The ovaries are two oval-shaped organs located on both sides of the uterus and in the abdomen in women. They are responsible for egg development and hormone production every month in women throughout the reproductive age. Structures that usually form as fluid-filled sacs next to or on these organs are called ovarian cysts.
Ovarian cysts can be seen in most women during the reproductive age. Most of these cysts are small, harmless and disappear on their own without causing any symptoms.
What are the types of ovarian cysts?
The most common ovarian cysts are Functional Ovarian Cysts. . These are Follicle Cysts and Corpus Luteum Cysts.
Functional Ovarian Cysts
1) Follicle Cysts: Every month, one of the ovaries, called a follicle, contains eggs. A cyst-like structure begins to grow. This structure also produces hormones called Estrogen and Progesterone. In the middle of the month, the follicle membrane breaks down and the egg is released. After this event, called ovulation, the egg is captured through the tubes and begins to move into the uterus. If it encounters sperm during this time, it is fertilized and pregnancy begins. The egg that does not meet the sperm is carried into the uterus, loses its vitality and is excreted with menstrual bleeding.
If the follicle membrane does not break down in the middle of the month, ovulation will not occur and the follicle will continue to grow. This cyst is a follicle cyst.
2) Corpus Luteum Cysts: Normally, after the follicle membrane breaks down and ovulation occurs, the follicle begins to shrink. If the follicle grows again and continues to fill with fluid, the cyst formed is a Corpus Luteum cyst.
Drugs containing Clomiphene citrate used for ovulation treatment can cause the formation of Corpus Luteum cysts. they know. The formation of these cysts does not prevent pregnancy from occurring, nor does it cause any harm.
Other Cysts:
1)Dermoid Cyst: These cysts may contain different tissues such as hair, bone, and fatty tissue.
2)Cystadenoma: These cysts consist of cells lining the outer surface of the ovaries. These cysts are filled with water-like or thicker gel-like fluid.
3) Endometrioma: The tissue that lines the inside of the uterus, called endometrium, settles on the ovaries and forms a cystic structure. These cysts are also called Chocolate Cysts because they contain a dark brown and dense liquid similar to melted chocolate.
4) Polycystic Ovary: When the egg matures and cannot be expelled from the follicle, it shrinks a little and continues to exist by settling just under the surface of the ovary. It makes you do it. Many small cysts are arranged side by side 'like a string of pearls' under the surface of the ovary.
What are the symptoms of ovarian cysts?
- Menstrual irregularity
- Continuous or intermittent pain in the lower abdomen that may radiate to the waist and upper legs
- Pain in the lower abdomen just before the start or end of the menstrual period
- Pain during sexual intercourse
- Pain during bowel movements and feeling of pressure in the intestines
- Feeling of pressure while urinating and incomplete evacuation of urine
- Nausea and vomiting
- Breast tenderness
Functional ovarian cysts are usually harmless, rarely cause pain, and often disappear on their own.
Dermoid cysts and cystadenomas can grow to large sizes. They can reach and cause pain and 'Ovarian Torsion', which is a painful condition in which the ovary rotates around itself.
Endometriomas, menstrual periods and may cause pain during sexual intercourse.
Polycystic Ovaries, when accompanied by complaints of menstrual irregularity, increased hair growth, acne, obesity and inability to become pregnant, create a clinical picture called Polycystic Ovary Syndrome.
How are ovarian cysts diagnosed?
Gynecological examination: Ovarian cysts can usually be diagnosed during routine gynecological examinations. Tests to be performed after ovarian cysts are diagnosed strengthen the diagnosis and help make a treatment plan.
Ultrasonography and Doppler: With this method, information can be obtained about the shape, size, location and content of the cyst (liquid or solid). . Doppler test also helps to decide whether the cysts are benign or malignant by measuring the blood flow.
Computed tomography and MRI: When a definitive decision cannot be made with ultra-asonography, these methods can be applied for further examination.
Pregnancy. test: This test determines whether there is pregnancy.
Hormone tests: If there are signs of hormone changes, hormone tests should also be performed.
Tumor markers: Over the age of 35, not spontaneously resolved, partially or completely In patients with solid content and a high risk of ovarian cancer, tumor markers are checked with a blood test. CA-125 is the most frequently investigated marker. It should not be forgotten that the CA-125 value can also increase in benign conditions such as myomas, infections, and endometrioma. Therefore, in suspicious clinical cases, it should be evaluated together with advanced tests such as Doppler USG and MRI.
What emergencies can ovarian cysts cause?
Ovarian torsion: It has reached large sizes. Cysts can rotate around the ovary itself, causing disruption of blood flow and a very painful condition. If surgery is not performed urgently, the blood flow of the ovary decreases. Because of this, tissues may be damaged or die. In such a case, ovarian tissue may have to be removed.
Cyst rupture: This very rare condition may cause intra-abdominal bleeding and severe abdominal pain, drop in blood pressure, palpitations, sweating, and fainting. Life threatening is prevented by urgent surgery.
How are ovarian cysts treated?
Treatment of ovarian cysts depends on the patient's age, clinical complaints, size and structure of the cyst. varies.
Clinical follow-up: If the patient is of childbearing age, has no complaints, and the cyst is fluid-filled and less than 5 cm in diameter, it can be followed up for 1 to 3 months. Usually these cysts will disappear on their own.
Birth control pills: If functional cysts have not disappeared with follow-up, they can be treated by suppressing ovulation for a while with birth control pills.
Surgical treatment: If the patient is in menopause, ovarian cancer Since there is a risk, the operation option should be considered
Surgical treatment is recommended for cysts that do not disappear even after being monitored for several months, grow gradually, look suspicious on ultrasonography, and cause pain.
There are two options for surgical treatment.
1) Laparoscopy: If the cyst is 5 cm or smaller and appears benign, it can be operated on with laparoscopy. Under general anesthesia, 1-2 cm incisions are made under the umbilicus and in the groin areas. It is performed with cameras and instruments placed in the abdomen.
2) Laparotomy: If the cyst is large and there is a possibility of cancer, laparotomy is preferred. The surgery is performed by opening the abdomen with a larger incision under general anesthesia. In cysts that are suspected to be cancerous, it is decided how the surgery will be performed with an urgent pathological evaluation (frozen section) during the surgery.
In benign cysts, if possible. Only the cyst is attempted to be removed. Sometimes, if the cyst covers the entire ovary, the ovary can be removed along with the cyst. If one ovary is removed, the other ovary takes over its function and continues to release the same hormone. Thus, normal menstrual cycle and fertility will continue until normal menopause.
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