Endometriotic ovarian cyst: diagnosis and treatment
Endometriotic ovarian cyst is a common gynecological gormonalnozawisimae disease developing on the background of internal endometriosis. Disease manifests itself in the formation of pathological cavities filled with accumulated menstrual blood. The characteristic brown coloration of the contents of the cyst determines its synonymous name “chocolate”.
Cause of disease is cyclic abnormal growth of the endometrium in the cortical layer of the ovary under the influence of sex hormones. Endometrioid cyst has similar symptoms with other functional structures on the ovaries, which are difficult to identify without special methods.
Insidious disease lies in the peculiarities of its flow. Endometriotic cysts may have a slow character with hidden symptoms or cause pronounced discomfort in the uterus and ovaries, worse during menstruation.
If in a woman’s body cells, identical to endometrium located outside the uterus, their klassificeret as endometriosis. With the emergence of small endometrial nodes on the surface of the ovary and starts the disease. Endometriosis nodes increase in size with each menstrual cycle, just like the endometrium in the uterine cavity. Menstrual discharge accumulates to form a dense mass in the resulting cavity.
Looks like “chocolate” cyst, demonstrates the photo below.
To suspect the presence of endometriotic cysts can be in the presence of symptoms such as:
- the pain of pulling character in the ovary region, lumbar spine, increasing with onset of menstruation;
- the emergence of spotting spotting brown before and after menstruation;
- deterioration of the General condition caused by the symptoms of intoxication;
- the increase in size of the abdomen;
- heavy periods;
- reduce menstrual cycle caused by the prolonged menstruation;
- the appearance of pain at the time of sexual intercourse;
- the inability to become pregnant for a long time against the backdrop of regular sexual life without contraception;
- violation of bowel movements (frequent constipation) and bladder.
There are 4 stages of development of endometriotic ovarian cysts:
|Stage I||Small point of education on one or both ovaries|
|Stage II||Cysts one of the ovaries measuring up to 6 cm|
|Stage III||Cysts of both ovaries measuring up to 6 cm with a possible transition to the serous covering of the uterus and appendages, the walls of the pelvis|
|Stage IV||Bilateral ovarian cysts larger than 6 cm with the transition process to adjacent organs and the appearance of adhesions|
The choice of treatment and further management tactics will depend on the stage of the process.
To confirm the presence of endometriotic cysts on the ovary by using instrumental and laboratory methods of research:
Special methods the study was conducted with the purpose of refuting other diseases with similar symptoms:
- uterine fibroids;
- recto vaginal endometriosis;
- endometriosis of the fallopian tubes;
- sarcoma of the uterus;
- luteum cyst;
- a follicular cyst;
- dermoid cyst;
- tumor of the ovary.
In most cases, the endometriotic cyst is diagnosed in women of reproductive age to 40 years of age who are unable to realize the dream of motherhood. Reproductive disorders occur due to abnormal growth of the endometrium outside the uterine cavity, which prevents the promotion of the egg in the right direction.
- Hormonal imbalance is the main cause of this disease. The disease develops under the action of the hormones released in the female body in the reproductive period. If a young woman delays pregnancy for a long time, it will automatically fall into the risk group. The chances of pregnancy decrease with each passing year.
- Endocrine diseases also contribute to the disruption of the natural hormone levels (decrease of progesterone, rising estrogen) and provoke the appearance of cysts. To imbalance of hormones lead to thyroid disease, adrenal insufficiency, diabetes mellitus, obesity and others.
- The rejection of the natural type of feeding suppresses the production of prolactin, disturbing the natural hormonal balance that leads to diseases of the breast and ovaries.
- Acute and chronic inflammatory processes in the reproductive organs caused by the activities of pathogens, is not less common cause of endometrial cyst.
- Surgery (abortion, uterine curettage, surgical diathermy of the cervix, surgery to remove the organs) increases the risk of formation of adhesions, abnormal growths of endometrial tissue in uncommon areas.
- Hypothermia of the pelvic organs, caused by prolonged stay in conditions of low temperature, produces inflammation of the ovaries and the appearance of cysts.
- The use of intrauterine contraceptive devices increases the risk of hormone-dependent diseases. Their use should be preceded by a thorough diagnosis of the organism, in particular the study of hormonal.
- Transplantation of reproductive organs promotes migration of cells of the endometrium together with blood and their reproduction in the ovaries.
- A genetic predisposition to the appearance of tumors explains the development of cysts on the ovaries. This condition is diagnosed in the presence of endometriosis in the family history, metaplasia of embryonic tissue residues.
- Emotional stress reduces immunity, which prevents the occurrence of pathological processes in the body.
To treat endometriotic cyst need to be mandatory. Unlike functional cysts, the pathology alone does not resolve with time, not always reduced in size as a result of application of hormone therapy, not treated with traditional medicine.
The classic version of treatment of endometriotic ovarian cysts involves surgery to remove it with the subsequent hormonal and anti-inflammatory therapy:
- Cyst removal by surgery is the only possible treatment option of the cysts in large sizes (over 5 cm). The task of the doctor is to preserve reproductive function, ovarian follicular reserve, to minimize tissue damage. Therefore, radical methods (oophorectomy, adnexectomy) resorted to only in exceptional cases, making the choice in favor of laparoscopy, laparotomy, resection of the ovary. Endometrioid cysts are prone to recurrence. Therefore, this treatment option is most effective. Endometriotic cysts are often diagnosed in the left ovary, but the pathological formation may be present on the right body, or on both.
- Hormonal therapy as primary treatment is allowed with a small endometriotic nodes at the initial stage. Hormonal treatment is preceded by the study of the natural hormonal levels of the patient and identification of associated genital abnormalities. Hormone treatment involves a prolonged course of low-dose combined oral contraceptives and agonists of gonadotropin-releasing hormone. Hormonal drugs are taken before surgery to reduce the functional activity of endometrial cells and reduce the size of the hearth. Taking hormones after surgery promotes regression residual endometriosis elements.
- Pregnancy acts as an alternative to hormonal treatment. If the inflammation is minor, a pregnancy would be the best way to get rid of the pathological elements. After surgery pregnancy it is advisable to plan for half a year. If reproductive disorders are resorting to in vitro fertilization (IVF).
- Anti-inflammatory therapy directed on elimination of symptoms during the period of rehabilitation, regeneration of damaged areas, rapid epithelialization. Particularly popular for repairing damaged tissues, metabolic processes used by the drug Wobenzym. Anti-inflammatory therapy combined with receiving analgesics for pain relief (Paracetamol, Nurofen, no-Spa).
- Physiotherapy also promotes a speedy recovery, restore lost functions of the ovaries, prevention of adhesive processes and recurrence of the disease. Positive treatment outcome was observed when using electrophoresis, magnetic, laser therapy, endonasal galvanizing, radon baths.
The result of treatment depends on the stage of the disease, the scale of the defeat treatment. Special attention requires operational way of treating the cyst. A positive result greatly depends on the skill of doctor who performed the operation, as well as individual characteristics of the organism.
Endometrioid cyst is rarely present in a single embodiment. If, at the time of diagnosis reveals a few endometrial nodes, they are removed completely to eliminate the risk of recurrence. The localization of the cyst often coexist with large blood vessels, their violation at the time of surgical intervention affects the recovery of the authority in subsequent period.
Security and prevention measures during rehabilitation increase the chances of full recovery of lost functions of the ovaries:
- full sexual hygiene;
- preventing the occurrence of inflammatory diseases of the reproductive system;
- exception casual sex
- a pregnancy for 6 – 24 months after the treatment;
- complete hormonal therapy prescribed by the attending physician;
- timely advice from a gynecologist, endocrinologist with the subsequent implementation of its recommendations;
- control study of pelvic organs with the help of instrumental methods of diagnostics;
- prevention of abortion;
- lack of stress and high physical exertion.
Timely diagnosis of the disease, the competent approach, adequate therapy and compliance with recommendations of a physician increase the chances of positive treatment outcomes and preventing relapse in the future.