Follicular ovarian cyst
The content of the article:
- Follicular ovarian cyst causes and risk factors
- Forms of the disease
- Ovarian follicular cyst symptoms
- Diagnostics
- Ovarian follicular cyst treatment
- Possible complications and consequences
- Forecast
- Prevention
Ovarian follicular cyst (functional cyst, retention cyst) is a benign formation of ovarian tissue that forms from a non-ovulated follicle.
Neuroendocrine disorders are the main cause of ovarian follicular cyst formation
The process of follicle maturation (folliculogenesis) begins in the antenatal period of intrauterine development (the period from the moment of formation of the zygote to the 40th week) and ends after the onset of menopause. Each follicle consists of an egg cell surrounded by a layer of epithelial cells and two layers of connective tissue. Part of the follicles goes through all stages of maturation and takes part in ovulation, the rest of the follicles die as a result of apoptosis. At the onset of ovulation, the largest and most mature follicle ruptures so that the mature egg cell comes out of it and then moves into the fallopian tube. After ovulation, a corpus luteum forms from the follicle, which produces progesterone. Progesterone prevents premature rejection of the functional layer of the endometrium and the onset of menstruation. If fertilization of the egg has not occurred,the corpus luteum stops functioning, the level of progesterone decreases and menstruation begins. If this process is disturbed, the egg does not leave the follicle, follicular fluid accumulates in it, due to which the follicle increases in size, turning into a cyst, the egg inside it dies. In the process of increasing the follicular ovarian cyst, its walls become thinner, which is due to cell atrophy.
Follicular cysts of small size, as a rule, do not manifest themselves in anything and can be detected when diagnosing for another reason. With a cyst size of 5 cm or more, the patient experiences discomfort in the iliac region. In addition, large follicular ovarian cysts can cause menstrual irregularities and interfere with conception. This is due to the fact that the surface of the cyst produces estrogens, which also contribute to the proliferation of the inner lining of the uterine body, which can lead to intermenstrual bleeding. The risk of malignancy of the ovarian follicular cyst, i.e., its transformation from a benign formation into a malignant one, is minimal.
Most often, a follicular ovarian cyst is diagnosed in women of reproductive age (18–45 years), less often during premenopause, and in some cases it can be congenital. In girls in the prepubertal period, the formation of a follicular ovarian cyst may be associated with premature development.
In the general structure of all ovarian cysts, follicular cysts are found most often (about 80% of cases). Follicular cyst localization is unilateral. The neoplasm can resolve on its own by the beginning of the next menstruation or over several menstrual cycles, which is due to the normalization of the hormonal background and / or the psycho-emotional state of the woman.
Follicular ovarian cyst causes and risk factors
The main cause of ovarian follicular cysts is neuroendocrine disorders that contribute to the development of anovulatory (single-phase) menstrual cycle. Risk factors include:
- physical and psycho-emotional overstrain;
- infectious and inflammatory processes in the body;
- endocrine disorders;
- sexually transmitted infections;
- medical abortion;
- uncontrolled intake of contraceptive drugs;
- infertility treatment (ovulation hyperstimulation);
- changes in hormonal levels (puberty, taking hormone-containing drugs, menopause).
Changes in hormonal levels during menopause can lead to the development of follicular ovarian cysts
The congenital form of the follicular ovarian cyst occurs, as a rule, under the influence of a pregnant woman's estrogen on the developing fetus.
Forms of the disease
Depending on the characteristics of the course, follicular ovarian cysts are subdivided as follows:
- retention, which is characterized by independent resolution;
- persistent, in which signs of regression are absent for several months;
- recurrent, that is, formed repeatedly.
In addition, ovarian follicular cysts can be congenital and acquired.
By the presence of complications - uncomplicated and complicated.
Ovarian follicular cyst symptoms
The clinical picture with a follicular ovarian cyst depends on the hormonal activity of the cyst, as well as on the presence of concomitant pathology in the patient (endometriosis, adnexitis, uterine myoma, etc.). In the case of a small follicular ovarian cyst (up to 5 cm), which does not actively produce hormones, clinical manifestations of the disease may be absent. Such follicular ovarian cysts are an accidental finding during a routine preventive examination or during a diagnosis for another pathology.
Symptoms of a large follicular ovarian cyst:
- pain in the lower abdomen from the pathology, which appear in the second half of the menstrual cycle and intensify with sexual intercourse, sudden movements, physical exertion;
- a feeling of heaviness, discomfort in the groin area (right or left, depending on which ovary the follicular cyst has developed);
- basal body temperature 36.8 ° C and below in the second half of the menstrual cycle;
- scant intermenstrual vaginal discharge;
- bloody discharge from the genital tract after intercourse;
- irregular menstrual cycle;
- excessively long and heavy menstruation;
- unsuccessful attempts to get pregnant over several cycles.
An irregular menstrual cycle, scanty menstruation may indicate a follicular ovarian cyst
Diagnostics
During the diagnosis of follicular ovarian cysts, complaints and anamnesis are collected, as well as an examination, including:
- gynecological examination (with a bimanual examination, a rounded, movable, slightly painful neoplasm is felt on the side and anterior to the uterus);
- a blood test for sex hormones (luteinizing hormone, follicle-stimulating hormone, estradiol, progesterone);
- ultrasound diagnostics of the pelvic organs (a spherical single-chamber cyst is found, which is filled with homogeneous contents, 3–8 cm in size, and sometimes more);
- dopplerometry of the vessels of the small pelvis (areas with slowed blood flow are found on the periphery).
In some cases, diagnostic laparoscopy may be required.
Follicular ovarian cyst is clearly visible on ultrasound
Differential diagnosis with ovarian cystoma, ectopic pregnancy, malignant neoplasm of the ovary, inflammatory diseases of the genitourinary system, acute appendicitis is required.
Ovarian follicular cyst treatment
Small follicular ovarian cysts usually do not require treatment. Such cysts usually resolve on their own over several menstrual cycles, without leading to any negative consequences.
If a larger follicular ovarian cyst is found that does not cause concern in terms of complications, expectant tactics are often justified. The patient is monitored for two months with an ultrasound examination to monitor the state of the ovarian follicular cyst. If during this period there is no positive dynamics, conservative treatment is prescribed.
Drug therapy for ovarian follicular cysts includes taking anti-inflammatory drugs and hormonal correction using oral contraceptives. To accelerate the reverse development of the recurrent form of the ovarian follicular cyst, physiotherapeutic procedures are shown: electrophoresis, phonophoresis, amplipulse therapy, therapeutic effects with a constant or alternating low-frequency magnetic field, oxygen therapy.
For the treatment of follicular ovarian cysts, hormonal contraceptives may be prescribed
With a large follicular cyst (more than 8 cm), a rapid increase in its size, as well as a persistent form of the disease, surgical treatment is recommended. Removal of the follicular ovarian cyst is usually carried out using the laparoscopic technique, much less often resorting to the laparotomy method.
Surgical treatment of uncomplicated follicular cysts in women of reproductive age usually consists of exfoliation (cystectomy). During the operation, the anterior leaflet of the fallopian tube mesentery is dissected, the follicular cyst is exfoliated from the interconnection space, followed by suturing of its walls.
Follicular cysts are usually treated laparoscopically
In other cases, with the addition of complications, part of the ovary (ovarian resection), the entire ovary (oophorectomy), or removal of the ovary with a fallopian tube (adnexectomy) can be removed.
After the performed surgical treatment of the ovarian follicular cyst, rehabilitation therapy is prescribed, which consists in the use of vitamin complexes (vitamin E, folic acid, ascorbic acid, etc.) and nootropic drugs for several months after surgery.
Since the psychoemotional factor is of no small importance in the occurrence of a follicular ovarian cyst, during treatment it may be necessary to stabilize the patient's psychoemotional state.
When pregnancy occurs, ovarian follicular cyst usually resolves by 15-20 weeks of gestation. In this case, the observation of the state of the ovarian follicular cyst using ultrasound is shown. If the size of the cyst exceeds 6 cm and the cyst does not tend to shrink, surgery may be considered to prevent complications.
Possible complications and consequences
With a large size of the follicular ovarian cyst, as well as during pregnancy, there is a possibility of serious complications: torsion of the ovarian cyst leg, rupture of the cyst capsule, necrosis of the ovarian tissue, ovarian apoplexy with the subsequent occurrence of intra-abdominal bleeding.
Torsion of the leg of the ovarian cyst is manifested by intense pain in the right or left side of the abdomen, which does not subside, increased heart rate, increasing weakness, dizziness, decreased blood pressure, pallor of the skin, nausea and vomiting. At the same time, the body temperature does not rise or rises slightly.
In about 10-15% of cases, the cyst ruptures. In this case, there is a sharp pain in the abdomen of high intensity, there is pallor or cyanosis of the skin, dizziness, weakness, decreased blood pressure, tachycardia, nausea and vomiting, a state of shock.
A ruptured cyst or torsion of its pedicle is an indication for immediate surgery.
Other complications of the follicular ovarian cyst can be menstrual irregularities (algomenorrhea, dysmenorrhea, menorrhagia, menometrorrhagia), termination of pregnancy, infertility.
Forecast
Follicular ovarian cyst in most cases resolves on its own, but even with large cysts, with the right treatment, the prognosis is favorable.
Prevention
In order to prevent the occurrence of follicular ovarian cysts, the following are recommended:
- timely diagnosis and treatment of diseases that can contribute to the development of neoplasms;
- regular preventive examinations by a gynecologist;
- avoidance of excessive physical and psycho-emotional stress;
- sufficient physical activity;
- balanced diet.
YouTube video related to the article:
Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
