🍫 Endometrioma vs. Hemorrhagic Ovarian Cyst — The Real Chocolate Cyst Showdown

cene opens on your ultrasound screen.
Two cysts enter. Both dark, both full of echoes, both suspiciously chocolatey.
But only one is the real drama queen — the chronic, sticky, pain-loving endometrioma.
The other? A temporary bleed with big emotions and a short lifespan.

Let the showdown begin.

🍷 Contestant #1: The Hemorrhagic Ovarian Cyst (HOC)

Personality: The ovary’s short-lived soap opera — loud, dramatic, and over before the credits roll.

Appearance:

• Reticular internal pattern — that famous “spider-web” or “fishnet” look.

• Fibrin strands floating around like artistic chaos.

• Sometimes a retracting clot that changes position between scans.

• Peripheral vascularity — the classic “ring of fire.”

Behavior:

• Appears suddenly, usually post-ovulation.

• May cause acute pain.

• Resolves spontaneously within 6–8 weeks.

Diagnosis: Functional hemorrhage into a corpus luteum or follicular cyst.
Clinical vibe: Temporary chaos that heals on its own — like a bad weekend decision that doesn’t leave emotional scars.

🍫 Contestant #2: The Endometrioma (The True Chocolate Cyst)

Personality: Dark. Mysterious. Chronic. The ovary’s long-term tenant.

Appearance:

• Homogeneous low-level internal echoes — smooth and velvety, like hot chocolate left to settle.

• Thick capsule, sometimes with bright wall foci (old blood residues).

• No internal vascularity — emotionally unavailable.

• No posterior enhancement — that flat, gloomy “ground glass” texture.

Behavior:

• Persistent. Never resolves spontaneously.

• Sticks to everything nearby — ovaries, tubes, bowel — hello adhesions.

• Causes dysmenorrhea, dyspareunia, and infertility.

Diagnosis: Endometriotic cyst — a chronic, estrogen-driven pathology.
Clinical vibe: The ex who refuses to leave your pelvis, moves in permanently, and brings pain with her.

🧠 How to Tell Them Apart (ISUOG / ESHRE Pearls)

Time is the ultimate diagnostic test.

• The hemorrhagic cyst appears suddenly and fades within 6–8 weeks.

• The endometrioma stays, unchanged, for months — stubborn and unbothered.

Ultrasound Clues:

• Hemorrhagic cyst: Lace-like echoes, fibrin strands, possible retracting clot, changing appearance.

• Endometrioma: Homogeneous “ground glass” echoes, no shape change, thick wall, no enhancement.

Clinical Context:

• HOC = acute pain.

• Endometrioma = chronic pain + infertility.

If it disappears, it bled.
If it stays, it’s chocolate. 🍫

🩸 The Clinical Drama

Hemorrhagic cysts are the one-episode guest stars of your ovary’s TV show.
Endometriomas are the recurring villains who steal the spotlight, the blood supply, and sometimes the fertility storyline.

💡 Final Verdict

• Hemorrhagic Cyst: Sudden storm — chaotic, painful, but short-lived.

• Endometrioma: Long-term climate change — persistent, adhesive, and emotionally exhausting.

So next time you see that ovary looking like stirred-up cocoa — don’t rush to call it chocolate.
Wait. Rescan in 6–8 weeks.
If it’s gone, it was drama.
If it’s still there, it’s endometriosis in disguise — the ovary’s most loyal, least welcome guest.

📚 Want More Like This?

Check out the OBGYNX Ultrasound Showdown Series™ — where clinical science meets sarcasm:

• Blighted Ovum vs Early IUP: The Empty Sac Saga

• Molar Pregnancy vs Twin: The Snowstorm Mystery

• Corpus Luteum vs Ectopic: The Ring of Confusion

Guidelines decoded. Secrets revealed. Only on OBGYNX.