Chocolate cysts (Ovarian endometriomas): A comprehensive review with emphasis on nursing management

Chocolate cysts, clinically termed ovarian endometriomas, represent a severe ovarian manifestation of endometriosis characterized by cystic lesions filled with altered menstrual blood. These lesions are closely associated with chronic pelvic pain, dysmenorrhea, dyspareunia, infertility, and significant psychosocial morbidity, leading to substantial impairment in quality of life among women of reproductive age. Despite advancements in diagnostic imaging and therapeutic strategies, ovarian endometriomas remain clinically challenging due to their chronic course, high recurrence rates, adverse effects on ovarian reserve, and rare malignant potential. This review provides a comprehensive synthesis of current evidence on epidemiology, etiopathogenesis, molecular and inflammatory mechanisms, clinical manifestations, diagnostic approaches, differential diagnosis, medical and surgical management, fertility implications, complications, and prognosis of chocolate cysts. A major focus is placed on integrated nursing management, highlighting the nurse’s role in pain control, hormonal therapy support, fertility counseling, perioperative care, psychological support, patient education, and long-term follow-up. Strengthening nursing-led interventions is essential to improving symptom control, treatment adherence, and holistic outcomes in women affected by ovarian endometriomas.