An ovarian cyst is a fluid filled sac inside the ovary. Often they do not cause symptoms. Sometimes they can produce bloating, lower abdominal pain, or lower back pain. The majority of cysts are harmless. If a cyst ruptures or causes an ovary torsion, it can cause severe pain. This can cause vomiting or fainting.
Most ovarian cysts are associated with ovulation, either follicular cysts or corpus luteum cysts. Other types include cysts due to endometriosis, dermoid cysts, and cystadenomas. Many small cysts occur in both ovaries in polycystic ovary syndrome. Pelvic inflammatory disease can also cause cysts. Rarely, cysts can be a form of ovarian cancer. Diagnosis is performed by pelvic examination with ultrasound or other tests used to gather further details.
Often, cysts are only observed over time. If they cause pain, drugs such as paracetamol (acetaminophen) or ibuprofen may be used. Hormonal birth control can be used to prevent further cysts in those who are frequently exposed. However, the evidence does not support birth control as the current cyst treatment. If they do not leave after a few months, become larger, look unusual, or cause pain, they can be removed surgically.
Most women of reproductive age develop small cysts every month. Big cysts that cause problems occur in about 8% of women before menopause. Ovarian cysts are present in about 16% of women after menopause and if there is more likely to be cancerous.
Video Ovarian cyst
Signs and symptoms
Some or all of the following symptoms may exist, although they may not experience any symptoms:
- Abdominal pain. Painful pain in the abdomen or pelvis, especially during intercourse.
- Uterine bleeding. Pain in or soon after the beginning or end of the menstrual period; irregular menstruation, or abnormal uterine bleeding or spotting.
- Fullness, weight, pressure, swelling, or bloating in the abdomen.
- When the cyst breaks from the ovary, there may be a sudden and sharp pain in the lower abdomen on one side.
- Changes in frequency or ease of urination (such as the inability to completely empty the bladder), or difficulty with bowel movement due to pressure on the adjacent pelvic anatomy.
- Constitutional symptoms such as fatigue, headache
- Nausea or vomiting
- Weight
Other symptoms may depend on the cause of the cyst:
- Symptoms that can occur if the cause of the cyst is polycystic ovary syndrome (PCOS) may include increased facial hair or body hair, acne, obesity and infertility.
- If the cause is endometriosis, then the period may be severe, and the sexual relationship is painful.
The effects of cysts unrelated to PCOS on fertility are unclear.
Broken cyst
Ovarian cysts are ruptured usually heal itself, and only need to monitor the situation and pain medication. The main symptoms are abdominal pain, which can last several days to several weeks, but may also be asymptomatic. Rupture of large ovarian cysts can cause bleeding in the abdominal cavity and in some cases of shock.
Ovarian torque
Ovarian cysts increase the risk for ovarian torsion; cysts greater than 4 cm were associated with about 17% risk. Torque can cause blood flow obstruction and cause infarction.
Maps Ovarian cyst
Diagnosis
Ovarian cysts are usually diagnosed with ultrasound, CT scan, or MRI, and correlate with appropriate clinical presentation and endocrinologic tests.
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Follow-up imaging in women of reproductive age for simple cysts found incidentally on ultrasound is not required to 5 cm, as these are normally normal ovarian follicles. Simple cysts of 5 to 7 cm in premenopausal women should be followed each year. A simple cyst larger than 7 cm requires further imaging with MRI or surgical assessment. Because they are large, they can not be reliably assessed by ultrasonography alone because it may be difficult to see soft tissue nodularity or thickened septation in their posterior walls due to limited penetration of ultrasound light. For the corpus luteum, the dominant ovulation follicle normally seen as a cyst with thickened thicken walls and cycled internal margins, follow-up is not necessary if the cyst is less than 3 cm. In postmenopausal patients, any simple cyst larger than 1 cm but less than 7 cm requires annual follow-up, while larger than 7 cm requires MRI or surgical evaluation, similar to women of reproductive age.
For accidentally discovered dermoids, diagnosed on ultrasound by their pathognomonic echogenic fats, either surgical removal or follow-up is indicated, irrespective of the patient's age. For peritoneal inclusion cysts, which have the appearance of tangled papers and tend to follow adjacent organ contours, the follow-up is based on a clinical history. Hydrosalping, or dilation of the fallopian tubes, may be mistaken for ovarian cysts because of their anechoic appearance. Follow-up for this is also based on clinical presentation.
For multiloculated cysts with less than 3 mm septation, surgical evaluation is recommended. The presence of multiloculation suggests neoplasms, although thin septation implies that the neoplasm is benign. For any thickened septation, nodularity, or vascular flow in color doppler assessment, surgical removal should be considered due to concern for malignancy.
System scoring
There are several systems to assess the risk of ovarian cysts to ovarian cancer, including RMI (risk of malignant index), LR2 and SR (simple rule). The sensitivity and specificity of this system is given in the table below:
Ovarian cysts can be classified according to whether they are variants of the normal menstrual cycle, called functional or follicular cysts.
Ovarian cysts are considered large when they are over 5 cm and giant when they are over 15 cm. In children, ovarian cysts that reach above the umbilicus level are considered giants.
Functional
Functional cysts are formed as a normal part of the menstrual cycle. There are several types of cysts:
- Follicle cyst, the most common type of ovarian cyst. In menstruation women, ovum-containing follicles, unfertilized eggs, will break during ovulation. If this does not happen, a follicular cyst can be found with a diameter of more than 2.5 cm.
- The luteum cyst appears after ovulation. The corpus luteum is the rest of the follicle after the ovum moves to the fallopian tube. This usually decreases within 5 to 9 days. The corpus luteum of more than 3 cm is defined as cystic.
- Teca lutein cysts occur inside the cell layer around the developing oocyte. Under the influence of excessive hCG, thecal cells can multiply and become cystic. This is usually on both ovaries.
Not working
Non-functional cysts may include the following:
- Ovaries with multiple cysts, which can be found in normal women, or in polycystic ovary syndrome settings
- The cyst is caused by endometriosis, known as a brown cyst
- Hemorrhagic ovarian cyst
- Dermoid cyst
- Ovarian serous cystadenoma
- Ovarian pulmonary cystadenoma
- perovarian cyst
- Cystic adenofibroma
- Boralline borderline cyst
Related medical conditions
In juvenile ovaries, multicystic ovaries are present in about 75% of cases, while large ovarian cysts and elevated ovarian tumor marks are one of the symptoms of Van Wyk and Grumbach syndrome.
The CA-125 marker in children and adolescents can often increase even without malignancy and conservative management should be considered.
Polycystic ovary syndrome involves the development of several small cysts in both ovaries due to an increase in the ratio of the leutenizing hormone to the follicle stimulating hormone, usually more than 25 cysts in each ovary, or ovarian volume greater than 10 mL.
Larger bilateral cysts may develop as a result of fertility treatments due to elevated levels of HCG, as can be seen with the use of clomiphene for follicle induction, in extreme cases leading to a condition known as ovarian hyperstimulation syndrome. Certain malignancies may mimic the effects of clomifene on the ovaries, as well as increases in HCG, particularly gestational trophoblastic disease. Ovarian hyperstimulation occurs more frequently with invasive moles and choriocarcinoma than complete molar pregnancies.
Cancer Risk
The widely known method of estimating the risk of malignant ovarian cancer based on preliminary examination is the risk of malignant index (RMI). It is recommended that women with RMI scores above 200 should be referred to centers experienced in ovarian cancer surgery.
RMI is calculated as follows:
- RMI = ultrasound score x menopause score x level CA-125 in U/ml.
There are two methods for determining ultrasound scores and menopausal scores, with the resulting RMI called RMI1 and RMI2, respectively, depending on what method is used:
RMI 2 over 200 has been estimated to have a sensitivity of 74 to 80%, specificity of 89-92% and a positive predictive value of about 80% of ovarian cancers. RMI 2 is considered more sensitive than RMI1.
Treatment
Cysts associated with hypothyroidism or other endocrine problems are managed by treating the underlying conditions.
Approximately 95% of benign ovarian cysts, not cancer.
Functional cysts and hemorrhagic ovarian cysts usually disappear spontaneously. However, the larger the ovarian cyst, the less likely it is to disappear by itself. Treatment may be necessary if the cyst persists for several months, grows, or causes increased pain.
Cysts that settle outside two or three menstrual cycles, or occur in post-menopausal women, may show more serious illness and should be investigated through ultrasound and laparoscopy, especially in cases where family members have ovarian cancer. Such cysts may require surgical biopsy. In addition, blood tests may be taken prior to surgery to examine the increase in CA-125, tumor markers, which are often found in elevated levels of ovarian cancer, although it can also be enhanced by other conditions that result in a large number of false positives.
Pain
Pain associated with ovarian cysts can be treated in several ways:
- Pain relievers such as acetaminophen, nonsteroidal anti-inflammatory drugs, or opioids.
- While hormonal birth control prevents the development of new cysts in those who often get it, it is not useful for the treatment of current cysts.
Surgery
Although most cases of ovarian cysts involve monitoring, some cases require surgery. This may involve the removal of a cyst, or one or both ovaries. The technique is usually laparoscopic, unless the cyst is very large, or if pre-operative imaging shows a complex malignancy or anatomy. In certain situations, the cyst is completely removed, while with cysts with low recurrence risk, younger patients, or those in the anatomical pelvic area, they may be dried. Features that may indicate the need for operations include:
- Complex ovarian cysts are persistent
- Persistent cyst that causes symptoms
- Complex ovarian cysts larger than 5 cm
- A simple ovarian cyst larger 10 cm or greater than 5 cm in postmenopausal patients
- Women who are menopausal or perimenopausal
Frequency
Most women of reproductive age develop small cysts every month, and major cysts that cause problems occur in about 8% of women before menopause. Ovarian cysts are present in about 16% of women after menopause and if there is more likely to be cancerous.
Benign ovarian cysts are common in premenarkal asymptomatic women and are found in about 68% of ovaries in girls aged 2-12 years and in 84% of ovaries in girls aged 0-2 years. Most are smaller than 9 mm while about 10-20% are larger macrocysts. While the smaller cysts are mostly lost within 6 months, the larger ones seem more persistent.
References
External links
Source of the article : Wikipedia
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