Ovarian cyst is a fairly common disease. It can cause the inability to have a child, pain in the lower abdomen. Cysts come in different types, structures and origins, but in any case they require surgical treatment. Most often, laparoscopy is prescribed for endometrioid ovarian cysts.
What is a cyst?
Endometrioid ovarian cysts are quite common
This is a round-shaped formation, hollow inside, which is located on the ovary or directly in it. The main characteristics of a cyst depend on its genesis and the tissues from which it originates. Sometimes it is possible for the formation to become malignant, its malignancy, which means the cells degenerate into cancerous ones.
In ovarian cancer, a cyst-like formation may also be detected. It develops because the center of the tumor disintegrates and forms a cavity, and is detected during an examination, for example, on an ultrasound, which can complicate diagnosis.
Ovarian cysts are among frequently detected pathologies, especially in at a young age, which can deprive a woman of the opportunity to become pregnant.
There are also paraovarian cysts originating from the fallopian tubes, in which the ovaries remain intact.
Classification of cysts:
- Follicular. Due to the remaining follicle that did not rupture during ovulation, a cyst occurs. A little blood can be found in its cavity.
- Luteal. It is formed in the corpus luteum instead of the ovulated follicle. The cyst cavity is filled with serous fluid and sometimes an admixture of blood.
- An endometrioid cyst develops when endometrial cells grow intensively outside the uterus. This formation is subject to cyclical changes, subject to the influence of the hormonal system. A thick fluid is observed in the cyst cavity.
- Dermoid. Another name is teratoma. It contains tissues considered germinal, sometimes teeth and hair.
- Mucinous. This formation is multi-chambered and includes several cavities containing mucus. Reaches enormous sizes.
Follicular cysts are most often multiple, in which case the diagnosis of polycystic ovaries is made. Ovulation does not occur, the follicle increases in size, forming a cyst within the ovary. Other types of formations are usually solitary.
When is treatment required?
Some of the neoplasms described above are hormone-dependent and can resolve on their own. If this does not happen, and the formation only increases in size, then it must be removed. Before removing an endometrioid ovarian cyst, prescribe conservative treatment. If it is ineffective, then a decision may be made to perform surgery. This applies to luteal and follicular cysts. Other types require surgical treatment.
The main goal of treatment is complete removal of the tumor. How radical the surgery will be depends on several factors. In a young woman, they will try to be as careful as possible in preserving ovarian tissue. But during menopause, most likely, the entire organ will be removed.
Advantages of laparoscopy
Laparoscopic intervention is gentle for patients. Instead of a standard incision, three small punctures are made, which heal easily and quickly, leaving virtually no marks.
Laparoscopy for endometrioid cyst has a number of features
Advantages of the method:
- Compared with normal operation With laparoscopy, the risk of adhesions is lower.
- Almost no hernia develops after the intervention. When performing a conventional laparotomy, the muscles of the anterior abdominal wall, which increases the risk of a hernia in the future.
- Rapid healing of punctures allows patients to recover quickly after surgery.
- The recovery period has very few restrictions and is characterized by early discharge from the hospital.
- The tissues heal without the formation of rough scars.
Preparing for surgery
Any surgical intervention requires careful preparation. Its purpose is to identify concomitant diseases, requiring timely correction of violations in test results. Thanks to a properly conducted preparatory period, the risk of complications in the future is reduced.
A standard examination includes:
- General blood and urine tests.
- Biochemistry of blood.
- It is mandatory to find out your blood type and Rh factor.
Before laparoscopy, it is necessary to take a blood group and Rh factor test.
- Coagulogram.
- Study of hormonal status.
- Tests for HIV, hepatitis and syphilis.
- Ultrasound of the pelvis.
- Fluorography.
Remember! Contraception is important before removing an ovarian cyst! Use reliable methods of protection.
IN preparatory activities Nutrition plays an important role. It is necessary to exclude all foods that provoke increased gas formation within a few days. Last time You can eat no later than 6-7 pm before surgery. You can drink until 10-11 o'clock. Immediately on the day of surgery, you should not drink or eat anything. It is also necessary to shave your pubic hair in the morning, on the day of the intervention.
Method of operation
Before laparoscopy, a woman has a conversation with an anesthesiologist to find out whether there are contraindications and to clarify the type of anesthesia that will be used during the operation. Endotracheal anesthesia is most often used. Before the procedure, the patient is given premedication, including sleeping pills and a sedative.
Surgeon performing laparoscopy
The operating table is at a slight angle. This is necessary so that the intestines move a little and do not obstruct the view. Next, a puncture is performed to introduce abdominal cavity gas to increase its volume. An instrument, a laparoscope, is inserted into the same puncture. After this, 2 more punctures are made, necessary for the introduction of manipulators.
Then the doctor carefully examines the operated ovary, assesses the situation and decides whether laparoscopy will be performed further or whether access needs to be expanded. The latter is performed in case of a malignant process, when radical surgery is needed.
Next, the doctor directly enucleates the cyst or removes part of the ovary with the cyst. In rare cases, the entire organ is removed. This completes the operation. But before removing the manipulators, the doctor once again examines the surgical site for bleeding. After this, the instruments are removed and the punctures are sutured.
The operation ends after the anesthesiologist assesses the patient's condition. If everything is fine, then she is transferred to the ward.
Contraindications to laparoscopy
One of the most common contraindications to laparoscopy in gynecological practice is hemodynamic instability.
Despite the apparent safety of laparoscopy for an endometrioid cyst or any other, the method has its contraindications:
- Obesity stage 3-4.
- History of cardiovascular accidents, exacerbation of chronic diseases.
- Serious dysfunctions in the blood coagulation system.
- Recent abdominal surgery, i.e. less than six months have passed since the intervention.
- Suspicion of a malignant ovarian cyst.
- Peritonitis.
- The patient's serious condition.
- Broken integrity of the anterior abdominal wall.
In all of the above cases, the question of how to perform the operation is decided strictly individually.
How does the postoperative period proceed?
Patients easily tolerate such intervention. Most often, recovery after laparoscopy of an ovarian cyst occurs without serious restrictions and pain. Women are recommended to undergo early postoperative activation. Literally 2-3 hours after surgery with feeling good the patient needs to sit up in bed, get up and slowly move around the room at first.
You will have to follow a gentle diet for some time so as not to burden the digestive tract and not stimulate gas formation. It is necessary to carry out daily monitoring of body temperature and treatment of sutures. They are discharged after removal of the ovarian cyst a few days later, usually on the 3-5th day. Caring for sutures and their subsequent removal is carried out in a clinic at the place of residence.
If unpleasant symptoms occur, you should consult a doctor
Typically, a woman fully recovers her health by the end of the second week after surgery. Sick leave is given for this period, but may be closed earlier.
In conclusion, it must be said that thanks to laparoscopy, women have the opportunity to quickly and effective treatment diseases of the genital organs without significant damage to the abdominal wall. Removing cysts allows you to solve the problem of infertility, especially if you follow all the rules and recommendations of specialists.
Pregnancy may occur in the next menstrual cycle after surgery. Therefore, it is extremely important to consult with your doctor about how long to use protection after surgery, so as not to harm the healing and restoration of the body after surgery.
An endometrioid ovarian cyst forms in the uterine appendages in cavities that form from proliferating endometrial cells. Menstrual blood accumulates in them during menstruation. If the diagnosis is made in a timely manner, it is possible to treat endometrioid ovarian cysts without surgery.
Causes of formation of endometrioid ovarian cyst
Endometriosis is characterized by the movement of endometrial cells into the wall of the uterus, reproductive organs and outside the genitals. Ovarian endometriosis is a genital type of disease. It ranks second among ovarian lesions and first among external genital endometriosis.
This localization of the process is interesting because in the case of ovarian endometriosis, rapid generalization of the disease occurs. So, as a result of infiltrative growth, the intestines are affected. From an endometrioid ovarian cyst, the treatment of which is possible without surgery in the initial stage pathological process, viable elements of endometriosis enter the space located behind the cervix, heterotopias can be located on the diaphragm and cause its perforation. In this case, the process spreads into the pleural cavity.
With ovarian endometriosis, heterotopias can spread to the ureters and bladder. Elements of the endometrium, passaged through an endometrioid ovarian cyst, acquire an increased ability to reproduce. If the contents of the cysts enter the abdominal cavity during perforation, they lead to intestinal paresis and subsequently to adhesive disease. If treatment of an endometrioid cyst without surgery or with its use was untimely, then its cells acquire the ability to become malignant. According to statistics, in twenty-two percent of cases, malignant ovarian cystomas originated from endometrioid cysts. Treatment without surgery in this case becomes impossible.
Endometriosis has been known for over a hundred years. All this time, scientists have been making unsuccessful attempts to figure out its nature. Today there are several theories that try to explain the etiology of endometriosis:
- The implantation theory of the formation of endometrioid ovarian cysts attempts to explain them by the formation of endometrial elements from the uterine cavity onto the surface of its appendages with menstrual blood. The hematogenous and lymphogenous origin of endometriosis cannot be excluded, but the pathogenesis of genital endometriosis is confirmed.
- The dysontogenetic theory of the pathogenesis of endometriosis is confirmed by the fact that during perineoscopy and surgical interventions heterotopias are found in young patients when trying to establish the cause of algodismenorrhea. This explains the cases of familial endometriosis.
Symptoms of endometrioid ovarian cyst
Up to a certain point, endometrioid ovarian cysts do not show any signs of themselves. Symptoms of the disease appear when microperforation of the chambers occurs, when their contents enter the peritoneal cavity and cause inflammation of the pelvic peritoneum or adjacent organs. Then patients begin to complain of pain in the lumbosacral region and lower abdomen.
If endometrioid cysts, which can be treated without surgery, are located on one ovary, then the pain will be localized only on the affected side. They intensify in last days menstruation or after their end. Seventy percent of patients have algodismenorrhea.
In this case, the clinical picture of the disease is similar to that of chronic recurrent adnexitis and periadnexitis. Unlike these diseases, with endometrioid ovarian cyst, despite treatment without surgery, there is an exacerbation, which clearly coincides with menstruation.
At this point, spontaneous perforation of the endometrioid cyst may occur and treatment without surgery becomes impossible. Patients complain of sudden, severe paroxysmal pain in the abdomen, which is accompanied by nausea and vomiting. At the time of perforation, the patient may lose consciousness. At this moment, tension in the abdominal muscles develops (their defence) and positive symptom Shchetkina-Blumberg, that is, signs of peritoneal irritation.
Intestinal motility stops and bloating increases. But, unlike adhesive obstruction, with an endometrioid ovarian cyst there are no cramping pains and periods of violent peristalsis. In such cases, patients are suspected of acute destructive appendicitis, perforation of a gastric ulcer, or duodenum, as well as destructive calculous cholecystitis.
While palpating the abdomen, dense, enlarged and slightly painful ovaries can be palpated either on one or both sides. In some cases, conglomerates of the uterine appendages are determined. From the very beginning of the disease, they become immobile and painful on palpation. The body temperature does not increase, and blood tests show no signs of inflammation.
If a patient with suspected chronic adnexitis or para-adnexitis becomes pregnant, after an abortion the disease worsens and spontaneous conception occurs again, then one must think about the presence of an endometrioid ovarian cyst. Treatment without surgery can be effective.
Gradually, the size of the endometrioid ovarian cyst increases, and attacks of pain periodically recur. The fusion of the cystic formation with the posterior leaves of the broad ligaments, as well as the uterus and rectum, becomes stronger. Often, the endometrioid cyst of the ovary and the uterus form a single conglomerate, which doctors mistake for uterine fibroids.
An endometrioid ovarian cyst, which has not been treated without surgery, grows and heterotopias form behind the cervix. Symptoms characteristic of this localization of endometriosis appear, including irradiation of pain into the rectum. In the area of the uterorectal cavity, when palpated at the lower pole of the cyst, one can find tuberosity, which suggests malignancy of the ovarian cyst. The latter is not characterized by cyclicity associated with menstruation.
In its development, an endometriotic ovarian cyst, the treatment of which is possible without surgery, goes through an average of four stages:
- There are no obvious signs of an endometrioid ovarian cyst. Treatment without surgery is quite possible. Only minor small swellings appear located on the surface of the ovarian endometrium.
- The neoplasms gradually increase in size and reach six centimeters.
- Endometrioid cysts are detected on both ovaries.
- The size of the endometrioid cyst is more than seven centimeters. Heterotopias begin to spread to organs located next to the uterine appendages, involving the rectum and sigmoid colon, as well as the bladder. Treatment without surgery is ineffective.
Laparoscopy and ultrasound can help confirm the diagnosis of “Ovarian endometrioid cyst” and decide what treatment to carry out - without surgery or surgical removal of the formation. Ultrasound reveals cystic formations characterized by heterogeneity of the internal echo structure and having numerous internal echo signals. Nowadays, gas radiographic pelviography and transuterine venography are practically not used for diagnosing endometrioid ovarian cysts and determining the type of treatment (without or with surgery).
Establishing the causes that became the catalyst for the formation of endometrioid ovarian cysts is one of important indicators, allowing you to competently prescribe treatment, especially if a decision is made to carry it out without surgery.
Factors that provoke the formation of endometrioid ovarian cysts
Endometrioid cystic formations in the ovaries can occur under the influence of the following factors:
- gynecological operations;
- retrograde menstruation, which is the reverse flow of blood and the entry of endometrial particles into the abdominal cavity;
- oppression immune system;
- dyshormonal disorders;
- stress and negative emotions;
- genetic defects;
- excess body weight;
- use of intrauterine devices over a long period of time.
Conservative treatment of endometrioid ovarian cysts (without surgery)
At the beginning of the disease, it is possible to treat endometrioid ovarian cysts without surgery. If there is severe severe pain, you should take antispasmodics or non-steroidal anti-inflammatory drugs, as well as non-opiate analgesics. But they do not cure the disease. To treat endometrioid cysts without surgery, hormonal drugs are prescribed.
Which of them to prescribe and in what combination is decided by the doctor, based on the results of the study. Janine is considered the most effective medicine. It contains ethinyl estradiol and dienogest. Janine promotes the reverse development of endometrioid ovarian cysts, that is, treatment without surgery.
Sometimes treatment of an endometrioid ovarian cyst without surgery is carried out by puncture of the formation and aspiration of its contents. The procedure is carried out as follows:
- local anesthesia;
- insertion into the vagina of a vaginal sensor, which is equipped with a conductor having a needle with an attached aspirator;
- puncture of the cyst and aspiration of its contents, which are sent to the laboratory for examination;
- injection of a small amount of alcohol into the cyst cavity, which causes aseptic inflammation, promoting gluing of the walls of the formation.
With its help, the accumulated secretion is sucked out of the cyst to be sent for further examination. Simultaneously with suction, small quantities of alcohol are introduced into the cavity freed from liquid, providing a disinfectant therapeutic effect.
Complications of endometrioid ovarian cyst. Prevention
Treatment without surgery is possible until the cystic formation perforates or the cyst ruptures. Ovarian cysts cause complications such as peritonitis and infertility. For peritonitis due to endometrioid ovarian cysts, treatment without surgery is impossible. If you are infertile, you may need to use assisted reproductive technologies.
The most difficult situation is when an endometrioid cyst is found in a pregnant woman. Treatment without surgery in this case should not be carried out, as well as surgery. The doctor has to limit himself to close monitoring of the pregnant woman. The ideal option is to get rid of the cyst at the stage of pregnancy planning.
The main method of preventing complications of endometrioid ovarian cysts is timely diagnosis of the disease, when treatment without surgery is still possible. You can also take immunostimulating drugs and vitamins. If such treatment is ineffective, surgery is performed.
Endometriosis requires a careful approach to diagnosis and treatment. Endometrioid cysts are the cause of infertility and many diseases of the reproductive system. Only timely detection of the disease allows treatment without surgery.
Start your path to happiness - right now!
Update: December 2018
An endometrioid ovarian cyst is one of the manifestations of endometriosis. Imagine that blood, parts of the inner lining of the uterus (endometrium) and clots that are normally released during menstruation begin to penetrate the wall of the uterus and then spread to the fallopian tubes and ovaries.
In addition to its abnormal location, this tissue (called endometrioid) continues to partially function. During the menstrual cycle, the same changes occur in it as in the normal uterus. The tissue also swells, grows and bleeds.
When endometrioid tissue reaches the ovaries, it penetrates its membrane and forms a capsule. As already mentioned, this tissue continues to function and blood accumulates in the capsule. The shell of the cyst is dense, and the contents are thick and resemble dark chocolate (the color of coagulated blood). Sometimes such cysts are called “chocolate” cysts.
The size of cysts can vary significantly.
What does this depend on? It has not yet been established, as well as the nature of endometriosis in general. Of course, the longer a cyst exists without treatment, the more its size will increase. But in some women the progression will be slow, while in others the growth of the cyst is very rapid and is combined with other symptoms of endometriosis (pain during intercourse and during menstruation, infertility and heavy menstrual bleeding).
Why are endometriotic ovarian cysts dangerous?
Among all pelvic formations (cysts, tumors), 10-14% are endometrioid ovarian cysts. The danger of these cysts is the development of infertility, frequent relapses of cysts after treatment, the development of massive adhesions in the pelvis and the formation of persistent pelvic pain. There is also a danger of cyst rupture due to their large size or sudden physical stress and injury.
Why do endometrioid ovarian cysts form?
The cause of endometriosis has not yet been identified. Obstetricians-gynecologists and endocrinologists, histologists, cytologists and pathologists are working on this. There is even a special association where the slogan is the phrase “When endometriosis is a sore point.”
What we managed to find out is the hormonal predisposition of some women to endometriosis and some other factors:
- a disorder with an excess of estrogens and a lack of progestins. Behind these terms lies the fact that the first phase of menstruation (up to the 15th day of the cycle) occurs with an excess of hormones, and the second phase (from the 15th day until menstruation) - with a deficiency.
- abortion surgically, that is, medical abortion. During an abortion, a sharp metal curette is used to scrape the inner wall of the uterus. During curettage, the layers of the uterine wall are damaged and cell migration may occur.
- heredity. If the mother or other close relatives suffered from manifestations of endometriosis, then this can be passed on genetically.
- chronic inflammatory diseases pelvic organs (PID). If there is presence in the tubes and/or ovaries chronic inflammation, then the tissues become more vulnerable and loose. Such tissue is always less resistant to damage, including the introduction of foreign cells.
- other dishormonal and metabolic diseases. As a rule, all hormonal systems are interconnected. Therefore, patients with diseases thyroid gland(especially with hypothyroidism, when thyroid function is reduced), cycle disorders and diabetes mellitus of any type are at risk.
Types of endometrioid cysts
In some sources, endometrioid cysts are divided according to the stages of the disease:
- Stage I – damage to one ovary, the size of the cysts is insignificant (up to 3 cm);
- Stage II – damage to one ovary, cyst sizes up to 5 – 6 cm;
- Stage III – damage to one or more often both ovaries, cyst sizes up to 5 – 6 cm, active formation adhesions in the pelvis and initial signs of damage to other organs (intestines, bladder, etc.);
- Stage IV – damage to both ovaries, the size of the cysts is large, more than 6 cm. Such cysts are already called cystomas. A cystoma is a large cyst, which at the initial stage of diagnosis is always suspicious of oncology.
But more often, everything is used purely clinical classification endometrioid cysts, which indicates which ovary is affected, the size of the cyst and complications. This helps not to be distracted from the main thing and formulate only the most important things in the diagnosis.
An example of a diagnosis:
- Common endometriosis. Endometrioid cyst of the left ovary. Cyst rupture. Internal bleeding. Hemorrhagic shock of the first degree.
- Common endometriosis. Large endometrioid cyst of the right ovary (5 cm). Secondary infertility.
As we can see, the presence of a cyst entails various consequences. Below we will talk about this in more detail.
Diagnostics
Clinical picture, that is, symptoms
The patient’s complaints, absence of pregnancies and analysis of the menstrual calendar allow us to suspect endometriosis and cysts as its manifestation.
Ultrasound examination (ultrasound)
Ultrasound is an accessible, safe and painless method for diagnosing a wide variety of diseases. In addition, this method allows you to get results immediately. Ultrasound reveals cysts of even very small sizes; the accuracy of detection depends on the level of resolution of the ultrasound machine, as well as on the experience of the doctor. Often we see descriptions of formations from 5-8 mm.
Ultrasound statistics show:
- unilateral cysts are detected in approximately 80% of patients;
- bilateral cysts in approximately 20%
- one cyst in the affected ovary occurs in the majority, this is approximately 80%
- two cysts in one ovary - 16%;
- three cysts in 2.5%;
- four cysts are very rare, up to approximately 0.5%.
Ultrasound features of endometrioid cysts:
- thick capsule (outer lining or wall of the cyst)
The wall of endometrioid cysts not only limits its contents, but also functions. Inner layer The shell of the cyst continues to “menstruate”, the contents accumulate, so the cyst grows.
- relatively small diameter of cysts, mostly cysts measuring up to 7-8 cm are found
- thick, “opaque” content for ultrasound. Ultrasound doctors call this “increased echogenicity.”
Due to the fact that the internal contents of cysts are very thick and dense, small cysts are sometimes mistaken for tumors.
- On ultrasound, the cyst wall sometimes has a double contour
- cysts are most often located on the side of the uterus or behind the uterus.
- endometrioid cysts are most often detected during childbearing age, when the menstrual cycle.
- cysts grow outward from the ovary
This means that the cyst does not “inflate” the ovary, but grows away from it. Therefore, with large cysts, the ovarian tissue seems to “spread out” and stretch over the surface of the cyst.
- often an adhesive process forms around the cyst
Magnetic resonance imaging (MRI) and computed tomography (CT)
This additional methods studies that can clarify the structure of the cyst, its adhesion to neighboring organs and other subtleties that may be needed to resolve the issue of further tactics treatment.
These methods are very expensive, and CT scan It also carries a significant radiation dose. CT is a method from the X-ray group, so it cannot be used during pregnancy.
Laparoscopy
Laparoscopy is an examination of the abdominal cavity from the inside using instruments (laparoscope and manipulators).
This is an operation that is performed under anesthesia. Are used spinal anesthesia or general anesthesia depending on the clinical situation. Holes are made in the anterior wall of the abdomen through which the devices are inserted. Air is pumped into the abdomen, the organs are slightly moved apart and the area of interest in the abdominal cavity can be examined.
Ideally diagnostic laparoscopy goes into treatment, which we will talk about below.
Depending on the symptoms and stage of the process, diagnosis can be carried out and completed at the ultrasound level or continue further.
If there are manifestations (pain, heavy irregular menstruation, etc.), on ultrasound we see small endometrioid cysts and endometriosis of the uterus, then it is logical to carry out drug treatment, evaluate the effect and carry out ultrasound monitoring.
If the patient does not become pregnant. severe abdominal pain before and during menstruation, then you may need more high-tech methods from points 3 and 4.
Symptoms
Pain syndrome
Pain occurs before and during menstruation, sometimes reaching an intensity that women describe as “unbearable” and “exhausting.”
The pain is most often nagging and aching in nature; pain in the lower abdomen and lower back is more common.
Less often, women notice the same pain in the middle of the cycle, approximately on days 14-16 of the menstrual cycle, that is, during the period of ovulation (the release of an egg from the ovary).
There may also be pain during sexual intercourse; they are usually localized on the side where the cyst has formed.
Menstrual irregularities
If the cyst deforms the ovary, is large and displaces normal ovarian tissue, then ovulation may not occur in this ovary. Then the cycle is broken.
Menstruation may be delayed and then come very heavily.
Infertility
The cysts themselves disrupt the maturation of eggs. In this case, it is necessary to take into account the causes of the development of endometriosis. One of the reasons is an excess of estrogens, female sex hormones, which predominate in the first phase of the cycle. If there is a lot of estrogens, and few gestagens (hormones of the second phase of the cycle), then the entire process of conception and implantation of the embryo in the uterus is disrupted.
Infertility in the case of cysts can be primary or secondary. Primary infertility is a condition where there has never been a pregnancy. Secondary - if there were pregnancies with any outcome (normal birth, premature birth, miscarriage or frozen pregnancy), and then the desired pregnancy does not occur for more than 1 year without contraception.
Nonspecific treatment
Non-specific treatment means that the treatment will not remove endometriosis and cysts from the body, but will help relieve symptoms (pain, heavy bleeding). NSAIDs (non-steroidal anti-inflammatory drugs):
- diclofenac,
- indomethacin,
- celecoxib,
- rofecoxib.
These drugs are used situationally, usually in the period before and during menstruation, if necessary in the middle of the cycle. You should be aware that uncontrolled use of these drugs is by no means harmless and can lead to serious liver damage.
Hormonal treatment
COCs (combined oral contraceptives)
COCs are used in women with endometriosis to reduce symptoms (pain, heavy bleeding) and recovery after surgery.
But contraceptives do not solve the problem of having cysts. It is impossible to “treat” exclusively with COCs, but they can be used in combination with other methods.
To date optimal mode COC intake is a continuous regimen after surgical treatment. Thus, the possibility of recurrence of endometrioid cysts is maximally suppressed.
Of the variety of combined estrogen-gestagen contraceptives for patients with endometriosis, those that contain the dienogest component are preferable: Janine (or its analogues Siluet and Bonade) or Qlaira (on this moment has no analogues).
Progestogens
These are drugs that are analogues female hormones, which predominate in the second phase of the menstrual cycle.
Typically, women with endometrioid cysts have excess estrogen. Progestogens “balance” this imbalance, and thus help suppress the growth of lesions and cysts.
There are progestogen preparations in tablets and injections, each type has its own disadvantages and advantages.
Drugs in tablets are easier to dose and stop if an allergy develops, but you have to take them every day, remember about it and control the intake at the same time.
Injections are easier to use; they are done once every few days or even once a month. But at the same time, if the drug is not suitable, then its effect cannot be taken and “cancelled”, because it has already been introduced and its formula is such that it will be absorbed slowly and gradually. One thing that can be said in favor of intramuscular drugs is that allergic reactions to them are still rare.
The following tablet drugs are used: dydrogesterone (Duphaston), norethisterone acetate (Norkolut), dienogest (Visanne), and much less commonly megestrol (Megais).
The following intramuscular drugs are used: medroxyprogesterone acetate (Depo-Provera or Medroxyprogesterone-Lance).
Duphaston is used from 1 to 3 tablets per day, dosage regimens and duration vary depending on the severity of the symptoms of the disease and other concomitant diseases.
Norkolut is used 1 tablet (5 mg) from days 5 to 25 of the cycle for up to 6 months, then readmission see a gynecologist to determine management tactics. It is categorically not recommended to prescribe the drug yourself, as you may not take into account many side effects and risk of thrombosis.
Megase is used extremely rarely, but still appears in clinical guidelines. Dosages and duration of administration are regulated exclusively by an obstetrician-gynecologist.
Visanne is currently the drug of choice or the first line of therapy. This is a hormonal drug of the gestagen group, which regulates a woman’s hormonal levels in such a way that it eliminates and balances excess estrogen. Namely, excess (absolute or relative) is a compelling reason for the development and further spread of endometriosis. And, as a result, the development of endometrioid ovarian cysts and adhesions in the pelvis.
Dienogest 2 mg (Visanne) is used continuously from any day of the cycle, 1 tablet per day. The duration of treatment is determined by the attending physician. As a rule, the initial intake cycle is 3 or 6 months. After the treatment period, ultrasound monitoring is indicated to evaluate the achieved effect. We want to see a decrease or disappearance of ovarian cysts and a decrease in the size of the uterus. Pure clinical control is also necessary. The patient's complaints must be assessed over time. You always need to know whether the pain (if any), heavy menstrual bleeding has disappeared and how much the amount of blood loss has decreased.
While taking the drug, menstruation changes its character; it may disappear completely in the second or third month of use, or may appear as scanty spotting without obvious cyclicity. This is not entirely convenient, but when the patient is accustomed to monthly five-seven-day (sometimes more) heavy bleeding, when the pad is changed once an hour or more often, the work activity and your well-being suffers, this is usually tolerated.
Also, while taking the drug, you need to be prepared for some unpleasant sensations. Symptoms of estrogen deficiency may appear, such as hot flashes to the face and body, episodes of sweating and rapid heartbeat, and dry mucous membranes. All these manifestations are temporary and will disappear after stopping use.
Depo-Provera (Medroxyprogesterone-Lance) is administered intramuscularly, your doctor will prescribe how and how many times a month to administer the drug. These drugs have significant side effect- breakthrough bleeding that does not coincide with the cycle, they are almost impossible to predict and cannot always be stopped quickly.
There is also an intrauterine therapeutic system with the hormone levonorgestrel. In everyday life, patients often call it a “spiral”.
But there is a fundamental difference between a regular copper IUD, which is intended only for contraception, and the intrauterine system.
The intrauterine therapeutic system (Mirena) releases a small dose of a hormone every day that acts on the inner wall of the uterus and suppresses the growth of endometriotic lesions and cysts.
As a rule, Mirena is installed after surgical treatment of cysts if the patient does not plan a pregnancy. Mirena has a significant drawback - its price, in different pharmacies it ranges from 10 to 15 thousand rubles. Not everyone can pay this amount at a time, but when calculated, the benefits are obvious, since Mirena is set for a minimum of 5 years.
Antigonadotropins
Danazol and gestrinone, which belong to this group of drugs, are currently rarely used due to the mass of side effects.
Gonadotropin-releasing hormone agonists
These are drugs that suppress the synthesis of your own hormones. They are quite difficult to tolerate, causing dry mucous membranes, hot flashes and other symptoms. which are similar to menopause. Drugs of this group (diferelin, buserelin) are not prescribed to adolescents and nulliparous women.
But in IVF schemes for women with endometriosis and after removal of endometrioid cysts, these drugs, in a short course and in combination with other drugs, are simply irreplaceable.
Should I delete or not? Surgical treatment
Question about surgical treatment endometrioid cysts are resolved taking into account clinical manifestations and a woman's reproductive plans. The same cysts in those who have given birth and in those who are planning a pregnancy are treated differently. Indications for surgical treatment of endometrioid cysts:
Endometrioid cysts and chronic pelvic pain
Chronic pelvic pain is always present. and in the middle of the cycle, before and during menstruation it intensifies. Sometimes painful sensations so pronounced. that the woman is unable to work. takes a large amount of painkillers, which in turn can increase bleeding and adversely affect the liver.
Infertility
In cases where cysts interfere with pregnancy, surgical treatment is indicated. If technical capabilities are available, laparoscopic surgery is recommended.
The extent of the operation is selected individually depending on the size of the cysts and the preservation of ovarian tissue.
In order for a woman to become pregnant in the future, we must preserve the maximum amount of ovarian tissue.
It is recommended to use different types modern technologies(laser knives, ultrasound), abdominal lavage. If possible, suturing the ovary with threads should be avoided; this interferes with blood flow and may impair the function of the remaining part of the ovary.
Compression of neighboring organs
Cysts can reach impressive sizes (8-12 cm or more). Of course, such “additions” in the abdominal cavity cannot but affect the functioning of other organs. Next to the uterus and ovaries are the bladder, rectum, and loops small intestine.
Depending on the direction in which the cyst grows (forward and backward), the functioning of one or another organ suffers. If the cyst/cysts grow backwards, they can put pressure on the rectum.
In this case, the process of defecation is disrupted, that is, difficulties when going to the toilet “in a big way.” You have to strain, make more effort, the toilet becomes less frequent, and the feces become harder due to stagnation. Due to constant straining, a crack may form anus or inflammation hemorrhoids(haemorrhoids).
People rarely associate problems with the toilet with gynecology, unless there are other complaints (menstrual irregularities or pain in the lower abdomen during menstruation). Therefore, patients often take laxatives for years, and then come to the gynecologist with cysts of impressive size.
If the cyst/cyst is located in the front, it can put pressure on the bladder. If the cyst is large, then the compression of the bladder is significant, its possible volume decreases. That is, for example, the average woman’s maximum bladder volume reaches 750 ml. And if a cyst puts pressure on the bladder, then its volume decreases, you can “endure” much less and you have to run to the toilet much more often.
Less often, patients are bothered by such a problem as stress urinary incontinence. Due to the small volume of the bladder, the tension in it becomes greater and with sudden movement (standing up, bending over), coughing, sneezing, small portions of urine are lost.
This greatly affects the quality of life; the patient has to constantly wear highly absorbent pads, time her movements around the city, and drink less fluid than she wants.
Also (less commonly), cysts can compress the loops of the small intestine, which descend into the small pelvis and cause pain and stool disturbances.
As we see, problems of adjacent organs sometimes come to the fore and significantly disrupt normal activity. Therefore, surgical treatment is indicated here.
Methods of surgical treatment
Laparoscopy
It is the “gold standard” in the surgical treatment of many gynecological and surgical diseases. Endometrioid ovarian cysts are among them.
The operation is performed under anesthesia. There will be general anesthesia or spinal anesthesia (an injection into the spine with pain relief in the lower part of the body while maintaining consciousness) - this is decided by the anesthesiologist before the operation.
For any type of anesthesia, the further surgical technique is carried out according to a specific algorithm. Incisions (punctures) of about 1 cm are made on the skin of the abdomen, usually three of them. Through these punctures, instruments are inserted into the abdominal cavity, with the help of which the operating doctor can examine the abdominal cavity and perform various actions.
A small amount of air is pumped into the abdominal cavity; this is necessary so that all organs straighten out and the area we are operating on is better visible. Also, after straightening the intestinal loops, it is better possible to examine the abdominal cavity and identify other foci of endometriosis.
It is rare for endometrioid cysts to exist on their own. More often, along with cysts, there are other manifestations, in this case we are talking about foci of endometriosis on the peritoneum.
If we find them during surgery, then we must ablate (cauterize) these lesions. This helps prevent the re-development of cysts.
Laparotomy access
Laparotomy is an operation with an incision in the abdominal wall. For endometrioid cysts, it is performed much less frequently. Open laparotomy may be chosen in women, taking into account individual characteristics. For example, if there have already been operations on the abdomen (not necessarily gynecological) and there is a risk of adhesions, then it is simply technically impossible to go through all the departments with a laparoscope. Either there was an unsuccessful laparoscopic operation, or if the doctor suspects a malignant degeneration of the cyst.
Related manipulations
During any of these operations, the following operational actions can be additionally carried out:
- ablation (cauterization) of endometriotic lesions on the peritoneum and intestines (more on this above)
- ablation of the uterosacral nerve (to reduce or completely eliminate pelvic pain)
- presacral neurectomy (removal of some nerves to relieve pelvic pain).
How to recover after surgery
The recovery period after surgery depends on the extent of surgery. After laparoscopic surgery, the sutures are removed on days 7-9, abdominal pain and suture healing go away quite quickly. By the time of discharge (the same 7-9 days), the patient usually feels quite well. After open surgery pain may persist longer, up to two to three weeks in decreasing order.
In order to recover after surgery and prepare for pregnancy, it is recommended to take a COC with dienogest or Visanne (see section on conservative treatment).
Traditional methods of treating endometrioid cysts
Unfortunately, neither herbs nor any “natural” remedies will help get rid of cysts and pain/heavy irregular periods. Therefore, you should not waste time on courses of questionable treatment. Sometimes a patient comes to the doctor with the process so advanced that there is very little hope of talking about pregnancy or regulation of the cycle.
What not to do if you have an endometrioid ovarian cyst
There are no specific restrictions for patients with endometrioid cysts. Only intensive ones are not recommended physical exercise and frequent thermal procedures(bath, sauna, hot baths), which can cause cyst rupture and/or bleeding.
Conclusion
In our article today, we tried to tell you in the most complete and accessible way about what endometrioid ovarian cysts are, what they threaten and how to treat them. We encourage you to promptly contact a gynecologist you trust and follow his recommendations. Take care of yourself and be healthy!
Endometriosis is a chronic, steadily progressive and genetically determined disease in which endometrial-like tissue grows outside the uterine cavity. The appearance of cysts on the ovaries is just one form of pathology. The disease is accompanied by menstrual irregularities and can lead to infertility. It is detected mainly at a young age and can spontaneously regress into menopause.
Treatment of endometrioid ovarian cysts involves the use of conservative and surgical methods. The choice of a specific product depends on the woman’s age, availability concomitant pathology and reproductive plans. Adequately selected therapy helps normalize the menstrual cycle, eliminate negative symptoms and preserve fertility.
Should endometriosis be treated?
An endometrioid ovarian cyst (endometrioma) is not a pathology whose course can be left to chance. Once established, the outbreak will grow steadily. The formation slowly increases in size, but theoretically it can reach almost any size - provided that nothing will restrain the progression of the disease.
Progression of endometriosis.
Refusal to treat endometrioma risks the development of the following complications:
- Increased pain syndrome. Pain with endometriosis is observed during menstruation, with intimacy. As the lesion grows, the pain becomes chronic, unrelated to the phases of the cycle;
- Progressive menstrual irregularities. There is an increase in the volume and duration of menstruation, the appearance bloody discharge before and after menstruation;
- Infertility. Endometrioma inhibits ovulation and triggers processes that prevent normal implantation of the fertilized egg;
- Compression of the pelvic organs. A large cyst puts pressure on the intestines and bladder, interfering with their full functioning;
- Development of life-threatening complications: rupture of the cyst capsule and torsion of its legs;
- Malignization. There is some possibility of developing malignant tumor. It is also known that endometriosis increases the risk of uterine carcinoma.
Adhesive process of the pelvic organs in endometriosis – common reason pain syndrome.
Since one of key reasons development of endometriosis is hyperestrogenism, observational tactics are allowed in the prevention menopause, but only if the following conditions are met:
- Endometrioma up to 3-4 cm in size without spreading to neighboring organs;
- There are no pronounced clinical symptoms;
- There are no life-threatening complications;
- The woman is not planning a pregnancy;
- Eat obvious signs the onset of menopause;
- There is no evidence for malignant degeneration of the cyst.
During menopause, endometrioma can spontaneously regress, but this does not always happen. If the formation does not decrease in size, surgical treatment is indicated.
It is important to know
The growth of an endometrioid cyst in postmenopause is a reason for urgent surgery. During this period, the likelihood of developing malignant tumors increases, and the suspicious lesion must be removed.
Progression of cyst growth into menopause is an indication for surgical treatment.
Surgical treatment of endometrioma
Indications for surgery:
- The size of the ovarian cyst is more than 4 cm;
- Development of complications leading to ovarian necrosis, peritonitis, sepsis;
- Dysfunction of the pelvic organs;
- Infertility due to endometriosis;
- Planning pregnancy, including through IVF;
- The presence of combined pathology of the uterus, leading to bleeding and chronic pain syndrome;
- Detection of endometrioid ovarian cysts during menopause and postmenopause;
- Suspicion of a malignant tumor or detection of ovarian cancer;
- Lack of effect from conservative therapy.
Routine removal of endometrioma is carried out after a complete examination:
- Consultation with a gynecologist and therapist;
- General clinical blood and urine tests;
- Ovarian cancer marker test;
- Screening for sexually transmitted infections;
- Ultrasound of the pelvic organs;
- Assessment of the condition of the cervix: oncocytology test, colposcopy.
Ultrasound of the pelvic organs allows you to assess the size of the cyst, its location and the presence of adhesions.
Women over 40 years of age are additionally prescribed:
- Examination of the uterus (endometrial aspiration biopsy or separate diagnostic curettage with histological examination);
- Assessment of the condition of the mammary glands (mammography);
- Intestinal examination (colonoscopy).
IN urgently surgery is performed when life-threatening complications develop. Only minimal preparation and testing directly in a gynecological hospital are indicated.
Surgical treatment options for ovarian endometriosis:
- Cystectomy. Enucleation of an ovarian cyst is performed using a traditional cutting instrument or a laser. After removing the formation, its bed is cauterized. Ovarian tissue is preserved. Fertility is restored after surgery;
- Wedge resection of the ovary. The formation is excised along with a small section of the organ. If the follicular reserve is preserved, the ovary can fully function after surgery; +Picture 6: Schematic representation of wedge resection of the ovary.
Schematic representation of wedge resection of the ovary.
- Ovariectomy. The entire ovary is removed along with the cyst. If the collateral organ is preserved, it takes over all functions. When both ovaries are removed, artificial menopause occurs.
The choice of treatment method depends on various factors:
- Woman's age. During postmenopause, the entire ovary is removed. The organ no longer functions, and it is impossible to leave a potential source of a malignant tumor;
- Cyst size. The larger the formation, the less functional ovarian tissue remains, and the worse the prognosis;
- Duration of the disease. Over time, the cyst displaces normal ovarian tissue, and it becomes just a capsule for the tumor;
- Concomitant pathology. IN individual situations removal of not only the ovary, but also the uterus is indicated.
Laparoscopic surgery is considered the gold standard for the treatment of ovarian cysts. This is a minimally invasive intervention during which the doctor performs all manipulations through small incisions in the abdominal wall. After the operation, subtle scars remain on the skin. Recovery after laparoscopy takes no more than 4 weeks (in the absence of complications). Endoscopic intervention is the method of choice for young women, including those planning pregnancy.
Laparoscopic removal of endometrioma.
On a note
As a temporary measure of relief, puncture of the ovarian cyst can be performed. When puncturing, fluid is pumped out of the cavity, the walls collapse, and the formation decreases. This tactic is also applicable when removing a large cyst.
Abdominal surgery (laparotomy) is performed in situations where the problem cannot be solved laparoscopically or the clinic does not have equipment and specialists. Laparotomy is also indicated for severe adhesions. During the operation, the doctor makes a longitudinal incision in the lower abdomen. Recovery takes 2-3 months, the frequency of complications increases.
Negative consequences of surgical treatment:
- Bleeding. Occurs when tissue is injured during surgery or when a cyst ruptures;
- Infection. Observed against the background of untreated inflammation of the appendages and uterus;
- Inflammation and suture dehiscence. Occurs when the rules for treating a postoperative wound are violated, or due to excessive physical activity;
- Intestinal dysfunction. Constipation is considered a natural consequence of surgery and can persist for up to 3-7 days after surgery;
- Adhesive process. It is noted mainly after abdominal surgery as a result of tissue trauma. May lead to infertility, ectopic pregnancy;
- Decreased ovarian reserve. Occurs when the ovarian stroma is damaged during surgery. A decrease in the number of follicles leads to infertility and early menopause;
- Menstrual irregularities. The failure lasts from 2 months to six months and is characterized by delayed menstruation and irregular bleeding.
Schematic representation of the adhesive process of the pelvic organs.
- Follow a diet: limit consumption of spicy, fried, fatty foods, increase the proportion of fiber in the diet;
- Limit physical activity: do not play sports, do not lift weights;
- Maintain sexual rest;
- Refuse thermal procedures, including hot showers and baths, saunas, solariums;
- Observe the rules of personal hygiene;
- Use medications prescribed by your doctor to restore your body. After surgery, hormones, antibiotics, immunomodulators, and enzymes (Longidase) may be recommended to resolve adhesions.
After removal of the ovarian cyst, observation by a local gynecologist is indicated. After 1, 3 and 6 months, an ultrasound examination is prescribed. If no complications are identified, it is usually allowed to plan a pregnancy 3-6 months after laparoscopy and 6-12 months after abdominal surgery.
This is what an endometrioid ovarian cyst looks like on ultrasound.
The cost of laparoscopic treatment of an endometrioid ovarian cyst in Moscow is 40-75 thousand rubles. The final price depends on the volume of the operation, length of stay in the clinic and other factors. IN government institutions in the presence of compulsory medical insurance policy and technical feasibility, cyst removal is carried out free of charge for the patient.
Drug therapy for endometrioid ovarian cysts
Treatment of endometrioma without surgery is possible under the following conditions:
- The size of the lesion is no more than 4 cm;
- Absence of severe symptoms that significantly disrupt the course of life (chronic pelvic pain, uterine bleeding);
- There are no complications associated with cyst growth;
- There are no signs of malignancy;
- Reproductive age (before menopause).
Hormonal drugs
Endometrioid ovarian cysts can be cured with the following medications:
- Gonadotropin-releasing hormone agonists (Diferelin, Buserelin, Lucrin, etc.). Drugs from this group put a woman into a state of artificial menopause. Menstruation stops, hot flashes and other signs of menopause are noted. The course of treatment lasts 3-6 months and is carried out under the guise of estrogen-containing drugs (add-back therapy). While taking GnRH agonists, there is a decrease in the size of the cyst to 50-70% or its complete regression;
- Combined oral contraceptives. Products based on strong gestagens are used (Janine, Marvelon, Regulon, Silhouette, etc.). The course of treatment lasts from 3 months, can be continued long time in the event that a woman is not planning a pregnancy. Therapy regimen: 21+7 or continuously for 3 months. While taking COCs, the lesions decrease in size and the appearance of new cysts is prevented;
COCs allow you to influence hormonal levels and regulate the menstrual cycle, thereby reducing the size of endometriosis lesions.
- Gestagens. Preparations based on progesterone (Duphaston, Utrozhestan) or other gestagens (Visanne, Norkolut) are prescribed in a course of 3-6 months from the 5th to the 25th day of the cycle or continuously. Drugs from this group reduce the production of estrogen and help reduce the size of the cyst;
- Progesterone receptor modulators (Esmiya). This drug affects not only endometriosis, but also uterine fibroids. Used daily for 3 months;
- Intrauterine hormonal system (Mirena). The IUD reduces tissue proliferation and helps reduce endometriosis lesions. Injected into the uterine cavity for 5 years. With the use of Mirena, the volume of menstruation decreases, pain goes away and improves general state women.
Hormonal therapy is also prescribed after removal of an ovarian cyst. You should take hormones for at least 3 months. If a woman is not planning a pregnancy, it is recommended to take COCs for a long time.
Non-hormonal drugs
The following drugs are used in the treatment of endometrioma:
- Non-steroidal anti-inflammatory drugs in tablets. NSAIDs relieve pain and are prescribed during menstruation for 5-7 days;
- Local anti-inflammatory drugs (ichthyol, indomethacin suppositories, etc.). They are used in the form of suppositories for rectal and vaginal administration. Helps eliminate pain;
- Antispasmodics (papaverine, drotaverine). Prescribed as an alternative to NSAIDs for painful menstruation;
- Vitamins. They are used taking into account the age and needs of the body. Helps strengthen the immune system and increase vitality.
Can be used as symptomatic therapy for endometrioma of the right and left ovary. homeopathic medicines. Official medicine does not always recognize their effectiveness, therefore such drugs are allowed only as an addition to the main methods of treatment.
Non-drug methods in the treatment of endometrioid ovarian cysts
To date, there is no effective evidence that non-drug treatment will help get rid of endometrioma. And numerous reviews from women practicing various gymnastics, diets, acupuncture and osteopathy techniques are very doubtful. As practice shows, such remedies only help eliminate the symptoms of the disease, but do not affect the growth of the cyst. After some time, the disease returns, and the woman’s condition worsens.
It is important to know
Refusal of traditional treatment options for endometriosis threatens the progression of the disease and the development of complications.
Practicing following methods non-drug therapy:
- Diet. Nutrition for endometrioma should be varied, balanced in the main components and vitamins. Limit the consumption of foods that enhance estrogen production (easily digestible carbohydrates, animal fats);
- Physiotherapy. It is assumed that yoga and some other techniques help normalize hormonal levels and eliminate foci of endometriosis. It is important to remember that excessive exercise can lead to torsion or rupture of the cyst;
- Acupuncture. Impact on certain points reduces pain and improves general condition. Acupressure has the same effect;
Non-traditional treatment methods (including acupuncture) are aimed only at general strengthening of the body.
- Physiotherapy. Electrophoresis with the introduction of vitamins B1 and E, magnesium, as well as magnetic therapy and ultrasound help eliminate pain during menstruation;
- Hirudotherapy. Treatment with leeches eliminates blood stagnation in the pelvic organs and reduces pain.
Non-drug therapy methods alleviate the course of the disease, eliminate unpleasant symptoms and improve quality of life. They cannot be used as the main treatment because they do not affect the ovarian cyst. It is permissible to use such techniques in combination with drug and surgical treatment.
On a note
If ovarian endometriosis is detected during pregnancy, observational tactics are indicated. Hormonal drugs are not prescribed, physiotherapy is used with caution. Surgical treatment is indicated for the development of complications that threaten the life of the woman and fetus.
Folk remedies and assessment of their effectiveness in ovarian pathology
Non-surgical treatment of ovarian cysts also involves the use of various recipes alternative medicine. Herbal medicine is very popular. Herbal decoctions and infusions are prepared at home. The main ingredients are traditional “female” herbs - boron uterus and red brush. The composition is complemented by yarrow, burdock root, St. John's wort, clover, and acacia flowers. Treatment is expected to be long-term – from one month to six months with breaks.
Facilities traditional medicine are used not only internally. Suppositories and tampons are prepared based on herbal ingredients and honey for insertion into the vagina. Douching is also practiced. It is assumed that this route of administration accelerates the delivery of beneficial substances to the tumor and alleviates the course of the disease.
It is important to know: traditional methods are ineffective in the treatment of ovarian endometriosis. At best, they can somewhat reduce pain and remove other symptoms of pathology. These drugs do not have a direct effect on the growth of the cyst. Following the tenets of alternative medicine threatens the progression of the disease and the development of complications. There is no need to waste time trying to cure a cyst with various herbs. The only way to get rid of endometrioma is surgery.
Traditional methods of treatment cannot be the basis of therapy, but in consultation with a doctor they can be used as an additional remedy.
Prevention of disease relapse: is there a chance?
Endometrioid ovarian cysts are prone to recurrence. To date, there is not a single method of conservative therapy that can guarantee to get rid of the problem. Hormonal drugs only suppress the growth of the lesion, but do not remove it completely. 6-18 months after discontinuation medicine re-growth of endometrioma is observed.
Surgical treatment also does not guarantee a 100% result. Often cysts grow back 1-2 years after cystectomy or resection of the ovary. The appearance of tumors can be definitely prevented only by removing the organ. But even in this case, the development of new lesions in the fallopian tubes, peritoneum, uterus and vagina is possible.
Because get rid of chronic pathology It’s not possible once and for all; it’s important to at least gain time. If a woman is planning a pregnancy, she should not postpone this event until long years. Conceiving a child is possible immediately after withdrawal hormonal drugs and 3-6 months after laparoscopic surgery. There is no more than a year in stock. After 12-18 months, the disease may return and a second course of therapy will be required.
If a woman is not planning a pregnancy, long-term use of combined oral contraceptives. While taking COCs, the endometrioma does not grow and new lesions do not form. After stopping the contraceptive, it is possible to conceive a child within the next year.
Useful video about endometrioid cyst and methods of its treatment
Surgical treatment of endometriotic cyst
When a cyst measuring 3 cm is discovered, how should you feel about it, should you be very upset or not very upset? Is it big or small, does it need to be operated on? The answers to these questions depend not only on the diameter of the bubble. Equally important are:
- location;
- origin;
- presence of complications.
A size of 3 cm in the absence of complications for any types of neoplasms is not considered critical and requires urgent surgical intervention. Observation with regular ultrasound monitoring should be mandatory under such parameters. Treatment depends on the characteristics of the clinical case.
Ovarian cyst 30 mm – what are the prognosis?
Several types of functional and pathological cysts can form in the female glands. A small structure up to 2 cm is not always detected. But even if an experienced ultrasound specialist has spotted such a spot, it is only observed or treated conservatively. As a rule, cysts up to 20 mm do not manifest themselves in any way.
Cysts of the right ovary are more common than those of the left. This is due to the fact that the right gland has a more active blood supply, since the abdominal artery runs nearby. This applies to all types of neoplasms, especially pronounced in dermoid cysts and corpus luteum.
The diameter of the neoplasm is 2-3 cm and requires more attention. The limit beyond which it makes sense to talk about removal is considered to be 25 mm. This applies more to pathological cysts rather than functional ones. Pathological ones are:
- endometrioid,
- paraovarian,
- dermoid
They don't disappear on their own. Their share in the total number clinical cases about 10%.
The main differences between functional cysts, luteal and follicular, are that they:
- with a size of up to 3 cm, sometimes up to 6 or more, they can resolve on their own;
- usually respond well to hormonal treatment.
The diameter of the neoplasm from 3 cm to 5 cm is an indication for observation, and sometimes for complex hormonal therapy. Surgery only in case of complications.
| Type of cyst | Origin | Dimensions |
|---|---|---|
| Follicular – 70% of all clinical cases | From a follicle that did not burst during ovulation | From 2.5 to 10 cm, on average 6-8 cm. Can resolve in 1-2 months. Observe up to 8 cm, if there are no complications. For larger diameters, surgery is indicated. It is also recommended to remove it at 5-8 cm, if treatment for 3 months has not led to a decrease. |
| Corpus luteum (luteal) – 5% | Formed at the site of a ruptured follicle from the corpus luteum of pregnancy | It happens 2.5-8 cm, often 3 cm, rarely up to 10 cm. Up to 6 cm is usually not operated on - it can resolve itself in 1-3 cycles. |
| Dermoid – about 20% | Embryonic development disorder involving skin structures | Up to 15 cm. Forms a long stem that can easily twist. It must be removed by resection or along with the entire ovary. |
| Paraovarian | In the epididymis | They are detected at a size of 2.5 cm. It is often 3 cm and grows to 12-20 cm. There may be torsion. Removed after detection, usually with a diameter of 5 cm. |
| Endometrioid | From migrated uterine mucosa | At 2-3 cm just observe. Usual sizes are 4-20 cm. Needs to be removed. It is better to do this before the bubble has grown to 10 cm; more often it is done at 6-7 cm. |
Mandatory treatment is required, regardless of size, for ovarian cysts that cause the following symptoms:
- painful, irregular menstruation;
- feeling of squeezing in the lower abdomen;
- noticeable deformation;
- increased body hair growth;
- increased weakness and fatigue;
- urinary disorders;
- soreness of the mammary glands.
If the girl is thin, then a superficial tumor measuring 30 mm may already be noticeable upon visual examination. For such a bubble size, complications that can occur in structures over 40 mm are unlikely - torsion of the pedicle, rupture, suppuration, degeneration. Although in rare cases, with a size of 3 cm this is also possible. Therefore, if signs of an acute abdomen appear:
- severe pain in the ovarian area;
- vomiting and nausea;
- hard, tense abdominal muscles;
- temperature;
- pulse above 90 beats for a minute,
need to be called emergency assistance. Perhaps strong tension or sudden movement caused a rupture or torsion, and this is dangerous due to internal bleeding and peritonitis.
How does a 3 cm ovarian tumor affect pregnancy?
Is it possible to get pregnant with a 3 cm ovarian cyst? Follicular and endometrioid cysts make fertilization difficult. Since the former arise due to hormonal disorders, the latter – as a manifestation of endometriosis. Cysts of the corpus luteum can also accompany infertility. All of these neoplasms are hormone-dependent, and with successful hormonal treatment, pregnancy is possible.
If the size of the endometrioid cyst is 2-3 cm, if the hormonal levels are not very disturbed, even an IVF procedure is acceptable.
Dermoid and paraovarian cysts do not prevent pregnancy; they make it very difficult and may even lead to the need for termination. Therefore, when planning a child, it is better to remove them in advance.
3 cm breast cyst - big or not?
From 20 to 30 mm is the usual size of a breast tumor. With such a diameter and a short duration of the pathology, it is not always possible to detect a bubble by self-examination, because its capsule is soft and thin. Such a structure can grow up to 10 cm, and then it is much easier to detect, since it is not only easily palpated, but also visible when viewed in the mirror.
Breast cysts up to 1.5 cm in size, sometimes up to 2.5 cm, can be eliminated with the help of hormonal therapy. With a diameter of 30 mm this is unlikely. Sectoral resection, that is, removal of part of the breast, is indicated only in cases where:
- multilocular cyst;
- there is suppuration;
- a biopsy showed the presence of degenerated cells;
- with polycystic disease.
If there are no complicating factors and the contents are only liquid, without solid particles, with a breast cyst size of 3 cm, you can get by with a puncture - suctioning out the contents and subsequent gluing of the walls, that is, sclerotization. This does not disrupt the function of the gland and will not interfere breastfeeding if the woman later gives birth to a child.
New growth 3 cm in size in the kidney
Kidney cysts without significant complications are removed from 5 cm, always when they grow to 10 cm. At 30 mm in diameter, surgery is rarely recommended, but treatment is necessary to avoid the growth of a cystic structure.
If the contents are not purulent, it can be removed by puncture. But in 80% of cases, the growth of the emptied vesicle resumes if sclerotization is not done - washing the cavity with alcohol mixed with an antibiotic or antiseptic.
For a cyst of any location and origin, a size of 3 cm is not critical, requiring urgent surgical intervention. But this size is not so small that it can be neglected. Definitely, a 30 mm cyst cannot be left without observation; in most cases, conservative treatment should be started.
Elective surgeries of this size are a controversial issue. Doctors can tempt you to them unnecessarily, with their own selfish intentions, if these are expensive paid surgical procedures. Therefore, there is no need to rush, it is better to find out the opinion of as many specialists as possible before making a meaningful and informed decision about surgical intervention or refusal.
