Ovarian cyst is probably one of the most common diagnoses that a woman can hear at a gynecologist’s appointment, and almost always this diagnosis causes excitement. This disease can be encountered at a very young age, when the menstrual cycle is just beginning to adjust, and often the treatment is inadequate, and the comments of doctors are frightening. Let’s figure it out.
WHAT IS AN OVARIAN CYST?
A cyst is, in fact, a rounded “bubble” with various contents. Cysts can be formed in any organs and are congenital or formed as a result of inflammation or violation of the outflow of secretions from the gland, but in the ovary they have a special origin. One of the structural elements of the ovary are follicles – small vesicles, inside which are located immature eggs. They are laid in utero, then their number gradually decreases and by the beginning of puberty reaches an average of 300 thousand.
By the beginning of puberty, a woman’s body contains an average of 300 thousand follicles – small vesicles that contain immature eggs.
During each menstrual cycle, part of the follicles begins to grow, then one of them bursts forward, becoming dominant, and the rest undergo reverse development. The dominant follicle bursts in the middle of the cycle-this process is called ovulation-and a Mature egg comes out of it. In place of a burst follicle, a temporary gland is formed – a yellow body that exists for 12-14 days and produces one of the female sex hormones – progesterone. The rupture of the follicle occurs when it reaches a size of 20-22 mm, this is important for further explanation, while during the rupture of the follicle, hemorrhage occurs in the forming yellow body, but some of the blood enters the abdominal cavity.
ABOUT FUNCTIONAL OVARIAN CYSTS
Now we can talk about the most common type of ovarian cysts – functional cysts. There are two types of functional ovarian cysts-follicular and yellow body cysts. The mechanism of their formation is simple: if the dominant follicle does not burst, but continues to grow, a follicular cyst is formed, and if the yellow body turns out to be defective, then a yellow body cyst is formed. Defective yellow body is most often due to excessive bleeding in it, which disrupts the production of progesterone by its cells.
The formation of ovarian cysts is influenced by stress, climate change, increased sports, taking hormonal drugs (not all), weight changes in one direction or the other.
Anything that can disrupt the normal course of the menstrual cycle can lead to the formation of such cysts: stress, climate change, increased sports, taking certain hormonal drugs, weight changes, etc.Periods of menstrual cycle formation in youth and the decline of ovarian function on the eve of menopause are characterized by the formation of follicular cysts. Clinically, the formation of such cysts is manifested in the form of a delay in menstruation (most often) or an earlier start.
Functional cysts are often completely harmless and pass on their own. The exception is one situation. Follicular cysts usually produce an excessive amount of female sex hormones, in particular estradiol, which causes the growth of the uterine mucosa-the endometrium. This growth should normally stop in the middle of the cycle, since after ovulation, estradiol production decreases and progesterone production begins, which no longer grows the endometrium, but transforms it for the beginning of pregnancy. The work of these hormones can be compared to building a house: estrogens build floors,and progesterone stops construction and finishes.
It turns out that during the formation of a follicular cyst, endometrial growth continues, and in the absence of progesterone, no one slows it down. This leads to the formation of a condition called “simple endometrial hyperplasia” (there is still a complex one, but it is a separate disease). There are two possible outcomes-sooner or later, this endometrium begins to be rejected, which is manifested by abundant uterine bleeding after a delay in menstruation. If this hyperplasia is seen on ultrasound, it is directed to scraping; of course, some doctors may know that this is not necessary and the problem can be solved by medication, but this is only part of it…
Functional cysts reflect disorders in the menstrual cycle.
Since the formation of a functional cyst is a reflection of a disturbed menstrual cycle, it is best not to leave functional cysts untreated. As a rule, one drug is prescribed (a modified hormone), which causes the growth of such a cyst to stop and causes menstruation. It is extremely important to perform an ultrasound after the end of this menstruation, to make sure that the cyst has resolved. In some cases, a functional cyst may resemble a true ovarian cyst that already requires surgical treatment, which is important not to miss. It is often necessary to meet with a situation when ovarian cysts begin to be treated with antibiotics, candles and enzymes. This is fundamentally wrong: cysts have nothing to do with inflammation, so antibiotics will not help.
So, here are some rules regarding functional cysts.
- Functional cysts never require surgical treatment, they resolve themselves or they can be helped to resolve by prescribing a special drug.
• Almost any ovarian cyst that you have detected can be functional, so always double-check the cysts after the next menstruation: true cysts do not shrink or resolve, unlike functional ones.
• For any delay in menstruation, make sure to do an ultrasound and a pregnancy test, if a cyst is detected and there is no pregnancy, a drug is prescribed that reduces the cyst and causes menstruation. Do not forget to repeat the ultrasound after menstruation.
• If you detect large cysts, more than 5 cm, refrain from sports and passionate sex, as such cysts can burst.
- A functional cyst is an error in one particular menstrual cycle, meaning that no further treatment is required after it disappears. Often doctors prescribe contraceptives ostensibly to prevent the re-formation of cysts, but this is not the case. If you do not need contraception, then the drug is not necessary. Moreover, after a short course of contraceptives (3-6 months), when the drug is canceled, there is again a risk of forming a functional cyst.
Thus, functional cysts are not dangerous, they pass by themselves or under the influence of medication. Parents of young girls may not worry if their daughters are suddenly diagnosed with such a diagnosis against the background of an irregular cycle: 10 days of taking the drug – and there will be no cysts. Older women are strongly advised not to delay the ultrasound if there is a delay in menstruation. If you have a follicular cyst, you are diagnosed with endometrial hyperplasia, do not rush to agree to scraping: medication therapy for the same 10 days will solve this problem. On ultrasound after treatment, there will be no cyst or hyperplasia, and the need for scraping will disappear by itself.
Functional cysts are not dangerous. As a treatment, a medication method is used. The drug is prescribed for 10 days, after which the cysts resolve.
In addition to functional ovarian cysts, there are true cysts, which are already called tumors or cysts. These include cystadenomas, endometrioid cysts, teratomas, and several other rarer formations. It is important to remember that ovarian cancer also looks like a cyst, so extreme attention is required for all true ovarian cysts.
Quite often, there are controversial situations when interpreting the results of tests for cancer markers, which are prescribed for the detection of ovarian cysts. Most often, the CA125 marker is assigned. This is a very non-specific marker, since it can be elevated in a variety of different, completely non-dangerous conditions from the point of view of Oncology. In particular, it increases with endometriosis, that is, if you, for example, have an endometrioid ovarian cyst and have concomitant endometriosis or adenomyosis (endometriosis of the uterus), the marker can be significantly increased.
The CA125 marker, prescribed for suspected cancer, is non-specific, meaning it can be elevated for a variety of different conditions, most of them non-dangerous.
An analysis for cancer markers is necessary when identifying any true ovarian cyst, that is, one that did not disappear after menstruation. As a rule, CA125 is combined with another marker – NE4 – and considered a special index ROMA. This allows you to increase the accuracy of diagnosis.
All true ovarian cysts require surgical removal, with the exception of small endometrioid cysts (less than 2 cm) – see the section “About endometriosis”. Most often, laparoscopy is resorted to-operations through small incisions on the anterior abdominal wall under the control of a video camera. Only after histological examination of the removed cyst can a final diagnosis be made, and this is very important, since ultrasound, magnetic resonance imaging (MRI) and cancer markers can not answer the question with the necessary confidence what kind of cyst it is. Of course, there are specific signs indicating that the cyst may be suspicious from the point of view of Oncology, but the absence of such signs does not exclude such a danger. Therefore, I emphasize once again: all true cysts must be removed and histological examination carried out.
I will not describe in detail the true ovarian cysts, it does not matter, the main thing is just to make sure that it is not a functional cyst, remove it and wait for a histological conclusion. If the cyst turned out to be benign, nothing additional should be done, except for regular ultrasound. In borderline or malignant tumors, the tactics are determined depending on the type of tumor.
PRO PARAOVARIAN CYSTS
There is also a separate type of cysts that are not related to the ovary, but are located next to it. These are so-called paraovarian cysts. Such cysts are found near the ovary, they are thin-walled bubbles filled with a transparent liquid. They are of embryonic origin and can be of various sizes. In most cases, paraovarian cysts are small, 3-5 cm, and do not interfere with women at all. In some cases, if such cysts begin to cause pain or grow, they are removed, and asymptomatic cysts are not touched, but simply observed.
So, the main idea that should be made in relation to ovarian cysts is first of all to decide what it is: functional or not. To do this, you need to review it after menstruation, perhaps drinking a special drug. If the cyst is functional, it will disappear or significantly decrease; if not, the cyst is true, and only then surgery is needed. Tests for cancer markers are required only if true ovarian cysts are detected. I hope that now the word “cyst” will not cause you unambiguously negative emotions, since in most cases they are completely safe.
Asymptomatic paraovarian cysts do not need to be removed.