WHAT ARE OVARIAN CYSTS?

The ovaries are part of the female reproductive system. They’re located in the pelvis on both sides of the uterus. Women have two ovaries that produce eggs; normally the egg production is alternated between the right and left ovary. They also produce hormones estrogen and progesterone.

Sometimes, a fluid-filled sac called a cyst will develop on one or both ovaries. 5-15% of women have ovarian cysts and in most cases they are painless and cause no symptoms.

Ovarian cysts are more common in women of reproductive age.

TYPES OF OVARIAN CYSTS                       

1. Follicular cysts

During a woman’s menstrual cycle, an egg grows in a sac called a follicle. This sac is located inside the ovaries. In most cases, this follicle or sac breaks open and releases an egg and its remnant is called corpus luteum, but if the follicle doesn’t break open to release the egg the fluid can accumulate inside the follicle to form a follicular cyst .

2. Corpus luteum cysts

Corpus luteum typically dissolves about 14 days after releasing an egg (if fertilization doesn’t take place). But sometimes the corpus luteum doesn’t dissolve in time and bleeds inside to form corpus luteum cyst. They can also be associated with pregnancy during the first trimester.

3. Lutein cysts

These develop in conditions that produce high levels of a hormone called HCG (Human chorionic gonadotropin) like twin pregnancy and molar pregnancy.

4. Cysts associated with Polycystic Ovarian Syndrome (PCOS)

Most time women with polycystic ovarian syndrome don’t ovulate and the fluid accumulate in the follicle to form many cysts in the ovary.

5. Endometriomas

These are cysts whose cavities are lined by endometrial cells. Endometrial cells are the cells which line the uterine cavity which women shed during menstrual bleeding.

6. Dermoid cysts

These are type cysts in the ovary capsule which is covered with a thick layer of leathery skin. They can grow on one or both ovaries and usually contain hair, nails, teeth, eyes and sebaceous glands. Most do not cause symptoms, however if the tumor grows it can result in complications.

Symptoms of an ovarian cyst

Often times, ovarian cysts do not cause any symptoms. However, symptoms can appear as the cyst grows. Symptoms may depend on the type of the cysts and they may include:

  • Abdominal  swelling due to pressure symptoms
  • Constipation
  • Lower abdominal pain due to compression of neighboring organs
  • Painful menstruation e.g in case of endometrial cysts
  •  Painful sexual intercourse ( Dyspareunia)
  • Heavy menstrual bleeding
  • Pain in the lower back
  • Breast tenderness
  • Nausea and vomiting
  • Fever (In case of infection)
  • Faintness or dizziness ( Due to rupture)
  • Rapid Breathing

 Ovarian cyst complications

Most ovarian cysts are harmless and are called functional cysts, they naturally resolve on their own without treatment. These cysts cause little if any symptoms. However, sometimes the following complications can occur with them:

  1. Ovarian cysts can cause ovarian torsion. This is when a large cyst causes an ovary to twist or move from its original position. Blood supply to the ovary is cut off, and if not urgently treated, it can cause death of the ovarian tissue which makes a woman going into early menopause

Although uncommon, ovarian torsion accounts for nearly 3 percent of emergency gynecologic surgeries.

  1. Rupture of the cyst is another, although also rare, can cause intense abdominal pain due to the resulting inflammatory process.
  2. They may persist and become cancerous.

Diagnosis of ovarian cysts

  1. Good history taking and examination of the patient is very important in making the proper diagnosis.

For example;

  1. Age of the patient; functional cysts are likely to be in females of reproductive age while the cysts that develop in postmenopausal women are likely to be cancerous. b) For polycystic ovarian cysts, there is infrequent menstrual periods and masculinasation (hairy body, bald head)
  2. Lutein cysts if there is nausea and vomiting
  3. Endometrioma if there is painful periods
  1. Some of the examination findings will include:
  • Lower abdominal swelling
  • Pelvic examination

INVESTIGATION OF OVARIAN CYSTS

Abdominal ultrasound scan/ transvaginal ultrasound scan is performed to determine the following

  • Features of the cyst; in case of simple cysts it has to be less than 8cm in diameter- unilocular, homogenous content (fluid), regular shape, normal blood vessel pattern
  • Whether unilateral or bilateral
  • Presence of ascites (free fluid) in the abdomen
  • Assess for spread (in case of ovarian cancer) to other organs like the liver

LABARATORY INVESTIGATION

  • HCG is done to rule out pregnancy
  • Blood test called CA-125 CEA and ALPHA FETEL PROTIEN to rule out other ovarian tumours

Testimony of ovarian cyst

  • Patient W aged 21 years came to our facility on 16-08-2016 complaining of pain in the right lower abdomen. She was sent to Kisubi Hospital 16-08-2016 to do pelvic ultrasound scan report which revealed that she had right ovarian cyst measuring 7cm along with Hepatic simple cyst she was put on medicine at Crest Natural Health Centre the pain reduced drastically. She went back to the same hospital yet for another pelvic ultrasound scan on 15-09-2016 which revealed that the ovarian cyst had reduced to 3cm. She continued with our medicine and finally the last pelvic scan revealed that she had cured ovarian cyst on 12-11-2016.
  • Another patient D aged 41 came to our facility on 20-10-2017 complaint of acute pain in the left lower abdomen and was diagnosed with Hemorrhagic ovarian cyst (Bleeding cyst) and endometrioma according to the pelvic ultrasound scan report done by Kampala Imaging Centre reference number KICK-S-2537/2017. She was put on medication at Crest Natural Health Centre the response was good. She went back to the same imaging company to do pelvic ultrasound scan on 9-11-2017 reference number KICB-S-2732/2017 the ovary size had reduced to 4cm and the treatment is on going

TREATMENT OF OVARIAN CYSTS

  1. For simple cysts less than or equal to 3cm in women of reproductive age, there is no worry and no more investigations are needed.
  2. Simple cysts between 3-8 cm they are managed with our remedies the treatment takes about 6 months.
  3. For cysts beyond 7cm at Crest Natural Health Centre we treat this condition without the involvement of surgery
  4. For those cancerous cyst (Malignant) referral is done for further management to Uganda Cancer Institute , Mulago Hospital