Ovarian Cysts
An ovarian cysts is a sac filled with fluid or a semisolid material that develops on or within an ovary. The number of diagnoses of ovarian cysts has increased with the widespread implementation of regular physical examinations and ultrasound technology. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during a woman's childbearing years. These are soft, have thin membrane walls, and contain clear fluid. These can rupture, causing sudden, severe pain which gradually goes away over several days. Usually, however, they spontaneously disappear over the course of one or more menstrual cycles. Occasionally ovarian cysts occur as part of an ovarian tumour; such tumours may be benign (non-cancerous) or malignant (cancerous) and usually have a complex structure. The follicle contains fluid to protect the egg as it grows and bursts when the egg is released. Sometimes a follicle doesn't release an egg, or doesn't shrink (shed its fluid) after the egg is released. However, a larger ovarian cyst can twist, rupture, or bleed and be very painful. Specific types of cyst include graafian follicles (which may rupture at mid-cycle and cause mittelschmerz ) or corpus luteum cysts (which may rupture about the time of menstruation, and take up to three months to disappear entirely). Other cysts are pathological , such as those found in polycystic ovary syndrome , or those associated with tumors .
Ovarian cysts and their complications can be present from the neonatal period to postmenopause. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months. Functional cysts normally shrink over time, usually in about 1 to 3 months. However, ovarian cysts can herald an underlying malignant process or, possibly, become a red herring, distracting the clinician from a more dangerous condition, such as ectopic pregnancy, ovarian torsion, or appendicitis. If you have a functional cyst, your doctor may want to check you again in 1 to 3 months to make sure the cyst has gotten smaller. Theca luteum cysts , the least common of the functional cycts, are often asscociated with an abnormal pregnancy. They most often occur in both ovaries, unlike the functional cycts described above. The term cyst refers to a fluid-filled structure. Therefore, all ovarian cysts contain at least some fluid. Some of these, called functional cysts , are part of the normal process of menstruation . Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst If rupture occurs, pelvic pain may result and last 24-48 hours. The pain is due to a small amount of bleeding which is irritating to the abdominal cavity. Surgery may be indicated in cases when bleeding continues or is excessiveIf your health professional has found that you have a functional ovarian cyst, you have no reason to worry about cancer-functional cysts do not lead to cancer. Most functional ovarian cysts go away on their own within a few months and are harmless.
Causes of Ovarian Cysts
The common Causes of Ovarian Cysts :
- Disordered folliculogenesis.
- Hormonal imbalances.
- Smoking is a controversial risk factor; some studies show no increased incidence of cysts among smokers, while other studies show up to a 2-fold increase in the incidence of cysts.
- Ovarian cancer.
- Tamoxifen therapy for breast cancer.
- Metastatic cance.
- Increased upper body fat distribution.
- Smoking (controversial).
- Patients being treated for infertility by ovulation induction with gonadotropins or other agents, such as clomiphene citrate or letrozole, may develop cysts as part of ovarian hyperstimulation syndrome.
- Infertility .
Symptoms of Ovarian Cysts
Some common Symptoms of Ovarian Cysts :
- Dull pain in the lower abdomen or discomfort.
- Pain with intercourse or pelvic pain during movement.
- Fullness or bloating .
- Pain during sexual intercourse, masturbation or exercise.
- nausea or vomiting.
- Pelvic pain shortly after beginning or ending a menstrual period.
- Irregular periods or spotting.
- Abdominal bloating or swelling.
- weight gain .
- breast tenderness .
- Fullness or heaviness in your abdomen.
Treatment of Ovarian Cysts
- Other medical treatment may be recommended if other disorders are found to be the cause of ovarian cysts, such as polycystic ovary disease
- Many patients with simple ovarian cysts based on ultrasonography findings do not require treatment.
- When the patient exhibits toxic signs, such as peritonitis or hemodynamic instability, consultations are indicated early in the work-up.
- To remove the entire cyst intact for pathologic analysis, including frozen section, which may mean removing the entire ovary
- Ovarian cysts that do not appear to be functional may require surgical removal by laparoscopy or exploratory laparotomy.
- Consider culdocentesis in the hemodynamically unstable patient who cannot wait for ultrasonographic studies and when experiencing a delay in taking the patient to the OR for continued workup.
- Preventing more cysts from developing by preventing ovulation (if recurrence is a problem). Treatment with birth control pills prevents ovulation.
- A laparotomy should be performed on patients thought to have a significant risk for malignant disease and on patients with benign-appearing cysts that cannot be removed intact laparoscopically.
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