Ovarian cyst

The ovarian cyst is a fluid-filled sac inside or on top of the ovary . It is one of the cysts that appears more frequently in women. This mass may have liquid content mixed with solid components inside.

Many cysts are not cancerous and occur due to ovulation , that is, the release of an egg by the ovary. These are known as functional cysts. Functional cysts typically decrease in size on their own over time; usually between one and three months.

Summary

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• 1 Causes, incidence and risk factors
• 2 Symptoms
  • 1 List of symptoms
• 3 Signs and tests
  • 1 Blood tests
• 4 Looking inside the body
• 5 Age also counts
• 6 Classification of ovarian tumors
  • 1 Non-tumorous
  • 2 Derivatives of the celomic epithelium
  • 3 Derivatives of germ cells
  • 4 Derivatives of the gonadal stroma
• 7 How many types of ovarian cysts are there?
  • 1 Follicular cysts
  • 2 Cysts of the corpus luteum
  • 3 Inclusion cysts
  • 4 Luteal cysts of teak
  • 5 Treatment
  • 6 The types of surgery for ovarian cysts include:
  • 7 Expectations (prognosis)
  • 8 Complications
  • 9 Situations requiring medical assistance
• 8 Prevention
• 9 Alternative names
  • 1 Tumors derived from the celomic epithelium
  • 2 Derivatives of germ cells
  • 3 Tumors derived from the gonadal stroma
• 10 Non-tumor ovarian cysts
• 11 Tumors derived from the celomic epithelium
• 12 Teratomas (dermoid cysts)
  • 1 Valuation
  • 2 Treatment
  • 3 Surgery will most likely be needed to
  • 4 The types of surgery for ovarian cysts include
• 13 Save the ovaries
• 14 Sources

Causes, incidence and risk factors

Every month during your menstrual cycle, a follicle (where the egg is developing) grows in your ovary. Most months, an egg is released from this follicle (called ovulation). If the follicle fails to open and release an egg, the fluid stays inside the follicle and forms a cyst, which is called a follicular cyst.

Another type of cyst, called corpus luteum cyst, occurs after an egg has been released from a follicle. It often contains a small amount of blood.

Ovarian cysts are relatively common and occur more frequently during a woman’s fertile years (from puberty to menopause). These cysts are less common after menopause.

No known risk factors have been found. Functional ovarian cysts are different from ovarian tumors (including ovarian cancer) or cysts due to hormone related conditions, such as polycystic ovarian disease.

Taking fertility drugs can cause a condition called ovarian hyperstimulation, in which multiple large cysts form on the ovaries. They usually disappear after the woman’s period or after a pregnancy.

Symptoms

Ovarian cysts often do not cause symptoms, but when they do occur, they are typically pain or a late period .

An ovarian cyst is more likely to cause pain if:

• it gets big.
• bleeds
• it twists or if it causes twisting of the fallopian tubes.
• is hit during sexual intercourse.

Symptom list

• bloating or bloating.
• pain during defecation.
• pelvic pain shortly after the start or end of the menstrual period.
• pain with intercourse or pelvic pain during movement.
• constant dull pelvic pain.
• Sudden, severe pelvic pain, often with nausea and vomiting, which may be a sign of twisting or twisting of the ovary over its blood supply or rupture of a cyst with internal bleeding.

Changes in menstrual periods are uncommon with follicular cysts and are more common with corpus luteum cysts. Spotting or bleeding may occur with some cysts.

Signs and tests

Your doctor may discover a cyst during a physical exam or when you have an ultrasound for another reason. Ultrasound is done in many patients to diagnose a cyst. The doctor may need to examine you again in 4 to 6 weeks to verify that it is gone.

Other imaging tests that can be done when needed include:

Ovarian cyst (English ovarian cyst ).

• Computed
• Doppler flow studies.
• Magnetic resonance.

The doctor may feel the ovarian cyst during a pelvic exam .

Blood tests

• Ca-125 test to look for possible cancer in women who have reached menopause or who have an abnormal ultrasound.
• Hormonal levels (such as HL, FSH, estradiol, and testosterone).
• HCG in serum (pregnancy test).

Looking inside the body

In general, when the doctor detects a cyst, the first indication is to take an ultrasound, since this examination provides valuable data to decide whether to treat it and how to do it. In general, the patient can wait a month before having another ultrasound in the event that:

It is a simple cyst, without thick dividing septa or internal structures; it is presented on one side only; is not more than 6 cm; appear at reproductive age; have no attached abnormalities such as nodes or fluid in the abdomen and do not produce significant symptoms such as pain and / or fever.

If the following ultrasound shows that the cyst has disappeared or its size is shrinking then it was a “functional cyst” and does not require treatment.

In the event that it has increased in size or does not meet the stated requirements, it is very likely that surgical treatment is required. Surgery will be necessary even if it is a functional cyst since these can be complicated generating a very strong pain picture, which in some cases can be confused with Appendicitis .

Age also counts

In addition to the types mentioned, there are so-called endometriotic cysts. Many times they generate infertility in young women since they tend to form over and over again unless the entire ovary is removed.

Fortunately, most ovarian cysts are benign, especially those that occur in a woman’s fertile age. If they require treatment, it is generally possible to do it by laparoscopy, a modern technique that involves almost invisible cuts, a short hospital stay and full recovery in a very short time. Before surgery, a good medical history will be necessary and occasionally, hormonal analyzes, plaques, Doppler ultrasounds , or other specialized exams, as ordered by the doctor.

A very important factor to consider in ovarian cyst surgery is the age of the patient. In the case of a young woman of reproductive age, treatment should be much more conservative so that she can have children later if she so wishes. In mature women, on the other hand, treatment can be more aggressive.

In other words, in a menopausal woman there would be little problem in removing the entire affected ovary, while in a young and childless woman the tendency when treating her should be to remove only the cyst, damaging the ovary as little as possible, and be very careful in the operative technique to generate the least amount of adhesions possible, so that the patient does not have subsequent fertility problems.

Classification of ovarian tumors

Non-tumorous

• Follicular cysts.
• Corpus luteum cysts.
• Inclusion cysts.
• Luteal cysts.

Derived from the celomic epithelium

• Serous cystadenoma.
• Mucinous cystadenoma.
• Solid tumors.

Germ cell derivatives

Derived from the gonadal stroma

How many types of ovarian cysts are there?

Follicular cysts

It is the most common of the ovarian cysts. Under normal conditions, the ovarian follicle is stimulated by the pituitary hormones FSH and LH, and a cyst is produced that measures around 20-24 mm by the time of ovulation. The follicle breaks when the pituitary produces high amounts of LH and releases the egg. If ovulation occurs, the formed cyst ruptures, the fluid that was inside falls into the pelvis, and the yellow body forms. If pregnancy does not occur, it atrophies and menstruation comes. When there are ovulation disorders, the follicle does not rupture and continues to grow above the normal values ​​of 20 to 24 mm. Although it rarely reaches 5 cm, it can sometimes be larger than 10 cm. Once the cyst has formed, it can evolve in various ways.

• Bleeding that simulates menstruation may occur and the cyst disappears spontaneously.
• It may not be large, it does not rupture and accumulates in the ovary (polycystic or multiple cyst ovarian syndrome).
• It can become large and rupture without causing problems, although in very rare cases there may be internal bleeding that requires emergency surgery. It can become large, not break and remain in the pelvis, causing pain, menstruation disturbances and lack of ovulation.

Corpus luteum cysts

It is produced as an effect of excessive bleeding during ovulation, due to a probable overproduction of luteinizing hormone. It may evolve spontaneously or may require emergency surgery for severe bleeding that simulates an ectopic pregnancy.

Inclusion cysts

They are quite frequent, are usually small and are not very important. They only operate if they reach large dimensions.

Luteal cysts of teak

It is associated with hydatidiform mole or choriocarcinoma, which are tumors that develop in placental tissue. Cysts occur as a consequence of the elevated chorionic gonadotropin secretion that occurs in this disease. They are bilateral cysts, reaching dimensions of up to 15 cm in diameter. They do not require treatment because they disappear once all the tumor tissue inside the uterus is removed. Cysts on the ovaries are the cause of many disorders in a woman’s life including infertility. Cysts are a kind of membrane sachets that contain air, liquids, or semi-solid substances. These cysts form in the ovarian follicles. These follicles are like eggs that are part of the ovaries.

Each woman is born with all the follicles stored and which will later transform into eggs. The follicles grow and develop to create the germ cell called the oocyte. The number of follicles ranges from 100,000 to 200,000, of which about 400 will reach maturity and the possibility of generating a new being. At the beginning of the menstrual cycle several follicles begin to mature, of all, only one reaches full maturity, two if there is the possibility of twins or twins. Parallel to the maturation of the ovarian follicles, the same mechanism allows the release of estrogens, which protect women against osteoporosis, cholesterol, excessive fats and many benefits that continue even after menopause.

Treatment

Functional ovarian cysts generally do not need treatment. They usually go away after 8 to 12 weeks without treatment. Birth control pills (oral contraceptives) can be prescribed for 4 to 6 weeks. Longer use can decrease the development of new ovarian cysts. These pills do not decrease the size of existing cysts, which often go away on their own. Surgery to remove the cyst or ovary may be needed to check for cancer cells. Surgery will most likely be needed to:

• complex ovarian cysts that do not go away;
• cysts that are causing symptoms and that do not go away;
• simple ovarian cysts that are larger than 5-10 cm;
• menopausal women or those who are close to menopause.

The types of surgery for ovarian cysts include:

• Exploratory laparotomy.
• Pelvic laparoscopy to remove the cyst or ovary.

Your doctor may recommend other treatments if a disorder, such as polycystic ovarian disease, is causing the ovarian cysts.

Expectations (prognosis)

Cysts in women who are still having periods are more likely to disappear. There is an increased risk of cancer in postmenopausal women.

Complications

Complications have to do with the condition that is causing the cysts and can occur with cysts that:

• They bleed.
• They break.
• They show signs of changes that could be cancerous.
• They present torsion.

Situations requiring medical assistance

Call for an appointment with your health care provider if:

• You have symptoms of an ovarian cyst.
• You have severe pain.
• You have bleeding that is not normal for you.

Likewise, make an appointment if the following symptoms have been present on most days for at least two weeks:

• Fill up quickly when eating.
• Lose appetite
• Lose weight without trying.

Prevention

If you are not trying to become pregnant and develop functional cysts frequently, they can be prevented by taking hormonal medications (such as birth control pills) that prevent the growth of follicles.

Alternative names

Functional ovarian cysts; Physiological ovarian cysts; Corpus luteum cysts; Follicular cysts.

Tumors derived from the celomic epithelium

1. Cystic tumors.

• Serous cystadenoma.
• Mucinous cystadenoma.
• Mixed forms.

1. Tumors with hypergrowth of the stroma.

• Fibroma, adenofibroma.
• Brenner’s tumor.

Germ cell derivatives

• Dermoids (benign cysts and teratomas.

Gonadal stromal tumors

• Teak cell tumors (thecomas).

The ovarian tumor represents one of the greatest diagnostic and therapeutic challenges for the gynecologist. Although sometimes they can produce pain or menstrual irregularities, at other times they present few clinical manifestations that lead to an early diagnosis.

Non-tumor ovarian cysts

• Germline inclusion cysts

They are frequent, non-functional, small in size and of no importance. If they are large, surgical removal is recommended.

• Follicular cysts

They develop by over stimulation of the pituitary gland on the ovary. They usually return alone in weeks or months. When they persist, they can secrete estrogens (female sex hormones), which can lead to irregular bleeding. Treatment: observation, oral contraceptives and cyst resection if it persists for more than 8 weeks.

• Corpus luteum cyst

It is produced by hormonal changes that occur as an effect of excessive bleeding in ovulation (between two rules). The cyst wall can rupture, giving symptoms very similar to those of an ectopic pregnancy. Treatment: surgical removal in case of rupture.

• Luteal cysts of teak

They coincide with a disease of the uterus called hydatidiform mole. They are bilateral cysts of more than 15 cm in diameter. They do not require treatment; Cysts are usually reabsorbed when the primary cause (removal of the mole) is treated.

Tumors derived from the celomic epithelium

• Serous cystadenoma

70% of serous tumors are benign. It is a thin-walled cyst with a watery content and a smooth surface.

• Mucinous cystadenoma

They constitute 15 to 25% of all tumors of the ovary; 85% are benign. They are the largest ovarian tumors (cases from 45 to 130 kg), sometimes bilateral, they are round or ovoid masses, with a smooth, translucent, bluish-gray surface. The interior is divided by partitions and contains thick, viscous mucinous fluid.

• Endometrioma

They can be single or multiple and with adhesions to the surface. They contain a thick chocolate-colored liquid. If they are large, the treatment is surgical.

• Solid tumors

Very rare. The most common is ovarian fibroma, which is sometimes associated with fluid accumulation in the pleura (membrane that surrounds the lungs) and the peritoneum (membrane that surrounds the intestines), in the so-called Meigs syndrome.

Teratomas (dermoid cysts)

They constitute 15% of tumors of the ovary, they appear in the first 3 decades of life and 80% in reproductive age. 95 to 98% are benign. Due to their embryonic origin, they show a strange content based on sebaceous material mixed with hair, cartilage, bone and teeth. Pelvic ultrasound (ultrasound examination) and radiographs are of great value in detecting the presence of teeth or calcifications. Treatment is surgical excision.

Assessment

The following resources should be used:

• Complete physical examination
• Pelvic ultrasound
• Abdominal-pelvic computed tomography (Scanner).
• Laparoscopy: direct examination of the abdomen with fiber optics through a small incision in the abdominal wall. It is done under regional (epidural) anesthesia. It may be indicated if serious injury is suspected.
• Exploratory laparotomy: Surgical intervention on the abdomen to diagnose and, where appropriate, treat, ovarian cysts or tumors.

Treatment

• Treatment of benign ovarian tumors is salpingo-oophorectomy (surgical removal of the affected ovaries and fallopian tubes).
• In young women, and in all those who are interested in reproductive function, the gynecologist will carefully remove the cyst or tumor with subsequent reconstruction of the ovary, whenever possible.
• In pre or postmenopausal patients, the entire womb will be removed along with the two ovaries and fallopian tubes.
• Functional ovarian cysts generally do not need treatment. They usually go away after 8 to 12 weeks without treatment.
• Birth control pills (oral contraceptives) can be prescribed for 4 to 6 weeks. Longer use can decrease the development of new ovarian cysts.
• These pills do not decrease the size of existing cysts, which often go away on their own.
• Surgery may be needed to remove the cyst or ovary to check for cancer cells.

Surgery will most likely be needed to

• Complex ovarian cysts that don’t go away
• Cysts that are causing symptoms and that do not go away
• Simple ovarian cysts that are larger than 5 – 10 centimeters
• Menopausal women or those who are near menopause

Types of surgery for ovarian cysts include

• Exploratory laparotomy
• Pelvic laparoscopyto remove the cyst or ovary

Your doctor may recommend other treatments if a disorder, such as polycystic ovarian disease , is causing the ovarian cysts.

Save the ovaries

Hence, it is not recommended to remove the ovaries, since even without follicles there is protection for women, even if to a lesser degree. The follicles after menopause disappear completely.