Ovarian cyst

definition

A cyst is a cavity filled with fluid that is lined with epithelium (tissue) and is found in various parts of the human body, including the ovaries (Ovary) can occur. Ovarian cysts are found practically only in sexually mature women, and they appear particularly frequently shortly after puberty and during the menopause (menopause).

Symptoms

The main thing is whether clinical symptoms occur in the context of an ovarian cyst depending on the size. Ovarian cysts that are only a few centimeters in size usually do not cause any symptoms. They mostly will randomly groped during an examination or at one Ultrasound examination discovered.
If the ovarian cyst reaches a certain size, it can get through Pressure on the organs in the neighborhood to dull Lower abdominal pain, Back pain and bowel and / or urination disorders occur. If the symptoms suddenly worsen with severe pain, this can lead to a potentially threatening complication such as a Twisting of the ovary and fallopian tubes indicate. In such a case, immediate action is required.
Other diseases can also occur, especially during pregnancy Pain in the ovaries lead: you can read more about this topic in the article Ovarian pain in pregnancy read.

Pain

A cyst causes the ovaries no symptoms in most cases and should be checked regularly if the findings are otherwise normal. In other cases it is accompanied by diffuse, dull or sometimes severe pelvic pain.
Pain in the lower abdomen is observed as a result of growth in size, irritation of the peritoneum and increasing pressure on the neighboring organs. Can accompany nausea, Vomit, Indigestion, urination disorders and in some cases even an increase in waist size. Also Menstrual cycle disorders irregular or heavy bleeding is common in cysts of hormonal origin.
Rare events with pronounced pain symptoms indicate complications. For example, it can be a Rupture (Bursting) a cyst or a so-called torsion (Handle rotation) act.
The cyst, including the ovary, often rotates its stalk during exercise. She provides one emergency that must be dealt with immediately. There is a risk of an irreversible loss of function of the organ.
A cyst rupture also manifests itself with sudden pain. There is a risk of bleeding into the abdominal cavity if a blood vessel ruptures at the same time.

Please also read our page: Ovarian pain- these are the most common reasons

causes

The cause of the ovarian cysts allows one Division into two large groups. A distinction is made between so-called functional cysts and Retention cysts, most of the cystic changes on the ovaries are called functional cysts.

Functional cysts

The main reason for ovarian cysts are functional ovarian cysts. These cysts can be characterized by the usual cyclical changes in the ovaries caused by varying degrees Hormone levels in the course of a cycle are explainable, form. That is why they occur especially in sexually mature women, with an accumulation shortly after puberty and during climacteric (Menopause).
Also Abnormalities in the hormonal system in the organism or a hormonal therapy can cause functional ovarian cysts. In this subgroup you can again choose between different ways of functional cysts: follicular cysts (vesicle cysts), polycystic ovaries, corpus luteum cysts, thekalutein cysts, endometriosis cysts (endometriomas) and parovarial cysts.

• Follicular cysts:
  Follicular cysts (Vesicle cysts) occur solitary in menstruating young women before ovulation (pre-ovulatory) on. It is a non-cracked Graaf’s follicle that has an egg cell inside. The Graaf's follicle itself can grow to a size of approximately 2 cm.
  The transition into a functional cyst is seamless, whereby they can reach a size of up to 10 cm, in pregnancy even up to 25 cm. The granulosa cells that the follicular cyst contains allow the cyst to be hormonally active and produce estrogens.

• Polycystic Ovaries:
  If the ovaries contain a large number of cysts, these cysts can possibly be viewed as a special form of follicular cysts. Polycystic ovaries occur in the so-called PCO syndrome (polycystic ovary syndrome) in combination with other clinical symptoms.
  Polycystic ovaries are caused by follicles (follicles) that develop below the surface of the ovaries, but do not burst. With each subsequent cycle, the number of follicles increases, which is why the ovary also increases in size.

• Corpus luteum cysts:
  The corpus luteum cysts, on average 5.5 cm in size, appear after ovulation (postovulatory), i.e. in the second half of the cycle. The corpus luteum (Corpus luteum) is formed from the remains of the cracked Graaf's follicle.
  If there is a hemorrhage into the corpus luteum, one speaks of a corpus luteum cyst, another subgroup of functional cysts. Corpus luteum cysts occur more frequently in pregnant women and in women who are undergoing ovulation-inducing therapy.

• Thecalutein cysts:
  Furthermore, they also count up to 30 cm tall nascent thekalutein cysts to the functional cysts. These are generally due to an increased or prolonged production of beta-HCG (human chorionic gonadotropin), a hormone produced by the placenta during the first three months of pregnancy.
  In addition to a multiple pregnancy, ovarian stimulation as part of fertility treatment can also be a cause of a thecalutic cyst. A mole of bladder or a subsequent chorionic epithelioma can also cause a thekalutic cyst.

• Endometriosis cysts (endometriomas):
  Endometriosis cysts occur as part of endometriosis. The clinical picture of endometriosis is characterized by the lining of the uterus that occurs outside of the uterine cavity. Because the cystic cavities in the ovary contain old, thickened blood, they are also called tar or chocolate cysts. Endometriosis cysts are removed through surgery. It is crucial that not only the fluid is drained, but that the entire cyst is removed, as any remains can cause the endometriosis cyst to recur.
  

  diagnosis

  

  Systematic questioning by the doctor (anamnesis) can provide first indications of a possibly existing ovarian cyst. In addition, large cysts may be palpable during the vaginal palpation examination.
  The ovarian cysts can then be visualized using ultrasound. Therefore, the ultrasound scan is an extremely crucial examination. The examination is carried out through the vagina and can be completed by the ultrasound examination from the abdomen.
  In order to rule out malignant mass of the ovary (ovarian cancer), other examination methods can be used. This is important for patients from the age of 40 and especially during climacteric (menopause).
  Other examination methods include the determination of tumor markers in the blood (CA-125), whereby an increase in the tumor marker does not necessarily have to come from a malignant disease, a Doppler examination and magnetic resonance imaging (MRI).
  If the results of these examinations are still inconclusive, only an examination of tissue can help. The tissue can be examined during a laparoscopy (laparoscopy) or in rare cases during abdominal surgery with an abdominal incision (laparotomy) be won.

  MRI of the ovaries

  

  Ovarian cysts (green) can be reliably detected in an MRI examination of the abdomen (MRI pelvis).
  Parts of the lumbar spine can be seen in blue.

  therapy

  The therapeutic options for ovarian cysts are vast and range from one wait and see attitude without therapy up to one Laparoscopy (laparoscopy) or even surgery. Which route is chosen depends on the type of cyst, the clinical symptoms, the length of the ovarian cyst's existence, and the patient's age.
  The most common functional cysts usually do not require any treatment, as they usually do not cause any symptoms and in the majority of cases they go away on their own. A regular ultrasound check-ups every three months should be done in spite of this.
  In addition, hormonal therapy for a period of three months with a progestogen-based therapy can also be used "Pill" be considered. There are reasons for starting therapy extremely large ovarian cystsCysts that cause symptoms, those that persist for a long time and do not resolve on their own.
  Ovarian cysts that occurred after the menopause (menopause) and complications in the context of an existing ovarian cyst are also reasons for initiating therapy. A therapeutic option for removing a benign ovarian cyst is a laparoscopy. You can choose between one organ-preserving and organ-removing procedure differentiate.
  In the organ-preserving procedure, only the ovarian cyst is peeled off, the ovary itself is preserved. With this procedure, pregnancy is still possible.
  If both ovaries themselves are removed in addition to the ovarian cyst, this is called an organ-removing procedure. This is an option for women after menopause (menopause), since the ovaries have mostly stopped producing hormones here. After the ovaries have been removed, pregnancy is no longer possible.
  In addition to being removed as part of a laparoscopy, an ovarian cyst can also removed by means of an abdominal incision (laparotomy) become. This can be considered in the case of very large ovarian cysts, or if a malignant mass is suspected.

  OP: yes or no

  • Advantages:
    The benefits of surgical removal of ovarian cysts are primarily based
    on the Relief from existing symptoms, of the Avoid complications such as bleeding and bursting a cyst as well as the Preventing spread suspicious (possibly malicious) looking tumors.
    Benign cysts that are to be treated can be noticed during the check-ups due to rapid growth, increasing symptoms in the form of pelvic pain and painful menstrual bleeding, as well as non-response to medication.
  • Disadvantage:
    The disadvantages of surgical removal of ovarian cysts include the general operational risks such as bleeding, injuries to neighboring organs etc.
    Most of the cysts that occur are so-called functional cysts in the context of the female cycle (enlargement of an existing follicle or corpus luteum). With a 90 percent regression tendency Too rapid an operation would produce more disadvantages than benefits. If bilateral removal of the ovaries is necessary, this is associated with infertility and menopausal-like symptoms.
    If ovarian cysts appear after the menopause, both ovaries are usually removed. According to current knowledge, this can be associated with a higher cardiovascular risk for strokes and coronary artery disease.
    

    Ovarian cyst burst (rupture)

    The ovarian cyst ruptures in around three percent of those affected. The bursting occurs mostly naturally, but it can also be caused by the vaginal examination at the gynecologist.
    Apart from severe pelvic pain rupture of an ovarian cyst is harmless in the majority of cases. Also become rare Blood vessels damaged, causing it to Bleeding into the abdomen can come. In such cases a operative care inevitable.

    Rotation of the stem of an ovarian cyst

    Also one Steely rotationthat often after abrupt movementssuch as dancing, for example, must be surgically taken care of as quickly as possible. It is necessary to act quickly, as the blood from the affected ovary can no longer adequately drain due to the twisting of the stalk, and neither can the Limited blood supply is. Without timely intervention, a permanent damage stay back.

    Bleeding

    One of the possible complications of an ovarian cyst is the bursting and simultaneous damage of a blood vessel. In this case, internal bleeding may occur, which requires immediate treatment. In rare cases, the cyst will burst during a palpation examination.
    Mostly, however, it is a random event with no trigger. Sudden, severe pain indicates the burst. If bleeding is found in the abdomen, surgery must be carried out to stop it. Heavy and irregular menstrual periods are possible symptoms of an existing cyst on the ovary.
    Bleeding may also occur during and after surgery for an ovarian cyst. After such an operation, lifting heavy loads and vigorous exercise should be avoided.

    Malignant cysts / cancer

    Ovarian cancer is the sixth most common type of cancer in women. With increasing age there is an increased risk of developing malignant tumors. This is especially true after menopause, when the Ovaries (Ovaries) stop their hormone production as far as possible.
    New ovarian cysts after menopause are mostly suspicious and make surgical treatment necessary. The amount of the Tumor marker CA-125 correlates after menopause with the presence of ovarian cancer.
    Frequently becomes bilateral oophorectomy if there is justified suspicion carried out. This minimizes the risk of further progression and spread to other organs.
    In women under 30, the risk of cancer is relatively low, apart from a high genetic predisposition. Ovarian cysts usually go away on their own after a while.

    Read more about the topic here: Ovarian cancer and Ovarian Cancer Symptoms