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Gynaecology

Ovarian Cyst

Ovarian cysts are sac-like structure in the ovary and mostly developed in a woman during her reproductive years. It can be single, multiple or bilateral and may contain either fluid (follicle cysts/cystadenoma), blood (endometriotic cysts) or substance like fat, hair and bone (dermoid cysts).

Possible causes of ovarian cyst:

The duty of the ovaries is to produce egg during the reproductive age and a cyst-like structure (follicle) is formed from the ovary. Every follicle carrying one egg cell. It will grow from small to big. When it reaches the size of 2cm - 2.5cm (20mm to 25mm), it will burst anytime, and when it burst the egg cell will be pushed out, this action called ovulation. After the ovulation, this follicle form corpus luteum (yellow like body) and starting to produce progesterone, progesterone will be needed for human body to change the endometrium into the condition ready for fertilization, they provide a good nice nutrition for fertilized egg. However, if no fertilization the whole endometrium will shed out and pass out through the vaginal and these called menses.

Types of ovarian cysts:

Functional cysts: These cysts are harmless and could be treated by tablet.

Dermoid cysts: These are ovarian cysts that are filled with various types of tissues, including hair, bone,skin and fatty tissue. These will need operative treatment.

Cyst-adenoma: These are ovarian cysts that develop from cells on the outer surface of the ovaries and can turn to cancerous then we called it cystsadenocarcinoma. They will need operative treatment.

Polycystic Ovarian Disease (PCOD): Is the complex of female hormone inbalance, is characteristiced by presence of multiple cysts between ovaries. If not treated, woman would face infertility issue. This can be treated by tab or surgery.

Generally, ovarian cysts may cause abdominal pain or a sense of fullness or pressure in the abdomen, often the women are mistaken it as increasing fat in the tummy. When women experience acute pain it surely cause by the bursting or twisted of the existing cysts and the patient need to go to the emergency room.

The most common type of ovarian cyst is follicular cyst, which results from the growth of a follicle. A follicle is the normal fluid-filled sac that contains an egg. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg. Usually, follicular cysts resolve spontaneously over the course of days to months. Cysts can contain blood from injury or leakage of tiny blood vessels into the egg sac called hemorrhagic cysts.

Another type of ovarian cyst that is related to the menstrual cycle is a corpus luteum cyst. This is harmless.

Endometriosis is a condition in which the endometrium cell (internal lining) that normally grow inside the uterus, but now grow outside the uterus. When endometriosis forming a brown-coloured cystic area sometimes referred to as a cholcolate cyst or endometrioma or endometriotic cyst.

How to detect ovarian cyst:

Most cysts are diagnosed by ultrasound, which is the best imaging technique for detecting ovarian cysts. Ultrasound is an imaging method that uses sound waves to produce and image of structures within the body. Ultrasound imaging is painless and causes no harm. Cysts can also be detected with other imaging methods such as CT scan or MRI scan

Endometriotic Cyst (Endometrioma)

Endometriosis is the endometrium tissues which were found outside of the uterus like in ovaries, bladder, intestinal or pelvic wall - known as pelvic endometrium. Although they are not in the uterus, the pelvic endometrium still behave like uterine endometrium and would bleed during the period, the pelvic endometrium has nowhere to go and bleeds directly onto the surface of the surrounding organs and tissues forming a brown-coloured cystic area. This causes irritation to the woman feeling painful during her period, inflammation, scarring and may have adhesions (abnormal fibrous tissue growth) between organs. Thus, affect the abilities to get pregnant and become one of the common cause in infertility issues. It may form cyst or number of cysts within the ovaries. These cysts are commonly known as 'chocolate cysts' (brownish fliud-filled sacs).

In some cases, deep endometriosis tissue and scarring may form small lump or lumps called 'endometriotic nodules' or 'endometrioma' and can be very tender and painful to touch. Some women experience pain during sexual intercourse may be due to scarring and nodules of endometriosis.

Some women with endometriosis may not notice because of no symptom but others may experience heavy, painful, irregular menses, pain during sexual intercourse, pain in the pelvis or lower abdomen, lower back pain, pain when passing urine or bowel and the doctor could only find out during ultrasound scanning.

The exact causes of endometriosis is still unknown. Nevertheless there are 3 possibilities to explain how endometriosis develop:

Retrograde menstrual flow: During the menses, instead of outflow of menses through the cervix canal, blood flows backwards up to the fallopian tubes into the pelvis. The overflowed tissue may fall onto other organs and formed 'chocolate cysts' usually collected and stick onto the ovaries, bladder, intestines. Chocolate cyst stick to ovary, fallopian tube do minimise the chances of pregnancy.

Lymphatic or vascular spread: Through the lymphatic drainage or blood vessels, the endometrial cells may flow through lymphatic drainage or blood vessels to the other parts of the body.

Metaplasia: It is describing a process during which cells in the body may undergo change into endometrial cells. Examples include cells lining the inside of the abdomen and cells from the ovary.

Tests to check for endometriosis include: Ultrasound scanning or laparoscopy.

Ultrasound scan: Use a small scanner (sound waves) to move across the abdomen to produce a video image.

An ultrasound scan could assess the severity of endometriosis and to identify cysts on the ovaries, ultrasound could also make an assessment of how severe on the stuck of ovaries and uterus.

Laparoscopy: This is to insert a telescope through a small cut in the naval to look inside the abdomen and pelvis to visualise the whole pelvic and their organ.

Choice of treatment may include medical treatment:

Tab/Injection only in early stage; or

Surgical treatment: by Laparoscopy to coutherised or removal of endometriosis.

Methods of treatment of all the above mentioned for ovarian cyst and endometriosis are based on case by case and on individual's condition, please consult your doctor for the right / suitable treatment.

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