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Ovarian cysts

Definition


Disease: Ovarian cysts Ovarian cysts
Category: Gynecological diseases

Disease Definition:

The ovaries are two bilateral organs, each about the size and shape of an almond, located on each side of the uterus. Eggs (ova) grow and mature in the ovaries and are released in monthly cycles throughout the childbearing years of a woman. Ovarian cysts are fluid-filled pockets or sacs within or on the surface of an ovary. At some time throughout their lives, many women have ovarian cysts. In most cases of ovarian cysts, they are harmless and cause little or no discomfort at all. Within a few months, most ovarian cysts go away without needing any treatment.

 

However, in some cases, serious symptoms may sometimes be caused by ovarian cysts, specifically those that have ruptured. Women should schedule regular pelvic examinations and protect themselves by knowing the symptoms and kinds of ovarian cysts that may signal a more serious problem.
 

Work Group:


Symptoms, Causes

Symptoms:

Because there might not be any symptoms associated with ovarian cyst, a woman can’t depend on symptoms alone to make sure whether she has ovarian cyst or not. But when a woman has an ovarian cyst, its symptoms might be similar to those of other conditions, like ovarian cancer, ectopic pregnancy, pelvic inflammatory or endometriosis. Signs and symptoms that mimic a ruptured ovarian cyst may also be caused by appendicitis and diverticulitis. Yet, it is essential to keep an eye on symptoms or changes in the body to know which symptoms are serious.

 

Some of the signs and symptoms that ovarian cysts may cause include:

 

  • Pelvic pain during intercourse (dyspareunia)
  • Menstrual irregularities
  • Pain during bowel movements or pressure on the bowels
  • Pelvic pain, which is a constant or intermittent dull ache that might radiate to the lower back and thighs
  • Fullness or heaviness in the abdomen
  • Pressure on the rectum or bladder, difficulty emptying the bladder completely
  • Nausea, breast tenderness or vomiting similar to that experienced throughout pregnancy
  • Pelvic pain preceding the period or just before its end

 

Immediate medical attention is required when having:

 

  • Pain accompanied by fever or vomiting
  • Abrupt and severe abdominal or pelvic pain

 

A woman should consult her doctor immediately in the case of experiencing these signs and symptoms, or those of shock, such as cold, rapid breathing, clammy skin and weakness or lightheadedness, which indicate an emergency.
 

Causes:

Each month, the ovaries develop cyst-like structures called follicles. Follicles produce the hormone estrogen and progesterone and release an egg when a woman ovulates. Occasionally, a normal monthly follicle may keep on growing. When that occurs, it becomes known as a functional cyst indicating that it began throughout the normal function of the menstrual cycle. Two kinds of functional cysts detected:

Follicular cyst:

The brain’s pituitary gland releases a surge of luteinizing hormone (LH) around the middle of the menstrual cycle, signaling the follicle holding the egg to release it. Under normal circumstances, the egg bursts out of its follicle and starts its journey down the fallopian tube in search of sperm and fertilization. When the LH surge doesn’t take place, a follicular cyst starts. The outcome is a follicle that doesn’t release its egg or doesn’t rupture; it grows and turns into a cyst instead. Follicular cysts are often harmless, seldom resulting in pain and usually going away on their own within two or three menstrual cycles.

Corpus luteum cyst: 

The ruptured follicle starts producing large amounts of estrogen and progesterone in preparation for conception, when LH does surge and the egg is released. This changed follicle today is called the corpus luteum. But occasionally, the escape opening of the egg seals off and fluid accumulates inside the follicle, resulting in the expansion of the corpus luteum into a cyst.

 

Even though this cyst often goes away on its own in a few weeks, but it could still develop to almost 4 inches in diameter and has the potential to bleed into itself or cause the ovary to twist, cutting off its blood supply and resulting in pelvic or abdominal pain. The cyst might rupture if it fills with blood, resulting in abrupt, sharp pain and internal bleeding. The risk of a corpus luteum cyst growing after ovulation is increased by the use of the fertility medication clomiphene citrate that is used to induce ovulation. However, the resulting pregnancy isn’t prevented or threatened by these cysts.
 

Complications

Complications:

Abdominal discomfort may result from a large ovarian cyst. A woman might feel the urgency to urinate more frequently than is due, because the capacity of the bladder will be reduced in case a large cyst presses on the bladder. Sometimes, less common forms of cysts may develop that might not produce symptoms, but be discovered during a pelvic examination. Cystic ovarian masses that grow after menopause might be cancerous (malignant). These factors make regular pelvic examinations essential.

 

Some of the types of cysts that are much less common than functional cysts include:

Endometriomas:

Endometriosis, a condition in which uterine cells grow outside the uterus, is the cause of this type of cysts. A growth may result in case some of that tissue attaches to the ovary.

Cystadenomas: 

These cysts grow from ovarian tissue and might be filled with a watery liquid or a mucous material. They could get large, about 12 inches or more in diameter, and contribute to ovarian torsion.

Dermoid cysts: 

Because these cysts develop from cells that produce human eggs, they may include tissue such as hair, teeth or skin. Although these cysts could get large, resulting in the movement of the ovary out of its common position in the pelvis, but they are rarely cancerous. The chance of painful twisting of the ovary, a condition called ovarian torsion, is increased by this condition.
 

Treatments:

The patient’s age, type and size of the cyst, and symptoms will determine the type of treatment. The patient may be recommended:

Watchful waiting: 

When being in reproductive years and having no symptoms and an ultrasound that reveals a simple, fluid-filled cyst, a woman might wait and be re-examined in one to three months. To see whether the cyst has changed in size or not, the doctor will probably suggest that the patient gets follow-up pelvic ultrasounds at periodic intervals.

 

Additionally, when a cyst in postmenopausal women is filled with fluid and is less than 2 centimeters in diameter, watchful waiting including monitoring with ultrasound on a regular basis is a common treatment.

Birth control pills: 

To decrease the chance of new cysts growing in future menstrual cycles, birth control pills might be suggested. Oral contraceptives provide the added benefit of significantly decreasing the risk of ovarian cancer; the longer birth control pills are taken the more the risk of ovarian cancer is decreased.

Surgery: 

If a cyst is large, doesn’t appear to be a functional cyst, is developing or is persisting through two or three menstrual cycles, its removal may be recommended. Cysts that result in pain or other symptoms might be removed as well.

 

In a procedure called a cystectomy, some cysts could be removed without having to remove the ovary. Additionally, in a procedure called oophorectomy, the affected ovary may be removed and the other may be left intact. If a woman is still in her childbearing years, both of these operations might allow her to maintain her fertility.

 

Additionally, a woman will have the benefit of maintaining a source of estrogen production in case she keeps at least one of her ovaries intact. However, the patient will be advised having a hysterectomy to remove both ovaries and the uterus in case her cystic mass is cancerous. The risk of a newly found cystic ovarian mass being cancerous increases after menopause. As an outcome, doctors usually surgery if after menopause a cystic mass grows on the ovaries.
 

Prognosis:

Not available

Expert's opinion

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