt more like a charlie horse of a very specific muscle. I thought it may even be my appendix, though I thought it a strange coincidence for it to be reacting during my period. Or it could be my hernia. Or an ovarian cyst. It turns out, I was partially right about the last option, but with a twist.

What was the cause?

When I got to the ER, they did a pelvic exam. When they pressed down on the sensitive spot, I yelped. I'd like to also offer the disclaimer that when I've been to the ER before I've never really cried, but I was in tears at the point from pain. They even gave me morphine, and while it knocked the pain down temporarily a few degrees, it did not go away completely. I was then transferred to a different hospital because the one I was in did not have an ultrasound tech on duty and wouldn't for hours. When I got to the new hospital, I still had to wait an hour, but within 30 min or so after the imaging was taken, I was told they found the culprit: a moderate-sized, "complex" ovarian cyst on my right ovary. I had had ovarian cysts before and they had hurt, but this felt different than those. Worse. They told me to follow-up with my gynecologist in the next few days. After my release from the hospital, I spent the next 48 hour mostly in bed. The pain on my right side did not really resolve till my period was done, which was weird. While I know cysts are impacted by menstrual cycles, I had never had them be so closely intertwined as they were now.

Getting answers

A few weeks later, my gynecologist's office finally got the ER records. It turned out, that my cyst seems to be a likely endometrioma. I didn't understand what the ER doc meant when he said my cyst was "complex," but it means that rather than being filled with fluid, the cyst is filled with cells and tissue. In my case, my gynecologist said it looked and sounded (they recorded sounds of it, which was strange and new to me) like an endometrioma. It also makes the most sense considering my history with endo and how the symptoms got worse with my period and better when it ended.

What is an endometrioma?

An endometrioma is basically a cyst made of endometriosis. They are also commonly called "chocolate cysts" (because they look chocolate-brown from having dried, dark blood in them). When I had my lap many years ago, the surgeon found several tiny chocolate cysts on one of my ovaries. However, this one is the first one I've had that was large enough to show up on an ultrasound and to cause such severe symptoms on its own.

What happens next

In some ways, the timing for finding it is good. I already have arranged for a surgical consult to discuss having second (and hopefully, final) lap, and perhaps a hysterectomy for adenomyosis. So, if I also have this cyst to contend with and it's not going away, I can have it removed then as well with the other excisions.

In the meantime, though, I can only hope my next periods will not again be accompanied by such sharp, severe pain, and the endometrioma will be less symptomatic.