Andrea D. Olanescu, MD: Obstetrics

5 Causes of Abnormal Bleeding: Andrea D. Olanescu, MD: Obstetrics

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Every woman is used to the normal cycle of menstruation. But when bleeding occurs between periods or when menstrual bleeding is unusually heavy or even unusually light, it can be concerning. At Medical Care for Women in Astoria, New York, Andrea D. Olanescu, MD, uses advanced techniques to identify the cause of abnormal bleeding, providing customized care solutions tailored to each woman’s unique needs.

Common causes of abnormal bleeding

It’s estimated that abnormal bleeding affects up to 35% of women worldwide. Many women may worry that cancer is the cause of their abnormal bleeding. But while cancer can cause unusual bleeding or bleeding between periods, other conditions are far more common and much more likely to be the cause.

Uterine fibroids

Fibroids are benign (non-cancerous) tissue growths that form inside the uterus, on the outside wall of the uterus, or even within the uterine wall. Fibroids occur during childbearing years, often shrinking during perimenopause and menopause. While they can be a common source of abnormal bleeding, cramps, and other symptoms, they almost never develop into cancer. 

Ovarian cysts

An ovarian cyst is a fluid-filled sac that forms on or in the ovary. Cysts are fairly common, and in many cases, they cause no symptoms and go away on their own. But sometimes, cysts can cause heavy periods or bleeding between periods. Cysts tend to be more common during periods of hormonal changes, like during puberty or right before menopause.

Hormonal fluctuations

Your menstrual cycle is regulated by your hormones, so it makes sense that if your hormone levels are fluctuating, it can have a direct effect on uterine bleeding. Many women experience abnormal bleeding during the months and years leading up to menopause as a result of declining levels of estrogen. Polycystic ovarian syndrome (PCOS) is another hormone-related cause of abnormal uterine bleeding.

Endometriosis

Endometriosis is a condition in which the tissue that normally lines your uterus (the endometrium) grows elsewhere — most commonly on the outer wall of the uterus, on your ovaries, or even on your bowel. In addition to abnormal uterine bleeding, endometriosis can cause significant pain, especially during your periods. As many as 10% of women suffer from endometriosis.

Birth control methods

Many types of birth control methods use hormones to help prevent pregnancy, and any of these methods can cause abnormal bleeding. That includes birth control pills, patches, implants, and shots, along with intrauterine devices (IUDs). Abnormal bleeding is more common when you begin a new type of birth control, while your body adjusts to the change in hormones.

Don’t ignore abnormal bleeding

Even though abnormal uterine bleeding can have lots of benign causes, that doesn’t mean it shouldn’t be evaluated. Abnormal bleeding can be associated with other potentially serious issues, and in any case, evaluation can help you take steps to control abnormal bleeding so it doesn’t interfere with your life.

If you’re having unusually heavy periods, bleeding between periods, very light periods, or you’re skipping periods, Dr. Olanescu can help you learn the cause and how to treat it. Call our office or use our online form today to schedule an appointment.

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3 Telltale Signs of Problematic Ovarian Cysts: Associates in Obstetrics & Gynecology: OB-GYNs

Most women develop ovarian cysts as a normal part of ovulation without even knowing it, and the cysts typically resolve on their own. For 8% of premenopausal women, however, ovarian cysts can present problems and require medical intervention.

At Associates in Obstetrics & Gynecology, our team of gynecologic experts offers expert treatment of problematic ovarian cysts, helping our patients avoid larger issues down the road.

Here’s a look at ovarian cysts and three telltale signs that they might be cause for concern.

A closer look at ovarian cysts

To better understand what we’re dealing with when it comes to ovarian cysts, let’s take a closer look at these mostly benign growths and how they form.

The two most common types of ovarian cysts are follicle cysts and corpus luteum cysts.

Follicle cysts

The primary role of your ovaries is to release an egg each month, which is what creates your menstrual cycle. The egg first develops inside a follicle, and when the egg matures, the follicle breaks open and releases it for fertilization. 

If your follicle fails to release the egg, a cyst can form as your follicle continues to grow. In most cases, these types of cysts resolve themselves within a month or two, and you’re largely unaware that there was a problem in the first place.

Corpus luteum cysts

Under normal circumstances, after the follicle releases the egg, the remaining pieces of the follicle form a group of cells called the corpus luteum, which releases hormones to prepare for the next cycle. If your follicle reseals itself, however, fluid can build inside, creating a cyst.

Here again, in most cases these types of cysts go away on their own, and you’re none the wiser. In a small number of cases, the cyst can continue to grow, which can lead to symptoms.

Telltale signs your cyst may be problematic

As we mentioned, most cysts don’t cause any symptoms, so when they do, it’s a sign that we need to take a closer look. 

The three most common signs of a problematic cyst include:

1. Pain and discomfort

Any time you develop pain in your pelvic region (outside of menstrual cramping), it’s a clear warning that something isn’t right. In cases where your ovarian cyst continues to grow, it can lead to pain, which can present itself as a dull ache or only come on during certain activities, such as sexual intercourse. 

The pain may also present itself in your lower back or upper thighs as a dull ache. Sometimes the cyst doesn’t quite lead to pain, but does cause a feeling of pressure or fullness in your lower abdomen.

2. Irregular urination

If your cyst grows to the point where it presses against your bladder, you may experience frequent urination or the inability to urinate properly.

3. Menstrual issues

If you experience irregular periods, including heavy bleeding, painful periods, or even a lack of menstruation, it may be a sign of problematic cysts. Any time you have issues with your periods, we typically investigate several areas, including whether ovarian cysts are present.

In rare cases, a woman may experience a sudden onset of pain, alongside nausea and vomiting, which is a sign that a cyst may have ruptured or twisted. If you develop any of these symptoms, we urge you to seek medical help right away.

The best way to find out whether cysts are at the root of your problems is to contact our office in Colorado Springs, Colorado, to set up an appointment.

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Rupture of an ovarian cyst (apoplexy) – symptoms, treatment, consequences, causes, diagnosis

Rupture of an ovarian cyst (apoplexy) is a hemorrhage in the ovary, which can lead to rupture of the ovary and cause internal bleeding. Ovarian apoplexy is an acute, often life-threatening condition that requires immediate medical attention.

This article is not to be used for diagnosis, treatment, and is not a substitute for seeing a doctor.

Ovarian cyst is a benign cavitary formation that tends to grow, inside which contains fluid.

Very often, ovarian cysts are asymptomatic, but may manifest as pain, discomfort in the lower abdomen, irregular menstrual cycle, urinary disorders. A cyst is a widespread disease that is more often diagnosed in women of reproductive age. Approximately every second patient with an ovarian cyst has a menstrual irregularity. The most common complications of cysts include pedicle torsion and rupture. Rupture of an ovarian cyst (ovarian apoplexy) is a pathological condition characterized by rupture of the cyst membranes and hemorrhage into the pelvic cavity. This is a serious complication requiring immediate surgical intervention. According to statistics, pathology is observed in 1–2.5% of patients.

Most often, the gap occurs in the middle or in the second phase of the menstrual cycle.

Development of the follicle during the cycle

Causes and mechanism of ovarian apoplexy

Causes of ovarian cysts may be different:

• disruption of the endocrine system, abnormalities in the functions of the thyroid gland or adrenal glands;
• unstable hormonal background, menstrual irregularities;
• infections or inflammations in the ovaries and fallopian tubes;
• abortion or surgery in the genital area;
• side effects from certain medications;
• genetic predisposition.

The main causes of ovarian cyst rupture are:

• excessive increase in intra-abdominal pressure;
• pathological changes in blood vessels in the ovaries, and, as a result, impaired blood flow;
• abdominal injuries;
• inflammatory processes of the ovaries;
• hormonal imbalance;
• uncontrolled intake of anticoagulants – drugs that thin the blood.

In some situations, a gap occurs in the midst of full health, and even a detailed examination does not allow to establish the true cause of the disease.

Symptoms of a ruptured ovarian cyst

• Severe pain in the abdomen, usually in the lower abdomen, usually pain from the affected ovary.
• Weakness, dizziness, chills.
• Nausea.
• Pale skin.
• Fainting.

All of these symptoms are related to internal bleeding and should be reported to a doctor.

Typically, a ruptured ovarian cyst is diagnosed by emergency physicians. Unfortunately, at this level, it is extremely difficult to distinguish a rupture from other acute surgical pathologies. The rupture of the right cyst very often resembles an attack of acute appendicitis, while the left cyst imitates perforation of a stomach ulcer, so most patients initially end up in the surgical department. Only in 5% of cases, doctors manage to make an accurate diagnosis.

The main signs of a ruptured ovarian cyst capsule are abdominal pain and signs of internal bleeding. The severity of the clinical picture depends on the size of the cyst and the intensity of bleeding. Pain when a cyst ruptures appears acutely, suddenly, against the background of complete well-being. Some patients compare it to being stabbed with a knife. The onset of the disease is often accompanied by a short-term loss of consciousness, after which the woman quickly recovers. Pain in the cyst is localized in the suprapubic or one of the iliac regions. There is irradiation to the lower back, labia, rectum. May be accompanied by nausea, vomiting, tachycardia, which occur due to irritation of the peritoneal receptors.

Symptoms of anemia indicate internal bleeding. At break, the woman becomes pale, complains of dizziness, weakness, dry mouth. Arterial pressure decreases, urine production decreases (due to poor renal blood flow), saphenous veins become empty. If the cyst was small, then it is the symptoms of internal blood loss that come to the fore. During a gynecological examination, the doctor notes soreness on the side where the rupture of the ovarian cyst occurred. There may be a slight discharge from the vagina of a bloody nature. With severe bleeding and accumulation of a sufficient amount of blood in the small pelvis, the walls of the vagina hang, which is clearly visible during an objective examination. The damaged ovary is enlarged, painful on palpation. The displacement of the cervix leads to an increase in pain.

According to the severity of symptoms, there are three degrees of severity of pathology:

• mild;
• medium;
• heavy.

With a mild rupture, the patient loses no more than 150 ml of blood, the average – up to half a liter. The severe course of the disease is indicated by a large amount of blood in the pelvis and abdominal cavity – more than half a liter.

Depending on which symptoms prevail, cyst rupture is divided into three forms:

• Painful — blood accumulates under the shell of a ruptured cystic formation. In such a situation, a blood clot quickly forms at the site of injury, which prevents further blood flow. The accumulation of fluid leads to irritation of pain receptors and the development of an intense pain syndrome.
• Anemic – there is severe bleeding into the abdominal cavity. Signs of blood loss come to the fore – dizziness, weakness, flickering of “flies” before the eyes, pallor of the skin and mucous membranes.
• Mixed – there is both pain and signs of anemia.

Diagnostics

Diagnosis of ovarian cyst rupture is based on the following algorithm:

• collection of complaints and study of anamnesis;
• gynecological analysis;
• additional examination.

Of the additional examination methods for suspected ovarian cyst apoplexy, the following are used:

• complete blood count;
• urinalysis;
• hCG blood test;
• biochemical blood screening;
• ultrasound;
• puncture of the posterior vaginal fornix;
• diagnostic laparoscopy.

Diagnosis of cyst rupture

In the general analysis of blood with a cyst, a decrease in the level of hemoglobin and hematocrit is noted. In the general analysis of urine, the level of protein increases, the appearance of red blood cells is possible. A blood test for chorionic gonadotropin makes it possible to exclude ectopic pregnancy and rupture of the fallopian tube – a pathological condition, according to the clinical picture, it is extremely similar to a ruptured ovarian cyst. Biochemical screening indicates damage to kidney function.

Ultrasound helps the doctor to see the accumulation of fluid in the pelvis. Also, the doctor will notice that one of the ovaries is enlarged, this will make it possible to suspect a cyst. In order for OMT ultrasound to provide more information, it is recommended to perform it transvaginally. In this case, the gynecologist can much better assess the condition of the female genital organs, in particular, the damaged ovary.

Puncture of the posterior fornix is ​​a minimally invasive procedure that is necessary to examine the contents of the pelvic cavity. The procedure is performed in a manipulation room, with strict observance of the rules of asepsis and antisepsis. In emergency cases, the puncture is performed without prior preparation. If necessary, a woman should empty her bladder and rectum. Since the procedure is quite painful, it is performed under local anesthesia or general anesthesia.

The patient is placed in a gynecological chair, and the external genitalia is treated with an antiseptic solution. The cervix is ​​displaced towards the pubis, and the posterior fornix of the vagina is stretched. Then the gynecologist makes a puncture and aspirates the contents of the pelvic cavity with a syringe. The resulting fluid is sent to a laboratory for analysis. As a rule, the doctor manages to get blood, which confirms the fact of internal bleeding. However, with a pronounced adhesive process in the small pelvis, provided that adhesions prevent free blood flow, the procedure may not be informative.

Diagnostic laparoscopy is an endoscopic examination that allows you to directly examine the organs of the small pelvis and abdominal cavity and see a ruptured cyst. Instruments are inserted into the body through small punctures in the anterior abdominal wall, after which the abdominal cavity is filled with a special gas, and the doctor proceeds to the examination. With the help of magnifying optics, a gynecologist can examine the uterus, fallopian tubes and ovaries in detail, evaluate the contents of the pelvic cavity and draw final conclusions about the woman’s health. Manipulation is carried out only under general anesthesia.

Is conservative treatment possible?

Depending on the form and severity of ovarian cyst rupture, treatment can be conservative or surgical. Conservative treatment is recommended only for mild disease severity. In such cases, the cyst is slightly damaged, and a rapidly formed thrombus prevents intensive bleeding. Therapy consists in taking antispasmodics, anti-inflammatory, analgesic and hemostatic agents. For the period of treatment, a woman is recommended strict bed rest. The duration of the course is until the complaints disappear. To prevent the negative consequences that pathology may entail, the course is supplemented with physiotherapy treatment.

Surgical treatment

Surgery is the main treatment for ruptured ovarian cysts. Laparoscopy minimizes the chance of adhesion formation. If symptoms appear, we recommend that you immediately seek qualified help, as any delay can lead to blood loss and serious consequences.

Currently, gynecologists perform the following types of surgical interventions in case of cyst rupture:

• unilateral oophorectomy – removal of the affected ovary;
• resection of the ovary – excision of the area of ​​the damaged organ while maintaining its function;
• tubovariectomy – removal of the uterine appendage.

Operations are performed laparoscopically or laparotomically. In the first case, all manipulations are performed through small punctures in the lower part of the anterior abdominal wall, using special tools. The laparotomy method involves making a large incision in the lower abdomen, along the midline.

The main advantages of minimally invasive surgery include:

• low traumatism;
• lower drug load;
• quick recovery.

Despite this, the final decision regarding the method of surgical treatment is made by the attending physician, taking into account all the individual characteristics of the patient.

Laparoscopy

Sequelae of ovarian cyst rupture

The most common consequence of ovarian cyst rupture is peritonitis, an acute inflammation of the peritoneum. In the early stages of development it is limited, in the later stages it is spilled. It manifests itself with all the symptoms of an “acute” abdomen.

It is hemorrhagic in nature.

• Sepsis – develops due to the addition of a bacterial infection. When a cyst ruptures, it is extremely rare.
• Intestinal obstruction. Depending on the period at which the complication appeared, it can be early and late. To prevent it, it is recommended to undergo several courses of physiotherapy during the first two years after the break.
• Adhesive disease – is the result of insufficient sanitation of the pelvic cavity when a cyst ruptures. May cause infertility.
• Severe anemia – occurs due to heavy bleeding.
• Disruptions in the menstrual cycle, painful periods as a result of hormonal imbalance that occurs with a cyst.

Accurate diagnosis, treatment is the main way to prevent undesirable consequences of ovarian cyst rupture.

***

References

1. Adamyan, L.V. Laparoscopy for ovarian and abdominal cysts in girls: a guide for doctors / L.V. Adamyan. – M.: GEOTAR-Media, 2018. – 481 p.
2. Ovarian apoplexy and rupture of ovarian cysts / A.S. Gasparov and others – M.: Medical Information Agency, 2015. – 176 p.
3. Gasparov, A.S. Ovarian apoplexy and ruptured ovarian cysts. Monograph / A.S. Gasparov. – M.: Medical Information Agency (MIA), 2018. – 570 p.
4. Borovkova, L. V. Diagnosis of ovarian tumors. Textbook / L.V. Borovkova, D.V. Pershin, L.P. Zagryadskaya. – M.: Publishing house of the Nizhny Novgorod State Medical Academy, 2015. – 224 p.
5. Kokh LI, Sodnomova NV, Kirillov AV Clinical and morphological features of various forms of ovarian apoplexy // Bulletin of Siberian Medicine. 2008.

why there is a delay and scanty periods, can a cyst come out during menstruation, diagnosis and treatment

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Ovarian cyst, which develops due to hormonal failure, causes various symptoms in women. Changing periods with an ovarian cyst are a characteristic sign of reproductive system disorders that can cause infertility.

Improving the quality of life of patients, strengthening and maintaining the reproductive health of women is one of the areas of work of the Yusupov hospital. Oncology clinic specialists detect neoplasms in the reproductive organs and treat them.

Delayed menstruation due to ovarian cyst

In a healthy woman, menstruation is regular, the duration of the menstrual cycle can vary from 21 to 35 days. If menstruation does not start on time, the woman needs to contact a medical institution to determine the cause of the delay. Most often, the absence of menstruation indicates the development of pregnancy, however, the reasons for the delay can also be hormonal imbalances and the functioning of internal organs.

A delay in ovarian cyst indicates the progression of the pathology, they can last from a week to a month. The absence of menstruation may be due to the fact that with some types of cysts, ovulation does not occur. When patients apply to the Yusupov hospital with complaints of delayed menstruation and other symptoms, one of the measures of complex diagnostics is a blood test for hCG to exclude the development of pregnancy.

Follicular ovarian cyst: delayed menstruation

Many women are interested in whether the follicular ovarian cyst and the delay in menstruation are interconnected. The development of this type of pathology is due to the fact that the destruction of the follicle occurred at a certain time. When this tumor is formed, hormones are produced and a cavity is formed, which is subsequently filled with fluid.

A follicular cyst capsule can be up to 10 cm in diameter. As the tumor progresses and grows, there is a delay in menstruation, which can last up to 20 days. However, after that, the woman begins to profuse discharge or bleeding. With a follicular cyst, a woman experiences characteristic symptoms:

• discomfort in the lower abdomen, pain;
• pain during intercourse;
• fever;
• change in the amount of menstrual flow;
• weakness.

A follicular ovarian cyst, if left untreated, can cause uterine bleeding due to tumor rupture or tissue necrosis that occurs when the cyst stem is torn. In these cases, a woman needs emergency help. In the Yusupov hospital, when patients with signs of these tumor complications are treated, immediate hospitalization is carried out.

Scanty periods with an ovarian cyst

Patients who are interested in the question of how many days a delay in menstruation with an ovarian cyst can last and whether there will be abundant discharge after it apply to the Yusupov hospital. A pathological neoplasm is reflected in the nature of menstruation, so a few days before menstruation, a woman may experience spotting.

Ovarian cyst affects not only the duration of the menstrual cycle, but also the nature of the discharge. A small benign tumor of the ovary is not dangerous if detected in time, in addition, it does not change the nature of menstruation.

Menstruation with a large ovarian cyst in most women is profuse. The duration of menstruation with the development of pathology averages 7 days, in the first days intense pain and discomfort in the lower abdomen are characteristic. The increase in the amount of secretions is associated with numerous damage to the capillaries during the separation of the outer layer of tumor tissues.

However, with this disease, scanty menstrual flow is also possible. Spotting, which can occur throughout the cycle, may be mistaken by a woman for the onset of menstruation.

Delayed periods and changes in the amount of menstrual flow are signs of various disorders, in addition, the absence of menstruation may indicate a woman’s pregnancy. Only a qualified specialist can determine the reasons for these changes. When contacting the Yusupov Hospital, a woman can get a free consultation from an oncologist and undergo an examination at a modern diagnostic center.

Can an ovarian cyst come out with menstruation

An ovarian cyst requires complex treatment, the duration of which can be up to 10 months. After examining a woman, the attending physician prescribes measures depending on the type of tumor and its development. A distinctive feature of functional cysts is the ability to self-eliminate with properly selected therapy. So, hormonal drugs block the work of the ovaries. As a result, the development of the tumor stops.

Some women come to the oncology clinic with a question about how an ovarian cyst comes out during menstruation. This process can begin after the third menstruation. The presence of dense blood clots in normal daily secretions indicates the process of tumor destruction. With the surgical removal of the tumor by laparoscopy, the liquid is removed from the capsule. The shell of the tumor can come out naturally.

Doctors-oncologists of the Yusupov hospital in the treatment of ovarian cysts in women explain to patients what results certain methods of therapy are used to achieve, and what transformations will occur in the process of treatment.

Diagnosis and treatment of ovarian cysts in Moscow

Multidisciplinary Yusupov Hospital is located on the site of a hospital opened in the first half of the 19th century with the participation of Prince Boris Nikolaevich Yusupov. Specialists of a modern medical institution continue the tradition of respectful attitude towards patients and provision of high quality medical care. The structure of the Yusupov hospital includes several clinics, including the oncology clinic, where women can be examined and begin treatment for ovarian cysts and other neoplasms.

Pain, feeling worse, delayed right ovarian cyst are the most common reasons for visiting Yusupov hospital specialists. Women who learn about the development of a tumor in the ovary experience fear and excitement, because they do not have sufficient information about the development of the tumor and methods of its treatment.

Complex diagnostics carried out using high-precision European equipment will help to establish the development of an ovarian neoplasm and its nature. When the diagnosis is confirmed, the specialist draws up an individual therapy program for the woman. The activities carried out by specialists are aimed at eliminating hormonal imbalances, improving the general condition of a woman, normalizing menstruation with an ovarian cyst and eliminating the tumor.