- 1 What are ovarian cysts?
What are ovarian cysts?
Ovarian cysts, follicular cysts or cystic follicles are a physiological alteration, frequent in women.
The ovarian follicle is a follicular fluid-filled cyst that forms in the ovary each month for an oocyte or reproductive cell to mature.
When maturation is complete, the follicle breaks open for ovulation to occur. If it does not break, the follicle can continue to grow and form a follicular cyst.
Generally, the tissue where this cyst grows is constantly renewed, so the cyst may disappear after the next menstrual period. For this reason they are called physiological ovarian cysts. If they do not disappear, they must be observed and controlled.
Characteristics of polycystic ovaries
A ovary with many ovarian cysts, which is very common in young women, is a polycystic ovary, which is quite different from the condition of polycystic ovary syndrome.
Technically follicular ovarian cysts are considered a type of benign tumor that occurs in the ovary. They are formed from the De Graaf follicle which, instead of evolving and maturing like an oocyte under normal conditions, accumulates follicular fluid inside. This mass can be up to 10 cm in diameter.
What is an ovarian tumor?
There are other types of masses that are called ovarian tumors. They consist of a solid ovarian cyst (unlike cysts, which are from follicular fluid), which can be benign or malignant, and which have the ability to spread to other areas of the body.
There are different types of ovarian tumors, among which those derived from the germinal epithelium (tumors of the superficial coelomic epithelium) stand out, among which is serous cystadenoma, which is an ovarian neoplasm. When the ovarian epithelium is also of interest, it takes the name of serous cystadenocarcinoma.
If it is not properly treated, it can malignise and develop into a serous cystadenocarcinoma.
Symptoms of polycystic ovarian syndrome
As the name itself describes, a syndrome is a set of symptoms that co-occur in a disease. Only the presence of cysts on the ovaries on ultrasound and the existence of polycystic ovaries cannot determine polycystic ovarian syndrome.
According to the official consensus, the following two or three criteria are required to diagnose polycystic ovarian syndrome (PCOS). Polycystic ovarian syndrome is diagnosed by:
- Ultrasound: Presence of cysts in the ovaries (currently the presence of 12 or more follicles from 2 to 9mm in diameter is required). In some cases these cysts are normal and disappear after a few months. The advice and control of the doctor must be followed.
- Clinical symptoms: Disorders in menstruation (anovulation or lack of ovulation, oligoovulation or rare or infrequent ovulation), hyperandrogenism, such as abnormal growth of body hair (hirsutism), acne, obesity, diabetes, insulin resistance (in women with and without obesity), pain, discomfort.
- Blood tests: Confirm hormonal changes, with high levels of androgens in the blood, hyperinsulinemia (insulin resistance).
Ovarian tumor symptoms
How are ovarian tumors noticed? Ovarian tumors are often asymptomatic. However, there may be symptoms such as:
- Weight in the abdomen, heaviness
- Diffuse pain in the abdomen
- Menstruation disorders
- Urine retention or urinary incontinence
- Defecation problems
- Pain in the sexual act
- Female infertility, etc.
Causes of ovarian cysts Why do ovarian cysts occur?
The main causes of ovarian cysts are as follows:
- Normal or functional ovarian cysts, which develop naturally after ovulation and disappear in about a couple of months without treatment.
- Excess androgen, related to polycystic ovaries, which has its manifestation in the appearance of amenorrhea.
- Exposure to hormonal disruptors such as bisphenol A from plastics, Teflon from spoiled pans, or pesticides that are persistent compounds.
- Benign tumors
- Malignant tumors (faced with this possibility, in front of the previous symptoms, gynecological revision is recommended, especially when a cyst appears that does not dissolve spontaneously in the first 2 months)
- Ovarian cysts are more common in women who have not had children.
- Ovarian cancer is more common in women who have had breast cancer.
- Socioeconomic factors: poverty can be related to less medical attention and fewer gynecological controls, especially in the population at risk (women with drug addiction, women living on the street, etc.).
Diagnosis of ovarian cysts
Disorders in menstruation are the most obvious indications that may indicate some alteration of female health. In the case of follicular-type ovarian cysts, they are diagnosed from the aforementioned symptoms: presence of cystic and clinical or analytic ovaries with hyperandrogenism. Ultrasound can detect abnormal masses inside the abdomen and distinguish whether they are solid or cystic (liquid).
On the other hand, the symptoms are of little help in the case of ovarian tumors, since when they appear clinically, they are usually in an advanced stage. One of the biggest limitations in the fight against ovarian cancer is that there is no effective screening method to detect it early (such as cytology in the case of cervical cancer). For this reason, the physical examination, abdominal palpation and vaginal touch, and ultrasound are the main methods available to the physician to see if there is formation of a mass in the ovaries. When a tumor is suspected, a laparoscopy with biopsy is usually performed to make the diagnosis.
If the above methods are not precise enough, in some cases a laparotomy (exploration of the abdominal cavity with possible removal) should be done. In the case of tumors, complementary tests can be performed to verify that there are no metastases, such as x-rays, resonances, and blood tests.
Treatment of ovarian cysts
The treatment of ovarian cysts depends largely on the type of cyst in question, whether it is cystic (liquid) or whether it is solid (tumors). The doctor will recommend the most suitable treatment according to the type of ovarian cyst in question. Normally, all ovarian cysts are removed except for follicular (fluid) cysts, because these usually disappear naturally over time. Therefore, in the case of polycystic ovaries or cystic follicles, they are regularly checked to verify that they evolve favorably. In the event of seeking a pregnancy, the professional may advise you to take medication to compensate for excess androgens.
In case of benign tumors that are large, have a rapid evolution or change morphology, having the ability to become malignant, the entire ovary and fallopian tube are usually removed (salpingo-oophorectomy).
When it comes to malignant tumors, surgical or laparotomy treatments are prescribed for the removal of one or both ovaries (lateral or bilateral oophorectomy), chemotherapy and/or radiotherapy.
Prognosis of ovarian cysts
The prognosis of ovarian cysts depends greatly on the type of cyst in question. Malignant tumors have a poor prognosis, mainly because these cancers have been seen to evolve very rapidly and aggressively, can become resistant to chemotherapy and often metastasize. Because the prognosis for ovarian tumors improves if detected early, annual gynecological monitoring is always recommended.
The physician should be consulted about what expectations he has based on the individualized assessment of his particular case.
More information on ovarian cysts.
7 July, 2020