What is a cyst?
Ovarian cyst is a growth with liquid inside of it, a kind of a bubble with "water" in it. Cysts are divided into functional and true cysts.
They first appear due to a malfunction of hormones.
The day the menstruation begins is the starting point of a new cycle. During this time, a follicle forms in the ovary, which bursts towards the middle of the cycle, releasing a mature egg. Ovulation takes place. In the event that the follicle does not burst or even continues to increase in size, a kind of a functional cyst forms – a follicular cyst.
Normally, a corpus luteum forms from the bursting follicle (“yellow body”, when translated from Latin). Its task is to produce progesterone, which will be especially necessary if the sperm fertilizes the egg and pregnancy occurs. If this does not happen, the corpus luteum gradually disappears. If the corpus luteum has not disappeared, and has even began to grow, accumulating fluid, we can talk about the emergence of another functional cyst – luteal cyst (the name comes from the phase of the cycle when the cyst has formed).
A complicated kind of a functional cyst forms in the case when blood accumulates inside it due to bursting blood vessels. Such a cyst is called hemorrhagic cyst.
True cysts include teratomas, cystadenomas, and endometriomas. The reasons for the occurrence of all three of these are not completely clear - genetics play an important role.
Teratoma is a congenital benign tumor, but it grows and develops very slowly. Interestingly, inside it there is the so-called undifferentiated body tissue - hair, fat, teeth, etc.
Cystadenomas - a kind of functional cysts - contain fluid or mucus. With such a cyst, you should be very careful, because cystadenomas can often reach quite impressive sizes and have increased oncological risks.
The most unpleasant cysts are endometriomas. It is associated with endometriosis - a situation when one of the layers of the uterus (the outer layer that lines the uterine cavity) for some reason "moves" outside of the uterus it and settles in another place - for example, the fallopian tubes or, in the case of endometrioma, in the ovaries. Regardless of the location, the uterine tissue retains its properties - for example, it bleeds once a month when menstruation occurs. And since the ovaries are an inappropriate place for this, chronic inflammation can be caused. This, in turn, provokes the appearance of adhesions - special “threads” formed from the connective tissues, which “stick” the ovaries together with surrounding tissues and provoke unpleasant symptoms.
What are the symptoms?
In general, the symptoms of a cyst are not dependent on its type, but on its size. Small formations (2-4 cm), such as functional cysts, teratoma or cystadenoma, may be asymptomatic.
If the cyst continues to grow, then this may cause:
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Drawing pains, feeling of heaviness in the lower abdomen,
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Pain during intercourse,
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Delays in menstruation.
In the case of endometrioma, one of the additional symptoms is infertility due to chronic inflammation and adhesions associated with this type of cysts. And it also most often causes atypical severe pain before and during menstruation.
The most common complication is cyst rupture. Most often this happens in the case of a functional hemorrhagic cyst in the middle of the menstrual cycle, especially after physical activity or sexual contact.
Smaller cysts rarely burst, and even if a rupture occurs, no additional measures are required. A large cyst can cause serious troubles, therefore, if the patient feels sharp and strong pains on one side of the abdomen, she has to consult a doctor immediately.
Another complication - due to the weight of the cyst, ovary torsion could happen. Blood supply is blocked, the ovary becomes inflamed, the tissues begin to die, which causes very severe sharp pains, nausea, vomiting, rapid pulse. This is also an acute situation requiring immediate surgery.
How to diagnose a cyst?
Since most often the cysts are small and do not cause any complaints, it is very important to visit the gynecologist for examination and preventive ultrasonography.
Ultrasonography is the main diagnostic method. It helps determine the size of the cyst, its type and plan the further tactics of treatment.
If the cyst looks “suspicious” on the ultrasonography, an additional blood test will be prescribed for the so-called cancer markers - CA-125, HE-4, CEA. It is important to evaluate several markers at once, because, for example, CA-125 can give a false-positive result - for example, with endometriosis, myoma, liver diseases, etc.
If there are suspicions about a cancerous growth, computed tomography or magnetic resonance imaging may be needed to check the nearby organs and lymph nodes.
How to treat a cyst?
The main question here is - in what cases is it worth treating? If this is a small, definitely benign cyst (up to 4 cm) that does not cause any symptoms, then it is better to choose an observational tactic. For example, functional follicular cysts usually disappear on their own within 3-6 months. Teratomas, endometriomas and cystadenomas, if they are small, are also better not touched - surgical intervention is an extra trauma for the ovary.
If the cyst does not disappear on its own, this process can be sped up with the help of hormonal contraception – medication is prescribed for 3 months to temporarily “block off” the ovaries from the hormonal system and allow the cyst to disappear. The doctor can choose this option for hormone-dependent cysts: follicular and luteal. Hormonal contraception can be combined with pain medication to relieve the symptoms.
In the case of a large cyst, which causes complaints or if there are suspicions of a malignant formation, of course, it is necessary to act quickly. And the only option is surgery. The main objective of this treatment is to remove the cyst, minimally injuring the ovary. In 95% of cases, laparoscopy is performed, during which under general anesthesia, the patient undergoes 3-4 small (not more than a centimeter in diameter) incisions in the anterior abdominal wall. Through these incisions, a camera and instruments are inserted into the abdominal cavity. After such an operation, the patient remains in the hospital for 2-3 days.
The most important thing: if there are complaints or discomfort, you should immediately consult a doctor who will help to diagnose and treat a cyst in a timely manner.
