A brief discussion of Cysts in Ovary
Cysts are a localised collection of fluid surrounded by a thin wall of fibrous tissue. Cysts are one of the commonest disorders of the ovary and almost every woman in her childbearing years will have a few cysts. This is commonly benign and easily managed. Cysts in Ovary are a normal phenomenon in the ovulating years; such cysts are called functional cysts and are of two types: Follicular cyst of ovary and luteal cyst of ovary.
Follicular cysts of ovary are a disorder of the graffiaan follicles. Graffian follicles contain the immature ovum. At every cycle a few of these graffian follicles start maturing, but only one follicle shed its ovum. The rest of the follicles in the cycle reduce in size and die of. But in some cases they do not reduce in size and instead form a cyst. These cysts are called follicular cysts of ovary.
Luteal cysts are cysts of the corpus luteum, the remnant of the graffian follicle once the ovum has been shed.
Apart from these functional cysts, there are other cysts known as non-functional cysts. The common amongst them are dermoid cyst and chocolate cyst.
Dermoid cyst are developmental abnormality that contain mature skin, hair complete with follicles and sebum, sweat glands, blood, fat, bone, nails, teeth and thyroid tissue. A dermoid cyst is almost always benign because it often contains fully developed tissues with no cancerous potential.
Chocolate cysts are seen in endometriosis. These are nothing but a collection of blood and aberrant endometrial tissue (the mucus membrane forming the insides of the uterus) in the ovaries.
Most cysts are small usually less than 2 cm but some can grow to the size of a big orange. They cause non specific complaints like a dull or sudden sharp pain in the lower abdomen, vagina, thighs and lower back. Other symptoms may include breast tenderness, pain during menstruation, irregular periods, heavy growth of facial hair, weight gain, acne, urinary disturbances(in large cysts).
Presence of more than 10 cysts in each ovary associated with a cluster of signs and symptoms is called polycystic ovary syndrome. This condition will be discussed separately and hence we will confine the discussion to simple ovarian cysts.
Since these cysts rarely produce specific symptoms, they are commonly diagnosed on ultrasound ot CT scan.
Ultrasound is a cheap, effective and accurate way to detect and localise cysts. It can diagnoses cysts as small as a few millimetres. Ultrasound will also be able to show any changes suggestive of a cancerous cyst. With the widespread availability of ultrasound, it has become the preferred investigation for diagnosis of ovarian cysts.
CT scan is generally reserved for an ambiguous ultrasound or to follow up a cyst identified as cancerous by the ultrasound.
Most cysts less than five cm can be observed and they resolve with 2-3 menstrual cycles. However big functional cysts and all non functional cysts will need excision by laprotomy(open surgery) or laproscopy(keyhole surgery). By laproscopy function cysts may be ruptured and this would save the requirement of an open surgery to excise the cyst.
For cysts less than five cm, a trial of oral contraceptives is usually effective in reducing the cyst count and size in functional cysts.
Pain is often the most troublesome aspect of these cysts. Usual doses of non opiod pain killers suffice in most cases of ovarian cysts. Addition of two different classes of pain killers will provide additive effect, so may be tried if single drug does not cause enough pain relief. Other measures that can be taken for pain relief include application of hot water bags to the lower abdomen and alternative application of ice to increase circulation.
This above mentioned discussion should have cleared many doubts about cysts in ovary. However there is one more condition amongst the cysts of ovary that requires a more detailed examination: PCOS
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