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Have endometriosis. Chocolate cyst near ovary. Taking regestrone 10 mg. Safe to take this medicine?

Mar 2016
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Practicing since : 2011
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Hi- my wife got diagnosed with endometriosis 3 months back. She had a lap cystectomy (right side) to have that removed.

Post that, now there is a chocolate cyst near the left ovary and she is on regestrone 10 mg for cycles (15 days medicines- menstrual cycle - 21 days medicines - menstrual cycle - 21 days medicines - menstrual cycle). have a few questions:

1) Is this the right approach?

2) What are the side effects of such extensive dosage of regestrone?

3) Is 10 mg per day too high? everywhere i read, people are prescribed on 5 mg only.

4) Does this impact the chances of pregnancy? She is 33 and has also suffered from Tuberculocis in the past.

Pls suggest.

Posted Sat, 23 Feb 2013 in Women's Health
Answered by Dr. S Patra 1 hour later

Thanks for writing to us. I am happy to help you.

I am trying to give answers according to your questions.

Your wife is suffering from endometriosis of the left ovary, contained dark old blood substance and hence it is called chocolate cyst or endometrioma.

1) Treatment modalities for chocolate cyst include medication with drug therapy and surgery (laparoscopy) or combination of both.

Medical treatment- Hormone therapy may be helpful in relieving symptoms temporarily but do not treat or actually remove the cyst. Androgenic drugs (like Danazol/gestrinone) and GnRH analogues are commonly used.

Regestrone contains norethisterone (progesterone pill) which is also quite useful to get symptomatic relief and reduce the size of cyst with regularization of period. But high dose (more than 20mg /day) may suppress ovulation & induce amenorrhoea.

Surgical treatment- It is the definite and ideal treatment to preserve fertility or desire for pregnancy. Here laparoscopic ovarian cystectomy is the procedure of choice. It has success rate more than 80% in preventing recurrence & relieving symptoms. Pregnancy rate is also more than 60% in moderate and around 35% in case of severe extensive disease. Please consult with your gynecologist or laparoscopic surgeon regarding this for suitable treatment option.

2) Common side effect of regestrone is menstrual irregularity/ prolonged bleeding. It may also cause breast tenderness, stomach problems,acne, headache, mood changes, changes in sexual drive, tiredness, as well as changes in weight and appetite etc. But it is well tolerated in recommended doses.

3) The recommended dose for regestrone is 10-30 mg daily for 6-9 months. Therefore, I do not think that taking 10 mg is too high dose. It is quite adjustable with less ill health effects.

4) Yes, chocolate cyst can reduce chance of pregnancy with greater percentage by hampering ovulation. Past history of TB is another causative factor for underlying infertility till it gets complete treatment. It is commonly associated with tubal blockage or endometritis.

In conclusion, as you want to preserve fertility/ desire for pregnancy, I suggest you to undergo for definite treatment by the means of laparoscopy.

An other thing, she will avoid certain food items that contain high carbohydrates XXXXXXX in estrogen that triggers the growth of an ovarian cyst. Caffeine and alcohol will also boost the production of estrogen. Food moderation is essential to reduce the cyst size and prevent recurrence.

Hope I have answered your query. If you have any further questions I will be happy to help.

Wish good health for both of you.

Dr Soumen.

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