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Functional cysts
Some, called functional cysts, or simple cysts, are part of the normal process of menstruation. They have nothing to do with disease.
Graafian follicle cyst
One type of simple cyst, which is the most common type of ovarian cyst, is the graafian follicle cyst, follicular cyst, or dentigerous cyst. This type can form when ovulation doesn't occur, and a follicle doesn't rupture or release its egg but instead grows until it becomes a cyst, or when a mature follicle involutes (collapses on itself). It usually forms during ovulation, and can grow to about 2.3 inches in diameter. It is thin-walled, lined by one or more layers of granulosa cell, and filled with clear fluid. It's rupture can create sharp, severe pain on the side of the ovary on which the cyst appears. This sharp pain (sometimes called mittelschmerz) occurs in the middle of the menstrual cycle, during ovulation. About a fourth of women with this type of cyst experience pain. Usually, these cysts produce no symptoms and disappear by themselves within a few months. Ultrasound is the primary tool used to document the follicular cyst. A pelvic exam will also aid in the diagnosis if the cyst is large enough to be seen. A doctor monitors these to make sure they disappear, and looks at treatment options if they do not.
Corpus luteum cyst
Another is a corpus luteum cyst (which may rupture about the time of menstruation, and take up to three months to disappear entirely). This type of functional cyst occurs after an egg has been released from a follicle. The follicle then becomes what is known as a corpus luteum. If a pregnancy doesn't occur, the corpus luteum usually breaks down and disappears. It may, however, fill with fluid or blood, and stay on the ovary. Usually, this cyst is on only one side, and does not produce any symptoms.
Hemorrhagic cyst
A third type of functional cyst, which is common, is a Hemorrhagic cyst, which is also called a blood cyst, hematocele, and hematocyst. It occurs when a very small blood vessel in the wall of the cyst breaks, and the blood enters the cyst. Abdominal pain on one side of the body, often the right side, may be present. The bleeding may occur quickly, and rapidly stretch the covering of the ovary, causing pain. As the blood collects within the ovary, clots form which can be seen on a sonogram. Occasionally hemorrhagic cysts can rupture, with blood entering the abdominal cavity. No blood is seen out of the vagina. If a cyst ruptures, it is usually very painful. Hemorrhagic cysts that rupture are less common. Most hemorrhagic cysts are self-limiting; some need surgical intervention. Even if a hemorrhagic cyst ruptures, in many cases it resolves without surgery. Sometimes surgery is necessary, such as a laparoscopy ("belly-button surgery" that uses small tools inserted through one or more tiny slits in the abdomen).
Dermoid cyst
A dermoid cyst, also called a dermoid or mature cystic teratoma, is an abnormal relatively rare cyst that usually affects women during their childbearing years (15-40; the average age is 30), is usually benign, and can range in size from half an inch to 17 inches in diameter. It is similar to those present on skin tissue, and can contain fat and occasionally hair, bone, nails, teeth, eyes, cartilage, and thyroid tissue. Up to 10-15% of women with them have them in both ovaries. It develops from a totipotential germ cell (a primary oocyte) that is retained within the ovary. A CT scan and MRI can show the presence of fat and dense calcifications. Though it often does not cause any symptoms, it can on the other hand become inflamed, and can also twist around (a condition known as ovarian torsion), causing severe abdominal pain and imperiling its blood supply, which is an emergency and calls for urgent surgery. These cysts can generally be removed easily, which is usually the treatment of choice, with either conventional surgery (laparotomy; open surgery) or laparoscopy. Removal does not generally affect fertility. The larger it is, the greater the risk of rupture with spillage of the contents, which can create problems with adhesions and pain. Although the large majority (about 98%) are benign, the remaining fraction (about 2%) becomes cancerous (malignant) -- those are usually in women over 40.
Endometrioid cyst
An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst is caused by endometriosis, and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries. As the blood builds up over months and years, it turns brown. When it ruptures, the material spills over into the pelvis and onto the surface of the uterus, bladder, bowel, and the corresponding spaces between. Adhesions can develop because of the rupture, and may lead to pelvic pain. It affects women during their reproductive years, and may cause chronic pelvic pain associated with menstruation. Overall prevalence in women has been estimated to be 1-10%.
Endometriosis is the presence of endometrial glands and tissue outside the uterus. It occurs primarily in women during their reproductive years, usually in women aged 25-29. Women with endometriosis may have problems with fertility, because 80% of all pelvic endometriosis is found in the ovary (1 or both). These cysts, often filled with dark, reddish-brown blood, may range in size from 0.75-8 inches. Treatment for symptomatic endometriosis can be medical or surgical. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used first in patients with pelvic pain, particularly if the diagnosis of endometriosis has not been definitively established. The goal of directed medical treatment is to achieve an anovulatory state. Typically, this is achieved initially using oral contraceptives. This can also be accomplished with progestational agents (i.e., medroxyprogesterone), danazol, gestrinone, or gonadotropin-releasing hormone agonists (GnRH), as well as other less well-known agents. These agents are generally used if oral contraceptives and NSAIDs are ineffective. GnRH can be combined with estrogen and progestogen (add-back therapy) without loss of efficacy but with fewer hypoestrogenic symptoms. Laparoscopic surgical approaches include ablation of implants, lysis of adhesions, removal of endometriomas, uterosacral nerve ablation, and presacral neurectomy. They frequently require surgical removal. Conservative surgery can be performed to preserve fertility in young patients. Laparoscopic surgery provides pain relief and improved fertility over diagnostic laparoscopy without surgery. Definitive surgery is a hysterectomy and bilateral oophorectomy.
Pathological cysts
Other cysts are pathological, such as those found in polycystic ovary syndrome, or those associated with tumors.
A polycystic-appearing ovary is diagnosed based on its enlarged size — usually twice normal —with small cysts present around the outside of the ovary. It can be found in "normal" women, and in women with endocrine disorders. An ultrasound is used to view the ovary in diagnosing the condition. Polycystic-appearing ovary is different from the polycystic ovarian syndrome, which includes other symptoms in addition to the presence of ovarian cysts, and involves metabolic and cardiovascular risks linked to insulin resistance. These risks include increased glucose tolerance, type 2 diabetes, and high blood pressure. Polycystic ovarian syndrome is associated with infertility, abnormal bleeding, increased incidences of pregnancy loss, and pregnancy-related complications. Polycystic ovarian syndrome is extremely common, is thought to occur in 4-7% of women of reproductive age, and is associated with an increased risk for endometrial cancer. More tests than an ultrasound alone are required to diagnose polycystic ovarian syndrome.
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Important notice:
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other
qualified health provider with any questions you may have regarding a medical condition.
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