Ovarian cyst: what to do, whether surgery is needed
Many women have this diagnosis, but not everyone knows what to do with this disease.
With the permission of the Eksmo publishing house, we are publishing a chapter from Dmitry Lubnin’s book Project Woman. The subtleties of attunement of the female body: find out how your body works. “
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 tune in, and often the treatment is inadequate, and the doctors’ comments are frightening. Let’s figure it out.
A cyst is, in fact, a rounded “bubble” with various contents. Cysts can form in any organs and are congenital or formed as a result of inflammation or a violation of the outflow of secretion 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 immature eggs are located.
They are laid in utero, then their number gradually decreases and by the beginning of puberty reaches an average of 300 thousand.
During each menstrual cycle, part of the follicles begins to grow, then one of them breaks forward, becoming dominant, and the rest undergo reverse development. The dominant follicle in the middle of the cycle bursts – this process is called ovulation – and a mature egg is released from it. In place of the bursting follicle, a temporary gland is formed – the corpus luteum, which exists for 12-14 days and produces one of the female sex hormones – progesterone. Follicle rupture occurs when it reaches a size of 20 mm, this is important for further explanation, while during follicle rupture, hemorrhage occurs into the forming corpus luteum, but part 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 corpus luteum 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 corpus luteum turns out to be defective, then a corpus luteum cyst is formed. A defective corpus luteum is most often due to excessive hemorrhage in it, which disrupts the production of progesterone by its cells.
Functional cysts are most often completely harmless and go away on their own. The only exception is one situation. Follicular cysts tend to produce excess amounts of female sex hormones, in particular estradiol, which causes the lining of the uterus, the endometrium, to grow. 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 to start pregnancy.
The work of these hormones can be compared to building a house: estrogens build floors, and progesterone stops construction and finishes.
So, here are some rules for functional cysts:
• Functional cysts never require surgical treatment, they resolve on their own, or they can be helped to dissolve with the prescription of a special drug.
• Almost any ovarian cyst that you have identified can be functional, so always recheck cysts after your next period: true cysts do not shrink or dissolve, unlike functional ones.
• In case of any delay in menstruation, be sure to do an ultrasound scan 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. Be sure to repeat the ultrasound after your period.
• If large cysts, more than 5 cm, are detected, refrain from sports and passionate sex, as such cysts can burst.
A functional cyst is an error in one particular menstrual cycle, that is, after it disappears, no further treatment is required. Often, doctors prescribe the use of contraceptives, ostensibly to prevent the recurrence of cysts, but this is not the case. If you have no need for contraception, then the drug is not needed. Moreover, after a short course of contraceptives (3-6 months), if the drug is discontinued, the risk of a functional cyst re-emerges.
In addition to functional ovarian cysts, there are true cysts, which are already called tumors or cystomas. These include cystadenomas, endometrioid cysts, teratomas, and a few more rare formations. It is important to remember that ovarian cancer also looks like a cyst, so the utmost attention is required for all true ovarian cysts.
Quite often, controversial situations arise when interpreting the results of tests for tumor markers, which are prescribed when identifying ovarian cysts. The most commonly prescribed marker is CA125. This is a very nonspecific marker, since it can be increased in many different conditions that are not at all dangerous from the point of view of oncology. In particular, it rises with endometriosis, that is, if, for example, you have an endometrioid ovarian cyst and have concomitant endometriosis or adenomyosis (endometriosis of the uterus), then the marker can be significantly increased.
An analysis for tumor markers is necessary when detecting any true ovarian cyst, that is, one that has not disappeared after menstruation. As a rule, CA125 is combined with another marker – HE4 – and a special ROMA index is considered. This improves the accuracy of the diagnosis.
All true ovarian cysts require surgical removal, with the exception of small endometrioid cysts (less than 2 cm) – see the section on endometriosis. Most often, they resort to laparoscopy – operations through small incisions in the anterior abdominal wall under the control of a video camera. Only after a histological examination of the removed cyst can a final diagnosis be made, and this is very important, since ultrasound, magnetic resonance imaging (MRI) and tumor markers cannot answer the question of what kind of cyst it is with the necessary reliability. Of course, there are specific signs indicating that a 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.