What is a functional ovarian cyst? What are the symptoms and treatment of a functional cyst?

What is a functional ovarian cyst?  What are the symptoms and treatment of a functional cyst?

Ovarian cyst: what is it?

20% of women develop at least one functional ovarian cyst within one year, that is, it arises as a result of the work of the ovary and disappears within 4-8 weeks (maximum up to 6 months).

The term “functional cysts” refers to the fact that they are caused by hormonal changes that occur during the menstrual cycle, and are more often observed during the reproductive period and less often during menopause.

Fuctional cysts of the ovaries include a follicular cyst that develops from a follicle that did not ovulate and a cyst of the corpus luteum (luteal cyst) – originating from the corpus luteum – the place where ovulation took place. Such cysts are nothing more than fluid-filled formations in the ovaries. They are benign, hormone-dependent.

To understand the mechanism of the occurrence of such cysts, it is first necessary to return to the functioning of the normal menstrual cycle.

In the previous menstrual cycle (MC), an average of 3-11 follicles begins to develop. From the 1st to the 5th day of MC, several of these follicles (antral) continue to grow (we can see them on ultrasound), others atrese (lag behind and stop developing). From the 5th to the 9th day of MC, one follicle – dominant (rarely two – and then there is a possibility of multiple pregnancy) grows to 10 mm and suppresses the growth of other follicles, continuing to increase to 18-22 mm (preovulatory follicle). Under the influence of luteinizing hormone (LH), such a follicle bursts with the release of an egg. And in the place of the follicle, a yellow body is formed.

What is the mechanism of follicular cyst formation?

At the end of the first phase of the menstrual cycle, usually on the 13th – 14th – 15th day of the menstrual cycle, the follicle reaches a size of 18-22 mm. It is at this size that the pituitary gland produces luteinizing hormone (LH), which signals the ovary to ovulate. If LH is not produced enough (with severe stress, a cold, especially with an increase in temperature, a flight with a change in climate, taking certain drugs (non-steroidal anti-inflammatory drugs, glucocorticosteroids, sedatives) – rupture of the follicle – (ovulation) does not occur, while the follicle is filled with liquid reaching the size of 3 cm and more and turns into a follicular cyst.

 

It also happens that due to the compaction of the ovarian membrane (usually under the influence of an excess amount of testosterone in the female body), the follicle membrane does not rupture in response to the influence of LH and it turns into a functional cyst.Follicular cysts usually disappear after a few months without the need for any treatment because they dissolve on their own.

And what is the mechanism of formation of a cyst of the corpus luteum?

When the follicle ruptures and the egg is released, a yellow body forms in its place. If the blood supply and lymph drainage are disturbed in it, this leads to filling with liquid or blood, an increase in size of 3 cm or more, and transformation into a corpus luteum cyst.

Cysts of the corpus luteum can also occur in the early stages of pregnancy, as a rule, when there is a lack of progesterone in the female body. In this way, the body tries to compensatory increase the volume of the corpus luteum, which leads to the formation of a cyst and can reach quite significant sizes (>8 cm), but it tends to disappear on its own by the 12-14th week of pregnancy with the beginning of the formation of the placenta.There are also non-functional cysts, among which the most common are: endometriotic cysts, which have a dark chocolate content, which is formed due to the breakdown of blood inside them; dermoid cysts formed from cells of embryonic origin may contain hair, teeth, cartilage, and bone within the cyst.

Complicated functional cуst – hemorrhagic cyst.

There are situations when there is a rupture of a follicular cyst or a cyst of the corpus luteum with excessive bleeding from the vessels of the ovary into this cyst, and then a hemorrhagic cyst is formed. This happens according to the principle of apoplexy (rupture) of the ovarian cyst into the lumen of the cyst itself, as a variant of its complication. Often this can be accompanied by sharp pain in the lower abdomen.Functional cysts can grow to sizes of 10 cm or even more. Each of these cysts has its own ultrasound features, by which the doctor recognizes them and determines further tactics.

What are the reasons? Why do functional cysts occur?

Stress, excessive physical exertion, excess weight, or sharp fluctuations in weight, thyroid gland dysfunction, increased prolactin level (PRL), excessive amount of androgens in the female body (of ovarian and adrenal origin). Sealing of the ovarian membrane against the background of inflammatory processes in the pelvis or after surgery on the ovaries in the past. Also, taking certain drugs can lead to the formation of functional cysts. For example, citramon.

 

What are the symptoms of functional cysts?

Most cysts do not have any symptoms and are usually discovered unexpectedly during an ultrasound. However, it also happens that cysts can cause discomfort in the lower abdomen during movement, physical activity or during sexual intercourse. On the other hand, a delay in menstruation can be the only sign and reason why a woman decides to visit a gynecologist.

When should you see a gynecologist?

If you feel inexplicable abdominal distension or sudden severe pain in the lower abdomen, pressure on the perineum, nausea or malaise, you should immediately consult a gynecologist and conduct an ultrasound of the pelvic organs. Because such symptoms can be a sign of ovarian distortion with large cysts or cyst rupture with bleeding into the pelvis.It is important to assess the appearance of the cyst. Simple cysts (with homogeneous liquid contents) tend to be benign, but in complex or solid cysts (with denser, heterogeneous, multi-chamber contents), the gynecologist may need additional diagnostic methods to rule out the risk of malignancy. On the basis of the corresponding examination: magnetic resonance imaging (MRI), tumor markers (such as CA-125 or the ROMA index), beta-hCG (pregnancy hormone) or rarely – laparoscopy. Histological examination of the cyst is a method of establishing an accurate diagnosis. One of the tests that has recently gained relevance in terms of diagnosing malignant ovarian neoplasms is the ROMA (Risk Ovarian Malignancy Algorithm) index. It consists of calculations that combine serum CA-125 levels and the HE 4 (Human Epididymis Protein 4) marker. This information, along with age and menstrual status (before or after menopause), means a high or low risk for ovarian cancer.

Possible complications and how to prevent them?

Sharp pain in the lower abdomen occurs with apoplexy of an ovarian cyst as a result of intra-abdominal bleeding or hemorrhage into the tissue of the ovary, which in most cases requires conservative treatment. At the same time, a blood-stopping drug, anti-adhesion therapy is prescribed, and anti-inflammatory therapy or the appointment of antibiotic therapy may also be required to prevent bacterial infection from joining. It is important to emphasize that surgical treatment of functional cysts and their consequences is used very rarely in modern gynecology, in order to prevent traumatization of the ovary and premature reduction of the ovarian reserve.

Surgical treatment is used for such a complication as torsion of an ovarian cyst.

Therefore, if you have such a diagnosis as a functional ovarian cyst, you must follow certain recommendations to prevent rupture and torsion of this cyst!Namely:·      exclude excessive physical activity (strength exercises, exercises aimed at the muscles of the abdominal press)·      limit sexual contact, and sometimes exclude altogether until confirmation of reduction in the size of the cyst.It is mandatory to conduct ultrasound control to confirm the regression of the functional cyst.

What about treatment?

This will depend on the age, symptoms, size and characteristics of the cyst. Most simple functional cysts disappear on their own, so in the next cycle, the gynecologist prescribes an ultrasound examination to make sure that the cyst is regressing.In cases of symptomatic functional cyst, treatment may be prescribed. If such cysts recur, the method of prevention (not treatment of this cyst) is the appointment of combined oral contraceptives in order to prevent the occurrence of new cysts.

It is important to determine the reason for the recurrence of functional cysts, which is why a hormonal examination is prescribed.It is important to remember that recurrent follicular cysts are a sign of chronic anovulation, so their timely diagnosis and prevention are extremely important for pregnancy planning.The prognosis for an ovarian cyst is favorable. However, it is very important to undergo regular gynecological examinations in order to quickly identify those cysts that do not have benign patterns and to carefully monitor how they develop.With frequent recurrences of functional cysts (more than twice a year), it is necessary to consult a qualified gynecologist-endocrinologist to find out the causes of their formation and eliminate them. This is important, because ovarian dysfunction has an effect on the female body (especially on hormone-dependent cells – mammary glands, uterus, endometrium, cervix).