What to know about endometriosis and ruptured cysts

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Endometriosis can cause cysts to form in the female reproductive system, most commonly in the ovaries.

The term for these cysts is endometriomas.

These cysts form because, in endometriosis, tissue similar to the endometrium, the lining of the uterus, develops outside of the uterus. This tissue is an endometrial implant.

Endometriosis implants may follow the same pattern as the lining of the uterus during the menstrual cycle, meaning it can swell and bleed during a menstrual period.

This can cause pain and swelling because the abnormal tissue is unable to leave the body. Scarring in the pelvis and abdomen from endometriosis can block the fallopian tubes, distort normal anatomy, and even affect the function of organs, such as the bowels and bladder. When endometriosis occurs in the ovaries, ovarian cysts filled with blood can form.

Although rare, endometriosis can result in a ruptured ovarian cyst. Ruptured endometriomas occur in less than 3% of known endometriomas, and usually in cysts larger than 6 centimeters (cm).

Ruptured cysts are more common during pregnancy, due to hormonal changes, in people with larger cysts.

What happens when an endometriosis cyst bursts?

Doctors may refer to endometriosis cysts on the ovaries as chocolate cysts due to the color of the blood in them. The cysts contain menstrual blood that would have left the body during a period.

If an endometrioma ruptures, the thick fluid inside can spill out into the abdomen, causing pain and inflammation.

A ruptured cyst may not always cause symptoms. If people do have symptoms, they may experience:

• pain at the time of rupture, which may be a sudden, sharp pain in the lower abdomen or back
• some discomfort for a few days following the initial pain
• abdominal bloating
• vaginal spotting or bleeding

Endometriosis cysts may occur if endometrial tissue forms on the ovaries. The endometrial tissue may swell and bleed, forming a cyst. The cyst may expand and get larger as it fills with blood.

A few other potential causes of ovarian cysts include:

• menopause
• polycystic ovary syndrome (PCOS)
• regular menstruation

It is not clear why some cysts rupture and some do not. Sexual activity and strenuous exercise may make it more likely for an ovarian cyst to rupture.

There is little research on specific risk factors for endometriomas.

Risk factors for ruptured cysts may include cysts that are larger than 6 cm and hormonal changes during pregnancy.

To diagnose endometriosis and endometrial cysts, a doctor will assess a person’s symptoms and, if necessary, order one or more of the following tests:

• a pelvic exam, to feel for areas of endometriosis tissue, cysts, and scars
• an ultrasound or MRI scan, to see images of the inside of the abdominal area and pelvis
• laparoscopy, a form of surgery that allows a doctor to examine the inside of the pelvic area to check for endometrial growths

A doctor may also prescribe hormonal medication, such as hormonal birth control or gonadotropin-releasing hormone (GnRH) agonists. GnRH agonists stop the menstrual cycle.

If people have symptoms that improve when taking these medications, they may have endometriosis.

If a person presents with symptoms of a ruptured cyst, a doctor may require a variety of tests to rule out other conditions and check if a cyst has ruptured, including:

• an ultrasound
• pelvic exam
• blood tests
• urine tests
• vaginal culture
• CT scan
• pregnancy test

Learn more

Learn more about diagnosing endometriosis and endometrial cysts.

• What to expect from a laparoscopy for endometriosis
• What to know about ultrasound examinations for endometriosis
• What to know about pelvic MRI for endometriosis

Treatment for endometriosis and its related cysts usually involves hormonal medication.

For people who do not want to become pregnant, hormonal birth control in the form of a pill, shot, or intrauterine device (IUD) may help.

Those who do wish to become pregnant may take GnRH agonists, such as Lupron, which are medications that temporarily stop the menstrual cycle and prevent endometrial growth.

GnRH agonists may help reduce the size of a cyst. People with endometrial cysts that are causing painful symptoms may require surgery to remove the cysts.

Treatment for a ruptured cyst may depend on whether the cyst is regular or complex.

People may be able to take over-the-counter (OTC) pain medication to treat symptoms of a regular cyst. People will need to monitor their symptoms and contact a doctor if they worsen or do not improve.

A complex ruptured cyst may be larger and have solid areas, bumps on the surface, or several fluid-filled areas. People may require medical care for complex cysts, which could include:

• intravenous (IV) fluids to help replace lost fluids
• monitoring of vital signs and red blood cell levels
• ultrasounds to check for internal bleeding
• surgery

People with endometriosis may experience infertility. Surgery and in vitro fertility treatments may help.

People may require surgery if endometriosis is causing severe symptoms, infertility, or other treatments are not effective. A surgeon may remove areas of endometrial tissue.

If people require surgery to treat a cyst or ruptured cyst, people may need a laparoscopy. A surgeon makes small cuts into the abdomen. They will operate through these holes using a small light and camera to guide them.

A surgeon may remove a problematic cyst, control bleeding from a ruptured cyst, or remove any excess fluid or blood clots. Then, they will close any incisions.

The overall outlook for endometriosis is good. Endometriosis is benign. However, it requires long-term management, and it can progress in severity.

Surgical removal of a cyst may help manage symptoms and improve fertility. Symptoms usually improve with menopause due to a lack of hormones that cause endometriosis.

In most people, a ruptured cyst will heal without treatment and the cyst fluid will disperse by itself.

However, in some, a ruptured cyst may be dangerous and require emergency treatment.

Cysts may occur with severe endometriosis. Early diagnosis and treatment of endometriosis may help slow or prevent disease progression.

Surgical treatment of a cyst may help prevent complications, such as ruptured cysts, adhesions, pelvic pain, and infertility.

People should contact a doctor immediately if they have sudden, sharp abdominal pain, heavy vaginal bleeding, or severe pain.

If a person knows they have ovarian cysts, they should let a healthcare professional know.

If a doctor has prescribed a home treatment for a ruptured cyst, people will need to contact a doctor if:

• the pain worsens
• they feel dizzy
• they have new symptoms

Seeking emergency medical attention

People should seek emergency medical attention if they have abdominal pain with:

• severe nausea and vomiting
• heavy vaginal bleeding
• a fever
• feeling faint or dizzy

This section answers some frequently asked questions about endometriosis and ruptured cysts.

Can an endometrial cyst rupture?

An endometrioma can rupture, although this is rare. Strenuous exercise or sexual activity may make an ovarian cyst more likely to rupture.

What does it feel like when a cyst ruptures?

People may feel a sudden, sharp pain in their lower abdomen or back when a cyst ruptures. Following this, people may experience some discomfort for a few days.

It is also possible that people will not experience any symptoms from a ruptured cyst.

Endometriosis can cause cysts on the ovaries, which in some cases, can rupture. A ruptured cyst may be harmless, but in some cases, it may require immediate medical attention.

Treatment for a ruptured cyst may require pain medication or surgery, depending on the severity.