PRACTICAL INFORMATION ON ovarian cysts
Ovarian cysts (ovarian cysts) are among the most common changes in women’s ovaries. They are confused with myomas, which are benign tumors originating from the uterus. Simple ovarian cysts seen in the reproductive age (adolescence to menopause) are usually benign and usually disappear spontaneously within two months.
During the reproductive age of women, simple cysts, called follicles, form on the right or left side of the ovaries every month. One of them will grow more (about 2-2.5 cm) by suppressing the others, and at the time of ovulation, it will crack and direct the egg inside to the ovary canals (fallopian tubes). In fact, in women, from puberty to menopause, the formation of a simple cyst called follicle every month is a physiological process under the control of hormones secreted from the pituitary and brain. Also, while the follicle cyst develops, this hormone that will secrete estrogen hormone will swell the inner layer of the uterus. After the follicle cyst cracks, the yellow body, which we call the corpus luteum, will secrete the hormone progesterone for 14 days, and this hormone will cause a protective change in the inner layer of the uterus, which we call secretion. When the corpus luteum loses its function after 14 days, the secretion of progesterone will stop and the uterine lining will be spilled and menstruation will occur. .
This means that simple cysts, which we call follicles, usually crack 14 days before menstruation and send the egg inside to the fallopian channels, where they will live for 2 days.
During the reproductive age, hormones secreted from the pituitary gland under the control of the brain are responsible for the premature cracking of the follicles or their growth from 2.5 cm to over 5 cm.
In short, all factors that affect the upper centers of our brain, such as weather change, travel, stress, fatigue, extreme sports, and weight loss, will prevent the follicles from cracking on time.
In addition, since the pituitary is the center of administration for all hormones, hormones such as thyroid (goiter), prolactin (the hormone that affects breastfeeding and breast milk production), cortisone (secreted from the adrenal gland), testosterone (responsible for acne and hair growth) and all drugs that will affect the formation of follicle cysts will affect.
Follicle cysts that are not cracked appear as black smooth ball-shaped rounds on ultrasonography because they are filled with fluid. Simple cysts are not treated with any medication. Most of these disappear on their own within two months. Contrary to old opinions, birth control pills do not cure cysts, they prevent the formation of new cysts.
Birth control pills, monthly injections and vaginal rings prevent the formation of follicle cysts by suppressing the hormone stimulus from the pituitary to the ovaries, thanks to the mixing of synthetic estrogen and progesterone, which are similar to the hormones secreted from the ovaries, into the blood. Thus, they prevent pregnancy by suppressing ovulation.
They are only effective when used. When you stop the method, a hormone stimulus will come from the pituitary again and follicles will begin to form.
If this warning does not come regularly, the follicle will not be able to crack at 2-2.5 cm, when it shrinks early or grows over 5 cm, the estrogen hormone secreted will be irregular and the inner layer of the uterus will shed early or late.
Due to the effect of the follicle that does not crack on time, menstruation may be delayed or delayed for months..
Simple ovarian cysts may not cause any symptoms in women. Sometimes menstrual irregularities, groin and lower back pain, bloating sensation, pain during sexual intercourse, sometimes frequent urination with pressure on the bladder and pain may be present..
Abdominal (from the abdomen) with a full bladder in virgins, and vaginal ultrasonography in women with sexual bruising are more clearly evaluated.
If simple cysts are seen as a black round ball, thin-walled and smaller than 7 cm on ultrasonography in the reproductive age, they are usually benign and are followed up..
In cysts that do not disappear in two months, tumor markers (the most commonly used is Ca 125) should be checked in the blood with fasting. In cases where Ca 125 is high, the blood flow to the ovaries is evaluated by an experienced specialist with Doppler ultrasonography. Surgery is the only solution for cysts that do not disappear. In the operation, a rapid pathological examination called frozen is performed. If the frozen result is benign, only the cyst can be removed, taking into account the patient’s age and having a child. If the frozen result is malignant, the necessary detailed operation is started immediately. The definitive pathology report, which comes out a few days later, may also be malignant, unlike frozen. In this case, the patient is taken to the necessary detailed operation for the second time.
If the cyst walls are seen thick on ultrasonography, if the cyst is not homogeneous or if there are sections of different thickness and tone, which we call septation, or if there are cauliflower-like protrusions, growths and white solid areas, if there is fluid appearance in the space behind the uterus, the detailed analyzes we mentioned above should be done as soon as possible and the operation should be done according to the results. should be planned.
Simple cysts smaller than 5 cm can be seen in the first 5 years of menopause, if additional tests are normal, they can be observed for a certain period of time. In other cases, the operation will be unavoidable.
Since the corpus luteum will continue in the first 8 weeks of pregnancy, it can be easily observed in ultrasonography and indicates the side where the egg comes out. . Other cysts seen in pregnant women are evaluated and followed up according to ultrasonographic images, and an operation can be performed during pregnancy if necessary. Aspirating and draining cysts with a needle during pregnancy has fallen off the agenda due to studies showing that new cysts are formed again.
Dysgerminomas are usually encountered in childhood. These are mostly benign ovarian tumors. They may contain sections from teeth, hair and other tissues. In ultrasonography, solid, non-homogeneous, different black, white, gray tones are seen. In this case, the tumor markers to be examined in the blood are different. (alpha FP) , such as beta HCG). Their treatment is surgical removal of the mass.
Rarely, ovarian cysts require emergency surgery. These are conditions such as bleeding into the abdomen as a result of rupture (explosion, rupture) of the cysts, torsion of the cyst (rotation around the stem)..
Severe, excruciating abdominal pain, nausea, vomiting, cold sweats, dizziness, fainting and other shock symptoms are observed in the patient. Laparotomy (operation by opening the abdomen) is performed without delay.
Polycystic ovary appearance is a condition seen in approximately 20% of women of reproductive age. The diagnosis is made by ultrasonography of more than 10 cysts with a diameter of 4-5 mm arranged like pearls on the outer wall of both ovaries. Hormone tests may come back completely normal. Testosterone levels may be high due to the secretion of these small cysts. Some people with polycystic ovaries will have delayed periods, hair growth and weight gain, and a tendency to diabetes mellitus in the future. For this reason, diet and sports are the first treatment options recommended for the complaints mentioned in order to lose weight.
Simple cysts are more common in those with polycystic ovaries. Polycystic ovary should not be confused with multicystic ovary, which looks like an abundance of cysts of different sizes in the ovaries, especially in adolescents and young women, and has no pathological findings.
Due to menstrual delays and ovulation irregularity, estrogen dominance (when the follicle cracks and the egg does not hatch, the corpus luteum does not form and does not secrete progesterone with a protective effect), swelling in the inner layer of the uterus, which we call hyperplasia, can lead to changes up to intrauterine cancer in long years. Symptoms of polycystic ovary continue until menopause.
For this reason, all other progesterone-containing contraception methods (hormone-containing intrauterine device, forearm implant, three-month injection), especially birth control pills (especially those with hair growth and menstrual delays), should be used until menopause (except during the periods when a child is desired).
Chocolate cysts occur only in reproductive age. disappears at menopause . Chocolate cysts can be encountered with a disease called Endometriosis, which is seen in the reproductive age, and often manifests itself with menstrual pain. Endometriosis occurs as a result of the migration of the tissue in the inner layer of the uterus into other tissues, for example, if it goes to the nose, there will be nose bleeding from month to month with the effect of estrogen and progesterone hormones that affect the inner layer of the uterus. The tissue of the inner layer of the uterus that goes into the ovary will bleed every month with the effect of the mentioned hormones, and the old blood accumulated in the closed environment will form a brown chocolate cyst. Chocolate cyst appears as a gray liquid with dense contents on ultrasonography.
Pains in endometriosis usually start in the week before menstruation and on the 1st and 2nd days of menstruation. the day continues. Sometimes menstrual irregularity and bloody discharge are seen. Birth control pills and prostaglandin inhibitor drugs can reduce menstrual pain, but menstrual irregularity may not improve despite the pills. It should be noted that blood Ca 125 values are generally higher in endometriosis.
By producing antibodies against sperm in the early stage of endometriosis, it can increase the risk of infertility (infertility) with adhesions (adhesion) around the bleeding foci in the abdomen under the influence of hormones, especially in the ovarian canals. Laparoscopy is a good option in the treatment of chocolate cysts and adhesions.
Endometriosis is benign and the probability of developing into cancer is less than 1/200. When you enter the menopause, the follicle cysts will be depleted, the estrogen and progesterone secretion in the ovary will stop, and the complaints of the inner layer of the uterus (endometriosis) located in different regions and the chance of chocolate cyst formation will disappear spontaneously.