Cyprus Treatment for Ovarian Cyst

What is Ovarian Cyst?

Ovarian cysts are fluid-filled sacs. When it comes to women’s health, the first thing that comes to mind is ovarian cysts. There is a risk for women to develop ovarian cyst after they start to have menstrual period. As ovaries start to function at adolescence and run out of functioning eggs with menopause, ovarian cyst does not develop during adolescence and after menopause. Ovarian cysts are divided into two as benign ovarian cysts and malign ovarian cysts. While ovarian cysts cause symptoms in some cases; in others, ovarian cysts which do not cause any symptoms may be coincidentally diagnosed during gynecological examination.

What are the Causes of Ovarian Cysts?

Ovaries develop ovarian cyst by structure in women with normal menstrual cycle. As menstrual period ends, one of the ovarian cells in ovaries start to grow and become a cyst. That cyst is named as ‘follicle’. In the middle of menstrual period, such cyst bursts and the ovarian cell it contains is released into the tubes. During such burst, slight bleeding occurs inside the abdomen most of the time and the body absorbs the bleeding itself.

During such time, some women feel pelvic pain and sometimes may notice vaginal bleeding, that is in form of slight spotting, between two menstrual periods. Such bleeding is normal and is an indicator of ovulation. There is no need to get concerned.

And sometimes cysts that are named as follicle and that will form the egg do not burst and may turn into overgrown ovarian cysts.

What are the Indications?

• Irregular menstrual cycle, spotting or inability to have menstrual period
• Painful menstrual periods
• Pelvic pain
• Pain during sexual intercourse
• Abdominal bloating
• Swelling of the breasts
• Urinary and intestinal problems
• Gaining weight
• Nausea, vomiting
• Increase in hairiness
• Inability to conceive
• Sudden and severe abdominal-pelvic pain

As cyst symptoms are not encountered physically, it would be useful to get gynecological examination regularly.

How is it Diagnosed?

Generally, ovarian cyst is noticed coincidentally and diagnosed during gynecological examination. Evaluation is made through vagina or abdominal ultrasonography and as such, information is acquired to detect type of cyst and whether it is benign or malign. Hormone tests and Doppler ultrasonography may be done separately for diagnosis. Further examinations such as computerized tomography and MR may be required though rarely.

What are Its Types?

1. Follicle Cysts

It is the type of cyst that is encountered the most in women aged between 20 to 50 years. It is formed when the developed egg cell does not burst and continues to grow. They are the cysts with smooth and limited edges, which are stretched and that contains clear fluid. They are viewed as black sac on the ultrasound. Their diameter is generally smaller than 5 cm and they do not cause any symptoms.

These cysts disappear after patient uses 2 to 3 boxes of contraceptives or by themselves. Operation may be required for cysts that do not get smaller or that continue to grow despite treatment. Cysts can be treated with operation.

2. Hemorrhagic (Corpus Luteum Cyst)

Follicle goes under structural change after ovulation and is named as ‘Corpus Luteum’ and releases progesterone hormone. When such structure grows more than average or bleeding enters into such structure, ‘Corpus Luteum Cysts or Hemorrhagic Cysts’ may be formed. Such cysts are generally more painful and bigger than follicle cysts. They can get smaller and healed through contraceptives or by themselves. As they release hormone, they may cause delay in menstrual cycle. They may cause bleeding and severe pain inside the abdomen if cyst ruptures, bursts or if cysts cause ovarian torsion and stop blood flow to the ovaries, though rarely.

Rupture or burst of an overgrown cyst is named as ‘Hemorrhagic Cyst Rupture’. Although bleeding that is caused by rupture in abdominal cavity stops by itself most of the time, it may be life-threatening from time to time. In such case, it would require operation.

Hemorrhagic cyst may cause infertility as it releases hormone.

Indications of severe bleeding;

• Cold sweats
• General lack of well-being
• Severe pelvic and abdominal pain
• Nausea, vomiting
• Palpitations
• Blackout
• Dizziness

3. Endometrioma (Chocolate Cyst)

It is the type of cyst formed when endometrial tissue, that covers the inner surface of uterus, grows in the ovaries. Endometrial tissue that transits to ovaries is named as endometriosis. Small and spotty endometrial implants bleed in themselves in time and turn into a cyst with dark brown content. This cystic structure that is formed is named as endometrioma. Such cyst is filled with dark brown fluid that is similar to chocolate. Therefore, it is known as ‘chocolate cyst’.

Complaints such as having painful menstrual periods frequently, pain during sexual intercourse, infertility and pelvic pain are among the symptoms of chocolate cyst.

Endometriosis disorder may bind abdominal organs, ovaries and tubes together. Such adhesions may cause pelvic pains and infertility.

4. Dermoid Cyst (Teratom)

It is encountered most frequently in young girls aged under 20 years. Such cysts contain tissues such as hair, bone, teeth and fat. Therefore, it is easy to diagnose dermoid cyst by use of ultrasonography. These cysts formed due to a problem that occurs in the mother’s womb.

When the cyst is detected, it must be removed through laparoscopy and by use of closed method without damaging the ovaries. The formation therein such as hair, fat and tooth must be taken before they spread into the abdomen. Dermoid cyst may occur in both ovaries by 12%. Therefore, both ovaries must be evaluated very carefully.

5. Cystadenoma

They are benign tumors which develop on the surface layer which wraps the ovarian tissue externally.

6. Fibroma

They are full and hard masses that are similar to billiard balls like myoma which develop in uterus. They require operation due to their resemblance to cancer.

Relationship between Ovarian Cyst and Cancer

80 – 85% of Ovarian cysts are benign. Although benign cysts are not inclined to turn to into cancer, they may cause different complaints in patients.

Malign Ovarian Cyst may occur in Following Conditions:

• Cysts that are formed in advanced age,
• Cyst in both ovaries,
• Diagnosis of a solid structure (hard, potato-like hard structure) besides fluid-filled cyst
• Cysts with irregular borders and limits, that are adhered around
• Cysts that grow faster than average
• Cysts in multiple numbers and that contain solid parts therein
• Cysts that cause water retention (acid) in the abdomen
• Cysts which do not disappear by themselves or which grow as diagnosed during periodical control
• Cysts that are accompanied by increases in blood tests that are called tumor markers

It ovarian cyst is suspected to be cancerous, it is very important that operation is performed by an experienced doctor so that spreading can be prevented. Pathological evaluation is definitely required in order to diagnose immediately the tissue taken by operation.

What Does Torsion of Ovarian Cyst Mean?

It is the condition of cyst turning around itself and as such, causing problem in its own blood circulation. It is also named as ovarian suffocating. Blood circulation is distorted and tissues lose their vitality. This is a quite painful condition. Risk of torsion is even greater especially in case of cysts with big diameter and dermoid cysts. In such case, one should immediately undergo operation. Laparoscopy is preferred for ovarian cyst operation. Ovaries may be lost if it becomes too late to treat an ovarian cyst.

Treatment for Ovarian Cysts

1. Medication

The most frequent method to treat benign ovarian cysts is use of contraceptives. Contraceptives ensure treatment by 90% in case of simple ovarian cysts. The size is checked through ultrasonography used during medication. In case of cysts which cannot be reduced in size by use of medication, operation may be considered. Although drugs categorized as GnRH analogues are used mostly to reduce size of chocolate cysts before operation or to prevent their recurrence after operation, operation is the first choice.

Treatment for ovarian cyst is determined based on the size of cyst, ultrasound view and the suspicion as to whether it is benign or malign. This problem is eliminated generally through ovarian cyst surgeries.

2. Surgical treatment

Treatment for ovarian cyst may include normal surgery or surgery by use of laparoscopy. Decision is made as to the form of operation as a result of examinations. Moreover; age, fertility and size and type of cyst also play a role. Laparoscopy method is not used especially if cancer is suspected. In case of malign cysts, the main purpose is to remove the cyst without damage.

-Laparoscopy

Laparoscopy which means closed operation must be the first choice of treatment for ovarian cysts. Closed endoscopic method, which is named as laparoscopy, is always the first choice in case of cysts other than very large cysts and cysts with high risk of being cancerous.

-Laparotomy

Laparotomy method is not preferred anymore today. However, it can be used for large cysts and cysts which have high potential to become malign. It may be required to have both ovaries and the cysts surgically removed.