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Ovarian Cyst – Symptoms – Surgery

Ovarian cyst treatment

The treatment for ovarian cysts depends on several things. This includes your age, whether you are having periods, the size of the cyst, its appearance, and your symptoms.

Functional cysts normally shrink on their own over time, usually in about 1 to 3 months. If you have a functional cyst, your doctor may want to check you again in 1 to 3 months to check on the status of the cyst. If you develop functional cysts often, your doctor may want you to take birth control pills or other hormonal birth control so you won’t ovulate. If you don’t ovulate, you won’t form functional cysts.

Surgery is an option for some people. You may need surgery if the cyst:

  • Doesn’t go away after several menstrual periods
  • Gets larger
  • Looks unusual on the sonogram
  • Causes pain

In addition, if you’re past menopause and have an ovarian cyst, your doctor will probably want you to have surgery. Ovarian cancer is rare, but individuals 50 to 70 years of age are at greater risk. People who are diagnosed with cancer at an early stage do much better than those who are diagnosed later.

There are 2 main ways surgery can be done on an ovarian cyst:

  • If your cyst is small (about the size of a plum or smaller) and if it looks benign on the sonogram, your doctor may decide to do a laparoscopy. This procedure is done with a lighted instrument called a laparoscope that’s like a slender telescope. It is put into your abdomen through a small incision (cut) near your navel (belly button). With the laparoscope, your doctor can see your organs. Often the cyst can be removed through small incisions at the pubic hair line.
  • If the cyst looks too big to remove with a laparoscope or if it looks suspicious in any way, your doctor will probably do a laparotomy. This surgery uses a bigger cut to remove the cyst. The cyst is then tested for cancer. If it is cancerous, you may need to have the ovary and other tissues removed. This could include the fallopian tubes, the other ovary, or the uterus. It’s important to talk to your doctor about all of this before that surgery.

Your doctor will talk to you about the risks of each kind of surgery. They will tell you how long you are likely to be in the hospital and how long it will be before you can go back to your normal activities.

Ovarian Cysts | CTCA

In the female reproductive system, ovaries are the two almond-shaped organs on each side of the uterus, where eggs mature and get released. Fluid-filled sacs may form on the ovaries as a normal part of menstruation, during childbearing years or after menopause. Every month during menstruation, at least one small ovarian cyst is likely to form on either ovary, according to the Office on Women’s Health.

Typically, these cysts are harmless, don’t cause any symptoms and go away on their own. It’s rare for an ovarian cyst to be malignant, or cancerous.

However, ovarian cysts may lead to serious symptoms in some circumstances, such as when one ruptures. Large cysts may cause pelvic pain, fullness or heaviness, and bloating in the abdominal region. Women who experience a sudden onset of severe abdominal or pelvic pain with a fever or vomiting should seek medical attention right away.

Types of ovarian cysts

Functional cysts: These are the most common kind of ovarian cysts that occur as part of ovulation. They typically resolve on their own without treatment in about one to three months. They’re broken down into two types.

  • Follicular cysts: During the menstrual cycle, the ovary releases an egg. Once mature, the egg bursts through the small follicle sac to travel down the fallopian tube. If the follicle doesn’t release the egg, it may continue to grow, forming a cyst.
  • Corpus luteum cysts: After a follicle releases an egg, the empty sac typically shrivels into a lump of cells called corpus luteum. In some cases, the corpus luteum doesn’t shrink—instead, it accumulates fluid and forms a cyst. Though they usually go away over several weeks, they may grow to almost 4 inches in size and may bleed or cause painful twisting of the ovary. Some drugs used in fertility treatments to cause ovulation may increase the risk of corpus luteum cysts.

Dermoid cysts (teratomas): These cysts may contain different types of bodily tissue, such as hair, skin or teeth. They’re often present from birth but may grow in size during childbearing years. Typically, they don’t cause symptoms and aren’t cancerous.

Cystadenomas: Fluid-filled cysts may form on the surface of the ovary. Though they may grow in size, they’re most often benign (noncancerous).

Endometriomas: These cysts form as a result of endometriosis, which occurs when tissues similar to those lining the uterus grow outside the uterus.

Polycystic ovary syndrome: Sometimes, ovaries develop many small cysts, which may cause health issues such as infertility.

Ovarian cancer: Malignant (cancerous) cysts are rare, but when they do occur, they are considered to be ovarian cancer.

Causes of ovarian cysts

The cause of ovarian cysts depends on the type of cyst. They may occur due to slight changes in bodily processes, another health condition or infection.

Hormonal problems or fertility drugs may produce functional cysts, while hormonal birth control may lower the risk. They may also develop early in pregnancy, when the body creates an ovarian cyst as a stop-gap measure before the placenta forms. If the cyst doesn’t go away, it may need to be surgically removed.

Endometriosis is a condition that may lead to an ovarian cyst. With endometriosis, tissue that’s similar to the lining of the uterus begins to form outside of the uterine cavity and may attach to an ovary, forming a growth called an endometrioma. These cysts may be painful during menstruation and sex.

A severe infection in the ovaries or fallopian tubes may also cause ovarian cysts to develop.

Symptoms of ovarian cysts

While most cysts are small and don’t cause symptoms, a ruptured cyst may prompt sudden and serious pain. A corpus luteum cyst, for example, may cause nausea, vomiting and pain if it results in a twisted ovary. Other symptoms include pressure and bloating, swelling, and pain in the abdominal and pelvic areas—often on the side where the cyst is located. Anyone experiencing severe symptoms, or feeling faint, dizzy or weak with rapid breathing, should seek medical attention immediately.

Other side effects aren’t as common but may happen, such as:

  • A dull ache in the lower back or thighs
  • Inability to fully empty the bladder or bowels
  • The need to urinate frequently
  • Painful sex
  • Painful menstruation
  • Weight gain
  • Unusual bleeding
  • Tender breasts

Who gets ovarian cysts?

Each month, most women make one functional cyst—or more. Women with a regular menstrual cycle are more likely to get ovarian cysts. After menopause, however, ovarian cysts are less common. Postmenopausal patients who have an ovarian cyst may be at higher risk for ovarian cancer.

Diagnosing ovarian cysts

For patients experiencing possible symptoms of an ovarian cyst, doctors may order one of the following tests:

  • A pregnancy test helps rule out pregnancy, and a hormone level test may help rule out or diagnose hormone-related issues.
  • An ultrasound image of the pelvis is used to determine whether symptoms such as bleeding and pelvic pain are caused by an ovarian cyst. The test uses sound waves to create pictures of the pelvic organs and detect the location and size of the cyst. It also helps doctors determine whether a mass is fluid-filled, solid or both. Having a complex or solid mass is linked to an increased risk for cancer, a 2018 study in the journal JAMA Internal Medicine found.
  • A CA-125 blood test measures the level of a protein called CA 125. Elevated levels are linked to ovarian cancer, particularly for patients who have gone through menopause.

Treatment of ovarian cysts

Treatment options may include those below:

  • Watchful waiting: Doctors may decide to regularly monitor an ovarian cyst with ultrasound exams.
  • Surgery: Doctors may recommend surgery if they suspect cancer, or if the cyst is large or causing symptoms. Removal of an ovarian cyst is called an ovarian cystectomy, and removal of one or both ovaries is called an oophorectomy. For benign cysts, a minimally invasive surgery done with a scope (laparoscopy) may be recommended. During a laparoscopy, the surgeon makes a small incision in the pelvis, then uses the scope to view and remove the cyst. In more complicated cases—if the cyst is large or cancer is suspected—doctors may need to perform surgery involving a larger incision to the abdomen, called a laparotomy, or open surgery.

Ovarian cyst symptoms & treatments – Illnesses & conditions

In most cases, ovarian cysts disappear in a few months without the need for treatment.

Whether treatment is needed will depend on:

  • its size and appearance
  • whether you have any symptoms
  • whether you have had the menopause (post-menopausal women have a slightly higher risk of ovarian cancer)

Watchful waiting

In most cases, a policy of “watchful waiting” is recommended.

This means you won’t receive immediate treatment, but you may have an ultrasound scan a few weeks or months later to check if the cyst has gone.

Due to the slightly increased risk of ovarian cancer in post-menopausal women, women who have been through the menopause may be advised to have ultrasound scans and blood tests every four months for a year.

If the scans show that the cyst has disappeared, further tests and treatment are not usually necessary. If the cyst is still there, surgery may be recommended.

Surgery

Large or persistent ovarian cysts, or cysts that are causing symptoms, will usually need to be surgically removed.

Surgery will also normally be recommended if there are concerns that the cyst could be cancerous or could become cancerous.

There are two types of surgery used to remove ovarian cysts:

  • a laparoscopy
  • a laparotomy

These are usually carried out under general anaesthetic.

Laparoscopy

Most cysts can be removed using laparoscopy. This is a type of keyhole surgery where small cuts are made in your tummy and gas is blown into the pelvis to allow the surgeon to access your ovaries.

A laparoscope (a small, tube-shaped microscope with a light on the end) is passed into your abdomen so the surgeon can see your internal organs. The surgeon then removes the cyst through the small cuts in your skin.

After the cyst has been removed, the cuts will be closed using dissolvable stitches.

A laparoscopy is preferred because it causes less pain and has a quicker recovery time.  Most women are able to go home on the same day or the following day.

Laparotomy

If your cyst is particularly large, or there is a chance it could be cancerous, a laparotomy may be recommended.

During a laparotomy, a single, larger cut is made in your tummy to give the surgeon better access to the cyst.

The whole cyst and ovary may be removed and sent to a laboratory to check whether it’s cancerous. Stitches or staples will be used to close the incision.

You may need to stay in hospital for a few days after the procedure.

After surgery

After the ovarian cyst has been removed, you will feel pain in your tummy, although this should improve in a day or two.

Following laparoscopic surgery, you will probably need to take things easy for two weeks. Recovery after a laparotomy will usually take longer, possibly around six to eight weeks.

If the cyst is sent off for testing, the results should come back in a few weeks and your consultant will discuss with you whether you need any further treatment.

Contact your GP if you notice the following symptoms during your recovery:

  • heavy bleeding
  • severe pain or swelling in your abdomen
  • a high temperature (fever)
  • dark or smelly vaginal discharge

These symptoms may indicate an infection.

Your fertility

If you have not been through the menopause, your surgeon will try to preserve as much of your reproductive system as they can. It’s often possible to just remove the cyst and leave both ovaries intact, which means your fertility should be largely unaffected.

If one of your ovaries needs to be removed, the remaining ovary will still release hormones and eggs as usual. Your fertility shouldn’t be significantly affected, although you may find it slightly harder to get pregnant.

Occasionally, it may be necessary to remove both ovaries in women who have not been through the menopause. This will trigger an early menopause and mean you no longer produce any eggs.

However, it may still be possible to have a baby by having a donated egg implanted into your womb. This will need to be discussed with specialists at a centre that specialises in assisted reproduction techniques.

In women who have been through the menopause, both ovaries may be removed because they no longer produce eggs.

Make sure you discuss your fertility concerns with your surgeon before your operation.

Cancer treatment

If your test results show that your cyst is cancerous, both of your ovaries, your womb (uterus) and some of the surrounding tissue may need to be removed.

Again, this would trigger an early menopause and mean that you would no longer be able to get pregnant.

Read more about treating ovarian cancer

Ovarian Cysts in Post-Menopausal Women: What to Look For and What to Ask

Ovarian cysts in post-menopausal women are now known to be very common and most are not cancerous.   However, because the greatest risk factor for ovarian cancer is age, any cysts in a postmenopausal woman should be taken seriously. Before ultrasound was readily available for physicians to use as a tool to evaluate the ovaries, any ovary which a physician was able to palpate (feel) on a physical examination in a post menopausal woman was recommended to be removed. After the advent of the use of ultrasound in pelvic imagining, any cysts noted in post-menopausal women were generally removed. Now, after years of widespread use and experience in ultrasound imaging, the criteria for how to manage an ovarian cyst has radically changed, and generally cysts that do not demonstrate well-defined malignant characteristics  and do not grow may simply be observed for change.

In one study of 7,700 healthy women, 450 were found to have ovarian cysts, and many of these resolved with time. Ovarian cysts may be detected on physical examination by your healthcare provider, because your physician has performed or ordered a pelvic ultrasound, or they may be found when imaging studies such as a CT scan, MRI, or ultrasound have been performed for another reason. Cysts may be associated with pelvic pressure or pain. When they twist, they may be associated with severe pain.

In general, all post-menopausal women with ovarian cysts should be evaluated by a physician and an expert in pelvic sonography.  A CA125 blood test should also be performed. Simple cysts (those which only contain liquid) are generally benign and may be followed through serial ultrasounds for a period of time. Cysts should be considered for removal if they are associated with pain or an elevated CA125. Complex cysts (those which have potentially malignant characteristics) should thoroughly be evaluated by an expert sonographer in pelvic imaging, and careful consideration about their removal should be made.

Removal of an ovarian cyst can many times be performed with minimally invasive surgery, such as laparoscopy (referred to as belly button or keyhole surgery). However, occasionally an open procedure (referred to as a laparotomy) will be required. It is important that the gynecologist, if not a gynecologic oncologist, have a gynecologic oncologist on standby if the cyst has potential malignant characteristics or if the CA125 is elevated. Your gynecologist may also pre-operatively order a new blood test called OVA1 to help determine if the cyst is malignant.

Important questions to consider when surgery is recommended are: Do I remove just the cyst, or the entire ovary? Do I remove both ovaries? These points should be thoroughly reviewed pre-operatively with your physician. If you have an elevated risk of ovarian or breast cancer, then careful consideration about removal of both ovaries should be made. If you are not at elevated risk for ovarian cancer, then you should discuss with your healthcare provider the fact that the ovaries, even after menopause, help protect women against cardiac disease, which remains the leading cause of death in women.

The take-home message:

  • Benign cysts are common in post-menopausal women.
  • If a woman has a small, simple ovarian cyst with a normal CA125 and no symptoms, she may be followed closely by a physician with serial ultrasound imaging, CA125 testing, and physical examinations.
  • Cysts which are growing significantly, have potentially malignant characteristics, are associated with an elevated CA125, or associated with symptoms should be removed.
  • Careful consideration should be given to surgical approach with minimally invasive surgery, and to whether the cyst, one, or both ovaries should be removed. A gynecologic oncologist should be on standby or perform the operation if there is a significant chance that the cyst could be malignant.

Current models suggest that there is a potential 5-year pre-clinical phase (a time where a cancer is developing and is not detectable or associated with symptoms) to ovarian cancer. So no cyst or ovarian abnormality should be ignored and forgotten about. All need some form of follow-up.

Ovarian Cysts

Definition

Ovarian cysts, also known as ovarian masses or adnexal masses, are frequently found incidentally in asymptomatic women. Ovarian cysts can be physiologic (having to do with ovulation) or neoplastic and can be benign, borderline (low malignant potential), or malignant. Ovarian cysts are sometimes found in the course of evaluating women for pelvic pain though the cysts may or may not be the cause of the pain.

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Epidemiology

Estimates of the prevalence of ovarian cysts vary widely, with most authors reporting between 8% and 18% of both premenopausal and postmenopausal women having ovarian cysts. Most post-menopausal cysts persist for years.1

In the United States, approximately 5% to 10% of women undergo surgical exploration for ovarian cysts in their lifetime though only 13% to 21% of these cysts are malignant.2 Presurgical evaluation of ovarian cysts is critical to prevent unnecessary surgical intervention while still detecting potential malignancy.

For the vast majority of women, ovarian cysts are not precancerous lesions and do not increase the risk of developing ovarian cancer later in life. Removal of benign cysts does not decrease future mortality from ovarian cancer.1,3-5

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Pathophysiology

Provided below is a brief description of the pathophysiology of various types of physiologic and neoplastic ovarian cysts and the potential complications that may arise.

Physiologic/Functional Cysts

During normal ovulation, a follicle matures and then ruptures, releasing an oocyte. After ovulation, the corpus luteum forms and subsequently involutes. When the follicle fails to rupture and continues to grow, a follicular cyst occurs. When the corpus luteum fails to involute and continues to grow, a corpus luteum cyst occurs. Both types of cysts are considered physiologic or functional and neither have any malignant potential. Either type of cyst can become a hemorrhagic cyst (see below).

Hemorrhagic Cysts

The granulosa layer of the ovary remains avascular until the time of ovulation. After ovulation occurs, the granulosa layer quickly becomes vascularized by thin-walled vessels, which rupture easily, giving rise to a hemorrhagic cyst.6

Dermoids (Mature Cystic Teratomas)

Dermoid cysts contain mature tissue of ectodermal (eg, skin, hair), mesodermal (eg, muscle, urinary), and endodermal (eg, gastrointestinal, lung) origin.7 Dermoid cysts are almost always benign but have the potential to rupture, spilling sebum, or torse.

Endometrioma

Endometrioma is a type of cyst that is filled with menstrual blood and endometrial tissue. Endometrioma cysts arise either via retrograde menstruation from the uterus or bleeding from an endometriotic implant itself.

Ovarian Malignancy

Studies suggest that some seemingly ovarian serous carcinomas actually originate in the fallopian tubes and then spread to the ovary. These tubal lesions have also been found to spread to the peritoneum, leading to an apparent peritoneal carcinoma. Germ cell and stromal tumors do arise from the ovary itself.

Complications
  • Ovarian torsion: all ovarian cysts have the potential to twist on their axes or “torse,” occluding vascular supply. Larger cysts (over 6 cm) are more likely to torse. Ovarian torsion is a surgical emergency as the ovary must be promptly untwisted to restore perfusion and preserve ovarian tissue. Ultrasound with Doppler can identify lack of blood flow to the ovary.
  • Cyst rupture: all cyst types can potentially rupture, spilling fluid into the pelvis, which is often painful. If the contents are from a dermoid or abscess, surgical lavage may be indicated.
  • Hemorrhage: In the case of hemorrhagic cysts, the management of hemorrhage depends on the hemodynamic stability of the patient, but is most often expectantly managed.

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Signs and Symptoms

Most women with benign or malignant ovarian cysts are asymptomatic and the cysts are found incidentally. Among women with symptoms, pelvic or lower-abdominal pressure or pain are the most common symptoms. Acute pain related to ovarian cysts can occur with ovarian torsion, hemorrhage into the cyst, cyst rupture with or without intra-abdominal hemorrhage, ectopic pregnancy, and pelvic inflammatory disease with tubo-ovarian abscess.8 Vague symptoms such as urinary urgency or frequency, abdominal distention or bloating, and difficulty eating or early satiety have also been reported.9 The positive predictive value of this symptom constellation is only about 1%; however, the usefulness increases if symptoms arose recently (within the past year) and occur more than 12 days a month.10

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Diagnosis

The differential diagnosis of benign ovarian cysts includes:

  • Simple cysts
  • Hemorrhagic corpus luteum cysts
  • Dermoids (mature cystic teratomas)
  • Endometriomas
  • Pedunculated Fibroids
  • Hydrosalpinges
  • Paratubal and paraovarian cysts
  • Peritoneal inclusion cysts (also known as pseudocysts)
  • Pelvic kidneys
  • Appendiceal or diverticular abscess
  • Ectopic pregnancy

The diagnosis of an ovarian cyst is most often made based on imaging rather than by physical examination, laboratory testing, or diagnostic procedures.

Ultrasound

Ultrasonography is considered the gold standard for the assessment of ovarian cysts. Transvaginal sonography is preferred, as the probe proximity to the ovary can result in superior images. If transvaginal sonography is not available or not tolerated by the patient, transabdominal sonography through a full bladder or transperineal sonography in virginal or atrophic women can still provide helpful, albeit limited, information. In some cases, ultrasound can specifically diagnose the type of ovarian cyst, especially if certain characteristic findings are present (Box 1). Figures 1– 5 illustrate and describe characteristic findings seen with simple cysts, hemorrhagic corpus luteum cysts, dermoid cysts, endometriomas, and malignant cysts.8

Box 1: Characteristics of Simple and Malignant Cysts



Simple cyst Malignant cyst

Round or oval

No solid component

Anechoic

Smooth, thin walls

No internal flow

No septation

Posterior acoustic enhancement

Non-hyperechoic solid areas (especially if blood flow)

Thick septations ( >2 – 3 mm wide, especially if blood)

Excrescences on inner/outer aspect of cystic area

Ascites

Other pelvic/omental masses

Identifying certain cyst characteristics is especially important in differentiating benign from malignant processes. The ten “Simple Rules” are five ultrasound features indicative of benign cysts (B-features) and five ultrasound features indicative of a malignant cysts (M-features) based on the presence of tumor morphology, degree of vascularity, and ascites (Table 1).11

Table 1: “Simple Rules” Differentiating Benign and Malignant Cysts




Benign (B) features Malignant (M) features

B1 unilocular cysta

B2 solid components present, but <7 mm

B3 acoustic shadowsb

B4 smooth multilocular tumor, largest diameter <100 mm

B5 no blood flow; color score 1

M1 irregular solid tumor

M2 ascitesa

M3 at least 4 papillary structures

M4 irregular multilocular-solid tumor, largest diameter ≥100 mmb

M5 very strong flow; color score 4

If only B features are present → benign tumor

If only M features are present → malignant tumor

If both B and M features or neither B nor M features present → inconclusive

a Most predictive feature.

b Least predictive feature.

Data from Timmerman D, Van Calster B, Testa A, et al. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol 2016; 214:424–437.

Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) is a valuable tool when ultrasound is inconclusive or limited. The advantages of MRI are that it is very accurate and it provides additional information on the composition of soft-tissue tumors.8 On the other hand, MRI is more expensive, is usually less available, and is more inconvenient for the patient than ultrasound. MRI for the evaluation of ovarian cysts is usually ordered with contrast, unless contraindicated.8 In one study of MRI as second-line imaging for indeterminate cysts, contrast-enhanced MRI contributed to a greater change in the probability of ovarian cancer compared with computed tomography (CT), Doppler ultrasound, or MRI without contrast.12 This may result in a reduction in unnecessary surgeries and in an increase in proper referrals in cases of suspected malignancy.

Computed Tomography

Computed tomography (CT) is usually not used in the evaluation of ovarian cysts. CT offers poor discrimination of soft tissue and exposes the patient to more radiation than does ultrasound or MRI. The utility of CT is primarily in the preoperative staging of a suspected ovarian cancer.13 Cysts discovered via CT scan should be further evaluated using ultrasonography.

Diagnostic Procedures

It is almost never appropriate to aspirate an ovarian cyst for diagnostic purposes. False negative results are common and leakage of cyst contents into the peritoneal cavity potentially increases the stage of any cancer found, decreasing patient survival.

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Management

Appropriate management of patients with an ovarian cyst depends on the presence of symptoms, likelihood of torsion or rupture, and level of concern for malignancy.

Symptomatic Cysts

The differential diagnosis for pain in women with ovarian cysts include tubo-ovarian abscess, ruptured ectopic, ruptured hemorrhagic cyst, and ovarian torsion.8

If the patient with pain is at low risk of a surgical emergency, pain medication and outpatient management is appropriate. If pain persists, refer the patient to a gynecologist. For a patient who appears toxic or is in shock, an immediate surgical consultation with a gynecologist is warranted.

For patients with symptomatic cysts that are concerning for cancer, consult a gynecologic oncologists directly.

Simple Cysts

Management of patients with simple cysts should follow the algorithm shown in Figure 6.

Cysts with a High Likelihood of Malignancy

Women with ovarian cysts with a high likelihood of malignancy should be referred directly to a gynecologic oncologist. High likelihood of malignancy exists if malignant features are found on ultrasound, in women with a personal history or a first-degree relative with history of ovarian or breast cancer, or if cancer antigen 125 (CA 125) is >35 (postmenopausal women) or CA 125 >200 (premenopausal women) (Figure 7). Direct referral to and treatment by gynecologic oncologists has been shown to improve survival rates in women with ovarian cancer.14-16

Cysts with an Indeterminate Likelihood of Malignancy

For women with cysts with an intermediate likelihood of malignancy, further workup is warranted. The most cost-effective test is a second ultrasound and a second opinion at a tertiary center. Obtaining the CA 125 level can be helpful in this instance (Figure 7).

Cysts with an Unclear Likelihood of Malignancy but Likely Benign

For women with cysts with an unclear likelihood of malignancy but most likely benign, repeat ultrasound in 6 to 12 weeks is warranted.8 There are no official guidelines as to when to stop serial imaging, but one or two ultrasounds to confirm size and morphologic stability has been suggested.17 Of course, once a lesion has resolved, there is no need for further imaging.

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Prevention and Screening

Prevention

Oral contraceptives may prevent new functional cysts from forming.18-19 Oral contraceptives do not, however, hasten the resolution of preexisting cysts. Some practitioners will, nevertheless, prescribe oral contraceptives in an attempt to prevent new cysts from confusing the picture. Oral contraceptives are also protective against ovarian cancer.20

Bilateral oophorectomy protects against ovarian and breast cancer but is associated with an increase in the all-cause mortality rate.21 Current research suggests that removal of the fallopian tubes is protective against ovarian cancer.22

Screening

Screening women with an average risk for ovarian cancer is not recommended.3,23 The incidence of ovarian cancer is too low, ultrasonography and CA 125 testing are too nonspecific, and the biology of ovarian cancer does not lend itself to screening. In one recent large study (N = 78,216), yearly screening with CA 125 and ultrasound did not decrease the mortality rate from ovarian cancer, and the surgical evaluation of false-positive screens was associated with complications.5

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Special Populations

Pregnancy

Ovarian cysts in pregnancy are usually benign. Benign cystic teratomas (also called dermoid cysts) are the most common ovarian tumor during pregnancy, accounting for one-third of all benign ovarian tumors in pregnancy. The second most common benign ovarian cyst is a cystadenoma. In caring for pregnant women with ovarian cysts, a multidisciplinary approach and referral to a perinatologist and gynecologic oncologist is advised.

Neonates and Prepubertal Children

Ovarian cysts in the neonate are exceedingly rare. It is estimated that 5% of all abdominal masses in the first month of life are ovarian cysts. While there are no precise guidelines for the monitoring and management of neonatal ovarian cysts, it is generally agreed that cysts >2 cm are considered pathologic. The majority of neonatal ovarian cysts are benign and self-limiting. Ovarian malignancy becomes more common in the second decade of life than in the neonatal period. In one small study, approximately 33% of adnexal masses were malignant in children >8 years whereas 2.9% of adnexal masses were malignant in children <8 years.24

Women with a History of Breast Cancer

Women diagnosed with ovarian cysts with a personal or family history of breast or ovarian cancer in a first degree relative should be referred directly to a gynecologic oncologist.

Polycystic Ovarian Syndrome

The finding of multiple small ( <1 cm) cysts in both ovaries (“string of pearls” appearance) on ultrasonography is indicative of polycystic ovarian syndrome, a condition unrelated to other ovarian cyst conditions. The “string of pearls” appearing cysts are a component of a multi-system syndrome, which usually also includes irregular ovulation and aspects of metabolic syndrome.

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Summary

  • Ovarian cysts are common. Most are variations of normal ovulatory function. Regardless of age, the likelihood of malignancy is significantly less than the likelihood of a benign lesion.
  • Patients with ovarian cysts with benign characteristics (round or oval, anechoic, smooth, thin walls, no solid component, no internal flow, no or single thin septation, posterior acoustic enhancement) may be followed by the primary care provider according to the algorithm in Figure 6, until resolution or stability of the cyst has been ascertained.
  • Women with symptomatic ovarian cysts, those with cysts over 6 cm in diameter, or those with an uncertain, but likely benign diagnosis, can be managed by a general gynecologist.
  • Patients with cysts with frankly malignant characteristics (complex structure with thick >3mm septations, nodules or excrescences, especially if multiple or with internal blood flow, solid areas, or ascites) should be referred directly to a gynecologic oncologist. Referral should also be made to gynecologic oncology if the patient has an elevated CA 125 value, a personal or family history of breast or ovarian cancer in a first degree relative, or evidence of metastases.

Acknowledgements

Thank you very much to Mina Tirabassi, RDMS, for the ultrasound images.

References

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  12. Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization—meta-analysis and Bayesian analysis. Radiology 2005; 236:85–94.
  13. Harris RD, Javitt MC, Glanc P, et al; American College of Radiology (ACR). ACR Appropriateness Criteria clinically suspected adnexal mass. Ultrasound Q 2013; 29:79–86.
  14. Engelen MJ, Kos HE, Willemse PH, et al. Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma. Cancer 2006; 106::589–598.
  15. Giede KC, Kieser K, Dodge J, Rosen B. Who should operate on patients with ovarian cancer? An evidence-based review. Gynecol Oncol 2005; 99:447–461.
  16. Vernooij F, Heintz P, Witteveen E, van der Graaf Y. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: a systematic review. Gynecol Oncol 2007; 105:801–812.
  17. Liu JH, Zanotti KM. Management of the adnexal mass. Obstet Gynecol 2011; 117:1413–1428.
  18. Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database Syst Rev 2014; (4):CD006134. doi: 10.1002/14651858.CD006134.pub5.
  19. Young RL, Snabes MC, Frank ML, Reilly M.A randomized, double-blind, placebo-controlled comparison of the impact of low-dose and triphasic oral contraceptives on follicular development. Am J Obstet Gynecol 1992; 167:678–682.
  20. The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development. The reduction in risk of ovarian cancer associated with oral-contraceptive use. N Engl J Med 1987; 316:650–655.
  21. Parker WH, Broder MS, Chang E, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses’ Health Study. Obstet Gynecol 2009; 113:1027–1037.
  22. Kurman RJ, Shih IeM. The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am J SurgPathol 2010; 34:433–443.
  23. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin. Management of adnexal masses. Obstet Gynecol 2007; 110:201–214.
  24. Jones HW, Rock JA, eds. Te Linde’s Operative Gynecology, 11th ed. Philadelphia, PA: Wolters Kluwer; 2015.

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Disclosures

Elisa Ross, MD; nothing to disclose. Chelsea Fortin, MD; nothing to disclose.

 

When Ovarian Cysts Become Problematic: North Texas OB/GYN: OB/GYNs

Ovarian cysts occur in about 8%-18% of premenopausal and postmenopausal women. They’re fluid-filled sacs that form inside or on an ovary. While ovarian cysts can occur for different reasons, most are harmless.

You can have an ovarian cyst and not know it. Many ovarian cysts exist without symptoms and disappear on their own. Ovarian cysts are usually benign, though they can be malignant. 

Most ovarian cysts are discovered during a pelvic exam. The OB/GYNs of North Texas OB/GYN in Plano, Texas, provide expert care for ovarian cysts. When an ovarian cyst is suspected, an in-office ultrasound confirms a diagnosis and determines the location and condition of a cyst. Your physician recommends treatment based on these findings and consideration of other factors including your medical history and overall health. 

While most ovarian cysts aren’t a cause for concern, abnormal ovarian cysts can cause life-threatening circumstances and require treatment. Read on to find out how these cysts can become problematic and what you can expect if this happens to you.

Complications of ovarian cysts

Abnormal ovarian cysts can occur for several reasons. An ovarian cyst can break open or rupture. A ruptured cyst can result in the loss of a large amount of blood and fluid. 

Depending on its location, an ovarian cyst can cause twisting of the fallopian tube. This can interfere with your normal blood supply to the affected ovary. Ovarian cysts related to polycystic ovary syndrome or endometriosis can make it more difficult to get pregnant. 

Most ovarian cysts aren’t cancerous. However, ovarian cysts that develop after menopause have a higher risk of being cancerous because your risk for developing cancer increases as you age.  

Symptoms that require care

Most ovarian cysts don’t cause discomfort or any noticeable symptoms. When symptoms occur, they typically involve pelvic pain, irregular periods, and pain after sex. Other common symptoms can include bloating, swelling, or pain in the abdomen on the side of the cyst. If you experience pain, it may start and stop.

Problematic cysts cause more intense symptoms. If a cyst ruptures, you may experience sudden, severe pain. Cysts that result in twisting of an ovary can cause intense pain accompanied by nausea and vomiting. 

If you experience any of the following symptoms with an ovarian cyst, you should get immediate medical treatment:

  • Sudden, severe abdominal pain
  • Feeling weak, faint, or dizzy
  • Rapid breathing
  • Pain with fever and vomiting
  • Bleeding not associated with your period

Treatment for problematic ovarian cysts

When an ovarian cyst appears normal, your OB/GYN may recommend watchful waiting. This involves repeated ultrasounds to determine if the cyst changes in size or appearance over time. Most cysts dissolve on their own within one or two menstrual cycles. Pain relievers can help relieve the discomfort of symptoms but don’t speed their resolution. 

You may require surgical removal of your ovarian cyst based on its location, size, and condition. A regular cyst appears clear, while a complex cyst has surface bumps, solid areas, or areas filled with fluid. Rupture of a complex ovarian cyst is more likely to require surgical removal. 

Removal of an ovarian cyst typically involves a laparoscopy, a procedure that removes the cyst using a small cut just below your navel. Your physician uses a laparoscope, a long, thin rod with a camera on the end, to remove the cyst through this cut in your abdomen.

If you have a larger cyst, removal may require a laparotomy. This procedure involves making an incision across your abdomen to remove the cyst. A laparotomy is also common if your physician suspects a cancerous ovarian cyst. If the biopsy taken during surgery indicates the presence of cancer, having the larger cut available allows for an immediate hysterectomy.

While you can’t prevent ovarian cysts, you can reduce the likelihood of developing them. Taking hormonal birth control pills stops you from ovulating, which lowers your risk of getting new cysts. 

Find out more about your risk for developing ovarian cysts and ways to manage this condition. Call our office to schedule an appointment for a consultation. 

Management of Ruptured Ovarian Cyst

What is management of a ruptured ovarian cyst?

An ovarian cyst is a fluid-filled sac that forms on or inside an ovary. In some cases, the cyst can break open (rupture). A ruptured cyst may be managed in several ways:

  • You may just need to keep track of your symptoms.
  • You may need to take pain medicine.
  • You may need surgery.

The ovaries are a pair of small, oval-shaped organs in the lower part of a woman’s belly (abdomen). About once a month, one of the ovaries releases an egg. The ovaries also make the hormones estrogen and progesterone. These play roles in pregnancy, the menstrual cycle, and breast growth.

An ovarian cyst can develop for different reasons. Most ovarian cysts are harmless. A cyst that ruptures may cause no symptoms, or only mild symptoms. Ruptured cysts that cause mild symptoms can often be managed with pain medicines. The cyst may be looked at with an imaging test such as an ultrasound.

In some cases, a ruptured cyst can cause more severe symptoms. These can include severe pain in the lower belly and bleeding. Symptoms like these need treatment right away.

You may need care in the hospital if you have severe symptoms from a ruptured cyst. You may be given IV (intravenous) pain medicines through a needle inserted into your vein. You may need to have fluids or blood replaced due to internal bleeding. In rare cases, a ruptured ovarian cyst may need surgery. This may be an emergency surgery.

If you need surgery because of internal bleeding, a surgeon will make a cut (incision) in your abdomen while you are under anesthesia. The doctor controls the bleeding and removes any blood clots or fluid. He or she may then remove the cyst or your entire ovary.  

Why might I need management of a ruptured ovarian cyst?

Some ruptured ovarian cysts can cause a lot of bleeding. These need medical treatment right away. In severe cases, the blood loss can cause less blood flow to your organs. In rare cases, this can cause death.

Many ovarian cysts do not rupture. Experts don’t know why some cysts break open and some do not. A cyst is more likely to rupture during strenuous exercise or sexual activity. If you have a health condition that makes you bleed easily, you will likely need surgery for a ruptured cyst.

There are different types of ovarian cysts. Functional cysts are the most common type. These only occur in women who have not gone through menopause. They often happen when an egg doesn’t release from the ovary during ovulation. These cysts are the most common type to rupture.

What are the risks of management of a ruptured ovarian cyst?

For many women, a ruptured ovarian cyst causes no symptoms, or only mild symptoms. Mild symptoms can often be managed with pain medicines. There are seldom any risks in this situation.

In some cases, you may have more severe symptoms. These can include extreme pain in your lower belly and bleeding. Uncontrolled bleeding can be life-threatening. See your healthcare provider right away. Depending on your symptoms, you may need to be hospitalized.

Severe cases may require surgery. This may be an emergency procedure. The surgery may be minimally invasive (a laparoscopy). This means it uses very small cuts (incisions). Or it may be a standard open procedure and use a much larger incision. All surgery has some risks, but in these severe cases, there are greater risks to you if surgery is not performed. Risks and possible complications of surgery for a ruptured ovarian cyst include:  

  • Bleeding
  • Infection
  • Incision doesn’t heal well
  • Blood clots
  • Risks of anesthesia
  • Damage to blood vessels, nerves, muscles, or nearby pelvic structures
  • The need for a larger incision (if you had a laparoscopy)
  • Scar tissue (adhesions) that occur after surgery

How do I get ready for management of a ruptured ovarian cyst?

A healthcare provider diagnoses a ruptured ovarian cyst. If you have sudden, sharp belly pain, see a provider right away. If you know that you have an ovarian cyst, be aware that it can rupture and need treatment.

Your healthcare provider or an ob-gyn (obstetrics/gynecology) doctor will diagnose the condition. Your provider will ask about your medical history and your symptoms. Be sure to tell the provider if you know that you have an ovarian cyst. You will also have a physical exam. This will likely include a pelvic exam.

If your provider thinks you may have a ruptured cyst, you may need tests. These tests can help rule out other possible causes of your symptoms, such as an ectopic pregnancy, appendicitis, or a kidney stone. Some of these tests may include:

  • Ultrasound. This test uses sound waves to view the cyst’s size, shape, and location.
  • Pregnancy test. This is done to check if pregnancy may be the cause of the cyst.
  • Blood tests. These check for low iron in your blood (anemia). They also check for infection and for signs of cancer.
  • Urine test. This looks for other possible causes of your pain.
  • Vaginal culture. This is done to check for a pelvic infection.
  • CT scan. This uses a series of X-rays and a computer to create a detailed picture of the area.

You may need more tests to rule out other possible causes of your symptoms.

If you need surgery for your cyst, your healthcare provider will tell you how to prepare. For example, you shouldn’t eat or drink after midnight before your surgery.

What happens during management of a ruptured ovarian cyst?

Management of a ruptured ovarian cyst depends on whether it is complex. A regular cyst is a simple fluid-filled sac. A complex cyst may have solid areas, bumps on the surface, or several areas filled with fluid.

Many women have functional ovarian cysts. Most of these are not complex. A ruptured cyst that is not complex can be treated with pain medicine. You may be told to watch your symptoms over time. In some cases, you may need to have follow-up ultrasound tests. You may not need any other treatment.

If the cyst is complex, you may need different care. This type of cyst may cause:

  • Blood loss that causes low blood pressure or fast heart rate
  • Fever
  • Signs of possible cancer                                                          

If you have a complex ruptured ovarian cyst, you may need care in the hospital. Your treatment may include:

  • IV (intravenous) fluids to replace lost fluid
  • Careful monitoring of your heart rate and other vital signs
  • Monitoring of your red blood cell level (hematocrit) to check the blood’s ability to carry oxygen
  • Repeated ultrasounds to check for bleeding into your belly
  • Surgery for a worsening medical condition or to check for cancer

If you need surgery, your provider may use a minimally invasive method. This is called a laparoscopy. The provider makes small cuts (incisions) in your belly while you are under anesthesia. A tiny lighted camera and other small tools are put through these incisions. The provider controls the bleeding and removes any blood clots or fluid. He or she may then remove the cyst or your entire ovary. The tools are then removed. The incisions are closed and bandaged.

If the provider does not use laparoscopy, the surgery will be done with larger incisions.                                                            

Talk with your provider about what type of treatment will work best for you.

What happens after management of a ruptured ovarian cyst?

You and your healthcare team will make a follow-up plan that makes the most sense for you.

If your ruptured ovarian cyst is not complex, you will likely continue your care at home. You can use pain medicines as needed. Your pain should go away in a few days. Let your provider know right away if you your pain gets worse, if you feel dizzy, or have new symptoms. Follow up with your provider if you need imaging or blood tests.

If you have a complex ruptured ovarian cyst, you may need to stay in the hospital for 1 or more days. If your cyst is no longer bleeding, you may be able to go home. You can use pain medicines as needed. You may need follow-up imaging tests to make sure that your bleeding has stopped and to see if the cyst needs surgery to rule out cancer.

If you had surgery, you will be told how to care for your wound and bandage. You may need to limit your physical activity for a while. Your healthcare team will give you more information.

In rare cases, a ruptured ovarian cyst is caused by cancer. This will need careful follow-up treatment from a doctor who specializes in cancer care. You may need surgery and other therapies.

Some women have more than one ovarian cyst. You can work with your healthcare provider to plan treatment for multiple cysts. A cyst that has not ruptured may need to be watched over time. In other cases, you may need surgical removal of the cyst. Your provider may prescribe medicines such as birth control pills. In some cases these can help shrink an ovarian cyst.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much will you have to pay for the test or procedure

 

90,000 Ovarian cyst. Advice from gynecologist Andrey Karachev

Ovarian cyst is one of the most common gynecological diseases that both adolescent girls and women face in young and old age. I, a gynecologist of the private medical center “Life Line” Andrey Karachev, will tell you about how and why ovarian cysts occur, how such a disease is recognized and treated, why it is important to seek help from a specialist as soon as possible and not try to diagnose yourself …

An ovarian cyst is diagnosed quite often and in all cases is classified as a tumor. It can be either benign or malignant. Benign neoplasms are more common in adolescents and young women, they account for about 65% of the total number of ovarian tumors. Malignant neoplasms are diagnosed mainly in patients after the onset of menopause. This is due, as a rule, to age-related hormonal changes in the woman’s body, due to which the functions of the ovaries are impaired.Therefore, after menopause, women need to undergo regular gynecological examinations. After all, the sooner a tumor is detected, the more chances that the treatment will be effective.

Most women who are diagnosed with an ovarian cyst start to panic. However, I believe that this should never be done. At this stage, it is important to consult with your doctor in order to understand what the treatment will be, and whether it is necessary at all.

What is a cyst and why does it occur?

A cyst is a mass that contains fluid or tissue.Cysts can be of various sizes, from 1 to 2 cm to 20 centimeters or more. They can be divided into two main groups – benign and malignant.

Benign tumors in most cases are retentional (corpus luteum cyst, follicular cyst). A follicular cyst is found in almost every woman, it is formed when the ovum matures, if some kind of malfunction has occurred in the body. As a rule, such a neoplasm contains fluid inside and disappears after several menstrual cycles without treatment.In some cases, a luteal cyst is formed at the site of the follicle that has opened, which is often called a corpus luteum cyst. It is formed after ovulation and often occurs in women during pregnancy. The corpus luteum is the supplier of progesterone, which is responsible for the normal development of the fetus. Therefore, even if the luteal cyst reaches a significant size, it is not considered a serious pathology. If the cyst remains, then it does not cause any special problems for the woman, although in some cases it can cause a delay in the menstrual cycle.

The least studied is the paraovarian cyst, since the reasons why it is formed are still unknown. It is possible that the formation of a tumor can be influenced by an unfavorable environmental situation, termination of pregnancy, past venereal diseases. Paraovarian neoplasms are the largest and can reach a diameter of 20-30 cm.

Endometrioid cyst occurs most often in patients. This is a capsule neoplasm, with the content of the rejected epithelium of the capsule itself and old blood in it.The reason for the formation of these cysts is poorly understood. In most cases, an endometrial tumor is accompanied by infertility.

Studies show that the formation of retention tumors is based on hormonal disorders in the body. The accompanying factors that can provoke the development of pathology include bad habits, sex during menstruation, a sharp change in diet, including the transition to various types of diets. Hormonal disorders also contribute to the development of malignant neoplasms.Risk factors in this case include diabetes mellitus, obesity, thyroid disease.

How is ovarian tumor diagnosed?

With follicular and luteal cysts, pain is usually absent. Endometriotic and paraovarian tumors are often accompanied by pain in the lower abdomen and menstrual irregularities. Indirectly, the presence of such neoplasms may indicate problems with urination and defecation. Pain symptoms, a general deterioration in well-being, a sharp weight loss are typical signs of a malignant ovarian tumor.

In the initial stages, when the size of the cyst is insignificant, it can only be detected during a routine examination by a gynecologist. The presence of a neoplasm must be confirmed by ultrasound. The type of tumor is determined using markers, and if we are talking about a malignant neoplasm, then an additional consultation with an oncologist is prescribed.

What you need to know: without exception, all patients diagnosed with an ovarian tumor undergo additional examination.This can be not only ultrasound, but also computed tomography, which allows you to more accurately determine the location of the cyst. If a malignant tumor is suspected, a new examination technique can be used, which consists in measuring the blood flow velocity in the tumor-like formation. If it exceeds certain indicators, then there is a high probability that it is still cancer. And, of course, the most accurate diagnostic method is still taking tumor tissue for examination.

In the Irkutsk region, all women with ovarian tumors are examined by an oncologist without fail.If the diagnosis is confirmed, then it is often accompanied by the appointment of gastroscopy, ultrasound of the abdominal organs. This is done in order to exclude the possibility of the spread of metastases. If they are absent, then the patient is operated on in a regular city hospital.

Treatment options for ovarian tumors

If patients are diagnosed with endometriotic and paraovarian tumors, as well as malignant neoplasms, then the only way to treat them is surgery.

Please remember that with retention tumors there is no reason for panic if their size does not exceed 7-8 cm. In other cases, it is advisable to consider the issue of surgical intervention. Modern medicine is focused on organ-preserving surgeries, so ovarian cysts are removed in 90% of cases by laparoscopy, which is considered minimally invasive and minimizes side effects. Of course, it all depends on the experience and qualifications of the surgeon, but today abdominal operations are usually resorted to in exceptional cases when it comes to a tumor of more than 10-15 cm, which has developed quite quickly.Such an operation is also performed when it is not possible to preserve the ovaries. During laparoscopy, this organ is preserved, therefore, for women, I consider this method of treatment to be a real salvation. Laparoscopy can be performed when a follicular or luteal cyst is diagnosed. In this case, only the neoplasm itself is removed, and the ovary is not affected and fully retains its functions.

What are the advantages of such an operation? It is carried out on the day the patient enters the clinic, after which he remains under the supervision of doctors for another day, calmly moves away from anesthesia and does not worry about anything.The next day, a dressing is performed, a course of treatment is prescribed, which, if necessary, may include pain relievers. Then the patient goes home. In 5-7 days we are again waiting for him at the clinic to discuss the results of the histological examination of the tumor tissues and undergo a gynecological examination. Further, all the dependences on the results of the histological conclusion are already.

If you have problems with the ovaries, I ask – in any case, do not look for information on the Internet and do not diagnose yourself.In this case, it is worth contacting a gynecologist as soon as possible, and even better – a gynecologist-surgeon who knows what can be operated on and what is not. Such a specialist will tell you in what conditions the operation will be performed, whether it is possible to preserve the ovary, and why. He will also determine if an oncologist’s consultation is needed. I am ready to provide you with such assistance and to give explanations not only on such a common disease as ovarian tumor, but also to tell you about other, no less serious, gynecological diseases.

I would like to point out that treatment in a private medical center has its advantages. The patient has the opportunity to quickly undergo examination and receive medical assistance much faster than in a public hospital. Patients are also discharged from a private clinic much faster, which relieves them of the fear of the need to stay in medical institutions. In the private center, everyone is provided with modern comfortable wards with limited contact with other patients, which very often also positively affects the treatment and the general emotional state of a person.

If you are faced with a tumor of the ovaries, then I am waiting for you for a consultation at the private medical center “Life Line”. As a specialist, I am ready to answer your questions and find the most effective way to treat gynecological diseases.

Climax – Symptoms and treatment – Make an appointment

From the metro Nakhimovsky prospect (5 minutes walk)

From the Nakhimovsky Prospekt metro station, exit to Azovskaya Street, then after 250-300 meters turn left onto Sivashskaya Street, then after 40-50 meters turn right into the courtyard.

From the children’s clinic and maternity hospital in Zyuzino (10 minutes walk)

From the children’s clinic and the maternity hospital in Zyuzino, you need to go to Azovskaya street, then turn to Bolotnikovskaya street and, before reaching the narcological clinical hospital N17, turn left into the courtyard.

From metro Nagornaya (15 minutes)

From the Nagornaya metro station you can get to our medical center in 15 minutes, having traveled 1 metro stop.

From Varshavskaya metro station (19 minutes walk)

From the Varshavskaya metro station, it is convenient to take trolleybuses 52 and 8 from the stop “Bolotnikovskaya ulitsa, 1” to the stop Moskvoretsky market, then walk 550 meters

From metro Kakhovskaya (19 minutes walk)

From the Kakhovskaya metro station, go to Chongarsky Boulevard, follow Azovskaya Street, turn right onto Bolotnikovskaya Street, then after 40-50 meters (behind house number 20, turn to the left into the courtyard)

From the metro Chertanovskaya district Chertanovo (20 minutes)

From Chertanovo district to our medical center can be reached from Metro Chertanovskaya in 20 minutes or on foot in 35-40 minutes.

From Profsoyuznaya metro station (25 minutes)

Exit from the Profsoyuznaya metro station to Profsoyuznaya street. Further from Nakhimovskiy Prospekt, from the Metro Profsoyuznaya stop, drive 7 stops to the Metro Nakhimovskiy Prospekt stop. Further along Azovskaya street 7 minutes on foot.

From Kaluzhskaya metro station (30 minutes)

From the Kaluzhskaya metro station, you can take 72 trolleybus in 30 minutes. Exit from the metro to Profsoyuznaya street, from the Kaluzhskaya metro stop proceed to the Chongarskiy boulevard stop, then 7 minutes walk along Simferopol boulevard

From the prefecture of the SOUTH-WEST (YUZAO) district (30 minutes on foot)

From Sevastopolsky Prospect, turn onto Bolotnikovskaya Street, not reaching the narcological clinical hospital N17 100 meters, turn left into the courtyard.

From the metro station Novye Cheryomushki (40 minutes)

Exit from the Novye Cheryomushki metro station on the street. Gribaldi, then at the stop on Profsoyuznaya Street “Metro Novye Cheryomushki” by trolleybus N60 proceed to the stop Chongarskiy Boulevard, then 7 minutes walk along Simferopol Boulevard

90,000 Risk of breast cancer from hormone therapy for menopause is higher than previously thought

  • James Gallagher
  • BBC Science & Health Correspondent

Photo Credit, Getty Images

By According to a new study, an increased risk of breast cancer from exposure to hormone replacement therapy in postmenopausal women persists for more than a decade after treatment ends.

As found in a new large-scale study, scientists from the University of Oxford, the risk of breast cancer in these cases is twice higher than currently reported to women.

According to them, about a million cases of breast cancer in women in the West since the early 1990s could be caused by hormone replacement therapy (HRT).

What is hormone replacement therapy?

Menopause is the process where a woman stops menstruating and can no longer get pregnant naturally.

The average age at menopause in Britain is 51 years. This period is characterized by a sharp drop in the level of two hormones, estrogen and progesterone, which affects the state of the entire female body.

As a result, a woman may experience brief episodes of hot flashes throughout the body, which can occur at night and lead to increased sweating, mood swings, vaginal dryness and decreased libido.

Hormone replacement therapy replenishes the missing hormones, relieving the woman of unpleasant symptoms of menopause, and this complex therapy includes not only two main hormones, but also thyroid hormones (thyroid gland), growth hormones and testosterone – the effect of the last three in the course of this study is not was considered.

Women can receive HRT in various ways: orally, that is, by taking pills; transdermally, that is, through a patch, or by means of a cream, gel or suppositories. Their content varies. Some include only estrogen, others include synthetic progestogen to replenish progesterone levels.

However, all drugs have side effects, including an increased risk of cancer.

How high is the risk?

In a study, researchers from the University of Oxford have calculated that 6 out of 100 women who do not receive HRT will develop breast cancer between the ages of 50 and 69.

If women took estrogen and progestogen every day for five years, breast cancer occurred in 8 out of 100.

Thus, out of 50 women taking combined HRT, one will develop breast cancer as a result.

Fractional HRT, when a woman took estrogen daily and progestogen for about half a monthly cycle, resulted in one additional breast cancer in every 70 women.

Taking estrogen alone has produced one extra case in every 200 women, but estrogen as a separate hormone increases the risk of uterine cancer and is usually given only after uterine cancer has been removed.

Photo author, Getty Images

Photo caption,

Estrogen levels in the female body at different periods of life

What’s new in this?

It was well known that HRT increases the risk of breast cancer.

These data are given in the official recommendations for the appointment and use of hormone replacement therapy, and usually all the pros and cons are discussed by the patient with the attending physician.

What is new here is that this study shows that the risk of breast cancer lasts more than 10 years, that is, longer than previously thought.

“Previous estimates of the risk associated with HRT in menopause should be multiplied by two, given the increased risk that persists after the end of hormone intake,” says Professor Valerie Beral of the University of Oxford.

She also noted that hormone replacement therapy increases the risk of breast cancer at any age, according to a new study.

“There is a popular theory that if you start [HRT] before age 50, then there is supposedly no risk, but this is not so. This is just a myth, but it is very widespread,” the professor explained.

Is the method of producing HRT important?

However, estrogen therapy in the form of vaginal creams or suppositories does not increase the risk, since hormones in this case are delivered locally and do not enter the bloodstream directly. Thus, this method of HRT does not have all the advantages, but does not bear all the risks.

Which one to prefer?

To decide whether to take HRT or not, you need to weigh the pros and cons; this was the case before the new data was published, and it should be adhered to in the future.

“We don’t want to scare women, but we also don’t want to give them false assurances,” Professor Gillian Reeves of the University of Oxford told the BBC.

“We would like to hope that women will use this information to make a more informed decision about whether they want to start or continue HRT,” explains the professor.

British Royal College of Internal Medicine urged patients not to panic and continue to take the prescribed course of HRT, and, if necessary, discuss all their concerns with their doctor.

Baroness Delice Morgan, executive director of Breast Cancer Care and Breast Cancer Now, said: “All things being equal, many women will choose HRT as a necessary measure because it can be very effective against debilitating menopausal symptoms such as like hot flashes. To reduce the risk of breast cancer, it is usually recommended to take the lowest dose for a short period of time. ”

Photo author, Matthew Flintoff

Caption,

Louise Rivers does not regret starting hormone replacement therapy

What do the patients say?

Louise Rivers from Bracknell is 51 years old and started having symptoms of menopause three years ago.According to her, her head simply “turned off”, it was hard for her at work, her joints hurt, she slept badly, and moreover, migraines began.

The decision she made a year ago to start hormone replacement therapy was not easy for her, but the right one, she says.

“I definitely feel that it’s easier for me to concentrate, my confidence is back at work. I still have disruptions, migraines, but overall I feel much better than before,” says Louise.

According to her, the data of the new study is a reason to think, but she is not going to panic. HRT has restored her normal state of health, so she will discuss the pros and cons with her doctor again at the earliest opportunity.

Risk of HRT compared to others?

The figures below are from Cancer Research UK, one of the leading cancer research charities, but do not include new findings from scientists at Oxford University.

However, they give an idea of ​​what other factors increase the risk of breast cancer in women:

    90,089 2% of breast cancer cases in women in the UK are caused by HRT
  • 8% – overweight or obese
  • 8% – excessive alcohol consumption
  • 5% – refusal to breastfeed

Oxford University doctors have calculated that 1 million out of 20 million cases of breast cancer in Western countries since the early 1990s were caused by hormone replacement therapy, which women received during the period menopause.

About 12 million women in the West use HRT: about 6 million in North America and about the same in Europe, including 1 million in Britain.

How reliable is the new data?

Oxford scientists did not conduct any new independent research.

Instead, they analyzed data from 58 studies from around the world that looked at 108,000 women with breast cancer.

“This is aerobatics – what was done and how, and these conclusions cannot be ignored,” says Stephen Evans, professor of pharmacoepidemiology at the University of Hygiene and Tropical Medicine, London.

The same opinion is shared by Professor Emeritus of Applied Statistics at the Open University, Kevin McConway, who called the new work of Oxford scientists “a very thorough, excellent study.”

What is it like to experience menopause at 22

Photo author, Katy Johnston

Photo caption,

Doctors suggested that Katy temporarily introduce her body into a state of artificial menopause in order to relieve her of the extremely painful symptoms of endometriosis

Katie Johnston never thought that at 22 she would be able to understand and empathize with women going through menopause.

A student from the Scottish city of Aberdeen understands very well how a woman feels during menopause, because she is going through the same.

Doctors suggested that Katy temporarily enter her body into a state of artificial menopause in order to get rid of the extremely painful symptoms that accompany severe endometriosis. And Katie agreed.

According to the doctors’ plan, Katie will be in a state of artificial menopause for at least a year. To do this, she will be given hormonal injections every three months.

“Now my body is in a state of hormonal chaos,” says Cathy.

“I take hormone replacement therapy, I get feverish 4-5 times a day. I feel sick, I feel bad, my mood changes quickly. It’s a hormonal riot,” says Katie.

“It’s terrible, but still the symptoms of menopause are better than what happened to me when I could not leave the house at all,” she adds.

She tells how she lived for a whole year before starting treatment.

Katie’s periods were very painful due to endometriosis, accompanied by severe colic, vomiting and headache. She was desperate because the doctors did not understand how painful this condition was for her.

Endometriosis is a gynecological disease in which the cells of the endometrium – the inner layer of the uterine wall – grow outside this layer.

According to Katy, her condition was so bad that her studies at the university had to be suspended.

“I vomited 6-7 times a day. I couldn’t go outside, my head was spinning all the time,” says Katie.

Photo caption,

Every tenth woman in Britain is diagnosed with endometriosis

According to Katie, she felt very unhappy and lonely.

“I couldn’t leave the house, meet friends. I couldn’t do what I love so much – singing, for example,” says Katie.

According to her, it took the doctors several months to make a diagnosis, and she had to go through painful examination procedures.

During laparoscopy, she was diagnosed with an ovarian cyst and severe endometriosis. According to doctors, this is one of the most severe cases of endometriosis that they have ever observed in patients at this age.

After graduating from the University of Glasgow, Katy began to lose weight. During her illness, she lost 19 kg.

Photo caption,

Katie says menopause at 22 is a strange experience

She was recommended for surgery. During the operation, the doctor saw that one of Cathy’s fallopian tubes had grown to the size of the uterus.Then the doctor decided that the most correct way would be to enter her body into a state of artificial menopause, and then do another operation.

According to doctors, such a decision will give Katie a chance to have children in the future.

E ndometriosis: facts

  • Every tenth woman of reproductive age in Britain suffers from endometriosis
  • Endometriosis is the cause of infertility in 30-50% of cases
  • 1.5 million women in Britain suffer from endometriosis – about the same How much from diabetes
  • Usually it takes 7.5 years from the onset of the first symptoms to the diagnosis
  • The treatment of endometriosis in Britain is spent $ 10.9 billion a year
  • The causes of the disease are not exactly established, just as there are no ways treatments that guarantee success

After the artificial menopause treatment is over, Katy will have surgery.

“Menopause at 22 is one of the strangest things in the world,” says Kathy.

“They say to me:” We’re going to put your ovaries on hold. But will they work again? Can it be guaranteed? Doctors say yes, “says Katie.

Katie is now helping those who also suffer from endometriosis.

She started an account on a social network dedicated to combating this ailment so that women diagnosed with endometriosis do not feel alone.

“We women need to talk about our problems and share our experiences. We need to be able to talk to each other,” says Kathy.

HORMONAL REPLACEMENT THERAPY – in the Persona clinic Arkhangelsk

HORMONAL REPLACEMENT THERAPY

For European women, hormone replacement therapy (HRT) for menopause is common. Our attitude towards her is fear and distrust. Are we right? Or are the stereotypes outdated?

According to statistics, 55% of British women, 25% of German women, 12% of French women over 45 and … less than 1% of Russian women use HRT.Paradox: our women are afraid of HRT drugs, which are identical to their own hormones, they call them “chemistry”, but they calmly take antibiotics – a real foreign chemistry. We fearlessly drink hormonal contraceptives to avoid unwanted pregnancies, and refuse HRT, which helps at least to postpone unwanted old age. Maybe because we do not fully understand what we are losing?

Almighty

The imbalance of sex hormones, which grows after 40 years, is not only a gynecological problem.In fact, they rule our lives. “The name“ sex hormones ”is rather arbitrary,” says gynecologist-endocrinologist Sergei Apetov. – They not only affect the reproductive organs, but also perform a huge number of functions in the body: they monitor cholesterol levels, blood pressure, carbohydrate metabolism, the function of the bladder, and the calcium content in bones. They also help to overcome depression, stimulate libido and bring joy to life. ”

HRT is designed to support all of this.But hormone phobia is firmly rooted in the minds of our women. “On forums, ladies scare each other with horrors about HRT, from which they get fat, become covered with hair, or even get cancer. In fact, everything that is so feared happens without hormones: hypertension, diabetes mellitus, osteoporosis, heart attack, obesity and even hair growth, ”says Professor Kalinchenko.

When to start?

If menstruation has stopped, then there is no estrogen. Here, most women are sure, and old age begins.And they are deeply mistaken. Aging begins much earlier, when the amount of estrogen just starts to slide down. Then the first SOS signal goes to the pituitary gland, and it reacts by increasing the production of the hormone FSH (follicle-stimulating hormone). This is the first warning: the aging program has been activated.

Therefore, from the age of 35, it makes sense for every woman to control her FSH level every six months. If it starts to rise, then it’s time to replenish the estrogen deficiency.And not only them. “It’s more correct to talk about polyhormone therapy,” says Leonid Vorslov. “Almost all hormones decrease with age, and all of them need to be supported.”

Over the years, the level of only two hormones increases: leptin – a hormone of adipose tissue, and insulin, which leads to type 2 diabetes. If estrogen and testosterone are maintained with the help of HRT, then leptin and insulin will stop growing, which means that the risk of obesity, diabetes, atherosclerosis and other diseases will disappear.“The main thing is to start treatment on time,” continues Professor Vorslov. – As soon as the blood test records the growth of FSH, we can safely say that the amount of estrogen is steadily declining and already secretly begins to develop atherosclerosis.

But the problem is that the range of FSH norms is huge, and it is different for each woman. Ideally, you need to pass blood tests for hormones and biochemistry during the period of maximum prosperity – from 19 to 23 years. This will be your individual ideal norm. And starting from 45 years old, annually check the results with it.But even if you hear about FSH for the first time, it’s better late than never: at 30, 35, 40 it makes sense to find out your hormonal status so that closer to the critical age you have something to focus on.

Professor Vorslov assures: “If you prescribe HRT when the first precursors of menopause appear, you can prevent osteoporosis, coronary heart disease, hypertension, atherosclerosis, and many other diseases associated with aging. HRT is not an elixir of immortality, it will not give extra years of life, but it will greatly improve the quality of life. “

Analysis without analysis

Estrogen levels decrease if:

  • out of cycle,
  • papillomas appeared,
  • dry skin and mucous membranes,
  • pressure rises,
  • has atherosclerosis.

Testosterone levels decrease if:

  • decreased sex drive,
  • lost confidence,
  • overweight does not lend itself to diets,
  • the inner side of the shoulders has become flabby,
  • Habitual physical activity seems too hard.

Men’s protection

For a woman, not only estrogens are important, but also testosterone – a male sex hormone that is produced in the adrenal glands. Of course, we have less of it than men, but libido, insulin levels, general tone and activity depend on testosterone.

In the postmenopausal period, when estrogens and gestagens disappear, it is testosterone that will maintain the cardiovascular system for some time. Those who have initially high levels of this hormone will more easily endure climacteric syndrome, since testosterone is responsible for our activity and resistance to emotional stress.

It also protects us from age-related fragility of bones: the density of the periosteum depends on testosterone. That is why in the West, doctors prescribe to women not only estrogen-gestagenic HRT, but also testosterone. Testosterone patches for women have been certified since 2006. And in the near future, European pharmacists promise to create a comprehensive HRT: one tablet will contain both gestagen, estrogen, and testosterone.

Much stronger than impending fractures, many women are afraid of the excess weight growing after menopause.Moreover, at this age we get fat like an “apple”, that is, instead of lush, but feminine forms, we acquire an ugly belly. And here testosterone will also help: without it, it is impossible to resist the accumulation of fat.

2 facts about testosterone

HE RETURNS LIBIDO. A deficiency of this hormone can occur with the use of certain hormonal contraceptives – in particular, those that increase the level of the protein that binds testosterone. A vicious circle is formed: a woman drinks pills in order to have a full sex life, and as a result, she does not feel any desire.Testosterone supplementation can help in this situation.

WE ARE AFRAID OF HIM BY INERTIA. In the 50-60s of the last century, Soviet doctors prescribed testosterone for uterine fibroids, endometriosis and menopause. The mistake was that women were prescribed the same dosages as men – from this, unwanted hair did grow and other side effects occurred. Testosterone in the correct doses will do nothing but benefit.

Caution, doors are closing

For different ages, the dosage of hormones is different: there are drugs for women under 45, from 45 to 50, from 51 and older.In perimenopause (before menopause), high doses are prescribed, then they are gradually reduced.

Unfortunately, you can be late to jump on the last car of the departing train. If, for example, atherosclerosis has already developed, then he managed to close the receptors for estrogen, and no dose of the hormone will force them to act. That is why it is so important to start taking sex hormones as early as possible, even if the climacteric syndrome is not yet pressed: hot flashes, sweating attacks, insomnia, irritability, hypertension do not suffer.

There is a term “therapeutic window”. After 65 years, hormone therapy, as a rule, is not prescribed: sex hormones will no longer be able to properly engage in the work of the human mechanism. But if HRT is started on time, then it can be continued while the heart is beating. If there are no contraindications.

Hormones and beauty

Anna Bushueva, dermatocosmetologist of the department of therapeutic cosmetology of the “Clinic of Professor Kalinchenko”: – Any hormonal changes affect the condition of the skin.Cosmetological procedures themselves are effective only up to 40 years. After that, injections of hyaluronic acid, botulinum toxin, peels are only half the battle, first of all, you need to normalize the hormonal status.

When doing a circular lift, the excess tissue is trimmed off, but the quality of the leather remains the same. If there are no estrogens, the skin will be dry, dehydrated, lacking the proper amount of collagen and elastin. Wrinkles will appear over and over again. If you replace the level of estrogen with HRT, the emerging wrinkles will not disappear, but will stop deepening.And the weight will not increase.

A decrease in testosterone leads to a decrease in muscle mass – the buttocks are flattened, the cheeks and the skin of the inner surface of the shoulders sag. This can be avoided if testosterone preparations are included in the HRT course.

The case of contraindications

As an experiment, let’s go to a commercial diagnostic center. In response to the tale of hot flashes, insomnia, and disappeared libido, the doctor gives a huge list of tests, including complete blood chemistry, all hormones, pelvic ultrasound, mammography and fluorography.”Does HRT require a total examination?” – I wonder, calculating how much eternal youth will cost. “We must exclude all contraindications! What if you have an ovarian cyst or endometriosis? Or liver problems? After all, hormones “plant” the liver. And keep in mind that against the background of HRT, you will have to donate blood for hormones and do an ultrasound, first every three months, and then every six months! ”

After hearing all this, I lost heart. Goodbye youth. To drink hormones, you must have the health of an astronaut…

“Don’t be alarmed,” reassures gynecologist-endocrinologist Sergei Apetov. – Many medical centers really force you to take a lot of unnecessary tests before HRT. This is a relatively fair way of withdrawing money from the public. In fact, the list of contraindications and examinations is much shorter. ”

  • The two main contraindications to HRT are a history of breast or uterine cancer. Any non-hormone-dependent tumors, including cervical or ovarian cancer, are not a contraindication to HRT.On the contrary, the latest research suggests that HRT itself is capable of preventing the development of certain neoplasms (in particular, skin).
  • As for the ovarian cyst, it matters which hormones it depends on. If not from genital, but from pituitary hormones, then there are no obstacles to the appointment of HRT. By the way, cysts are formed when the pituitary gland produces a large amount of the already mentioned hormone FSH, and they just hint: it’s time to do HRT.
  • Fibroids and endometriosis are compatible with HRT in most cases.“Cases when uterine fibroids grew against the background of HRT are extremely rare,” says Sergey Apetov. “It is important to understand that the doses of sex hormones in modern drugs are hundreds of times less than in hormonal contraceptives, which everyone drinks indiscriminately.”
  • Diseases associated with increased thrombosis may be a contraindication. Most often they are hereditary. “Such women should be prescribed HRT with caution, in small doses, under the strict supervision of a doctor,” says Leonid Vorslov.”It is necessary to take measures to prevent new blood clots and do everything possible to dissolve the old ones.”
  • If a woman has suffered a real myocardial infarction (the one that happened due to coronary heart disease), then the time for HRT, alas, has been missed. “A heart attack at a relatively young age suggests that the woman had a long history of estrogen deficiency and caused the development of atherosclerosis,” explains Professor Vorslov. “But even so, there is a chance to start treatment with small doses of estrogen.”
  • Fibroadenoma (a benign breast tumor) can develop into cancer with estrogen doses. Therefore, if it is available, the doctor decides on the appointment of HRT individually.

Not everything is so scary

In many ways, hormone phobia was generated by the well-known study of American scientists conducted in the 80s of the twentieth century. It showed that hormones can be taken for no more than 5 years, since over this period, treatment is fraught with stroke, breast and uterine cancer.

“Don’t panic,” reassures Leonid Vorslov. – The results of this study have been severely criticized by scientists in other countries. First, in those years, HRT, unlike modern, was not safe for the heart and blood vessels. Secondly, only women aged 60 and over were included in the program, 25% of whom were over 70 years old. Moreover, without exception, everyone was given drugs in the same doses, which in itself is a big mistake! ”

So what about the analyzes?

There are no universal recommendations: it is necessary to pass those tests that will help to exclude contraindications.Plus some basic research.

  • Mammography, ultrasound of the uterus and ovaries are always required.
  • It is important to test your blood for clotting and glucose levels so you don’t miss diabetes.
  • If you are overweight, you should find out what is the reason. Is thyroid dysfunction causing increased prolactin production that leads to obesity? Or maybe the fault is the increased activity of the adrenal cortex, where hormones are produced that are responsible for the accumulation of fat?
  • The liver does not need to be tested unless you have complaints.“The claims that these drugs plant the liver are unsubstantiated,” says Sergei Apetov. “There is not a single study on this topic.”

After the appointment of HRT, it is enough to be examined once a year. It is also very important to remember when starting therapy: hormones are not a magic wand. The effect may be reduced due to improper nutrition. Anyone today knows what proper nutrition is: a lot of vegetables and fruits, lean meat, fish is required several times a week, plus vegetable oil, nuts and seeds.

How estrogens affect blood vessels

All arterial vessels are lined from the inside with a thin layer of endothelial cells. Their task is to expand or narrow the vessel in time, as well as to protect it from cholesterol and blood clots. The endothelium depends on estrogens: if suddenly it is damaged, estrogens help it to recover. When there are few of them, endothelial cells do not have time to recover. Vessels “grow old”: they lose elasticity, become overgrown with cholesterol plaques, and narrow. And since the vessels cover all organs, it turns out that estrogens act on the work of the heart, kidneys, liver, and lungs… Receptors for estrogen are found in all cells of a woman’s body.

Will herbs help?

Recently, phytohormones have been actively promoted as the best and safest remedy for menopause. And many gynecologists advise to drink dietary supplements with phytoestrogens during perimenopause.

Plant hormone-like substances really work, help to cope with hot flashes, insomnia, irritability. But few people know that against their background, endometrial hyperplasia (proliferation of the inner layer of the uterus) is more common.A similar property of estrogen and estrogen-like substances in standard HRT compensates for gestagen – it does not allow the endometrium to grow. Exclusively estrogen (without progestogen) is prescribed to women if the uterus is removed. True, recent studies show the beneficial effect of gestagen both on the central nervous system and on the mammary glands – it prevents the development of neoplasms. Unfortunately, unlike real estrogens, phytoanalogues do not in any way affect metabolism, calcium absorption, or the state of blood vessels.

Plant hormones are a compromise and salvation for those for whom real HRT is contraindicated. But doctor’s supervision and regular examinations are also necessary.

Conclusions of “Health”

  • HRT is by no means for pensioners. The sooner you figure out your ideal harmony of hormones, the longer, healthier and more beautiful you will live.
  • Hormonophobia are ancient horror stories. There are fewer contraindications to HRT than we are used to thinking.There is no reason for fear if there is a qualified doctor.
  • HRT will only be truly effective if you eat right and maintain a healthy lifestyle.

Diagnosis of the cause of female infertility and treatment in gynecology at the Litfond polyclinic

Conception of a child is an urgent problem for many families. The program “Diagnosis of the causes of infertility”, developed at the Polyclinic of the Literary Fund, can effectively help married couples to identify all the factors that led to infertility and to solve this problem.

What are the causes of female infertility?

Often, hormonal disorders are the cause of female infertility. This can lead to the absence of menstruation at all, or to the lack of maturation of the egg. In this case, violations can relate to both sex hormones and any others, for example, the thyroid gland, pancreas.

The figure below shows the menstrual cycle, egg development, changes in the endometrium and changes in hormonal levels (4 hormones) in a healthy woman.

Hormonal causes of infertility

Hormonal causes of infertility can be caused by abnormalities in the blood levels of such basic hormones as FSH (follicle-stimulating hormone), LH (luteinizing hormone), prolactin, estradiol, progesterone, testosterone, DEA sulfate and others. As a rule, a comprehensive study of the hormonal status allows you to identify this cause and begin effective treatment of the identified disorder (s).

Problems with ovulation

If a woman does not have a regular menstrual cycle, or if the menstrual cycle is less than 21 days or more than 35 days, then there is a risk that the egg does not mature or is not viable.

At the same time, in almost half of cases of absence of ovulation, the ovaries do not produce mature follicles, from which eggs could then develop. Therefore, ovulation is impossible, mature eggs do not appear, sperm have nothing to fertilize. This is the most common cause of female infertility.

The main purpose of examining women in this direction is to trace all stages of the formation, maturation and release of an egg, ready for fertilization. The examination can reveal a violation at one of the stages or deny the presence of a violation in the maturation of the egg.

Ovarian dysfunction

Ovarian dysfunction (disruption of the formation of a “young” egg [follicle]) in 20% of cases is the result of hormone production disorders in the hypothalamus-pituitary gland. If the activity of this system is disrupted, the corresponding signals do not enter the ovaries, and therefore the rhythmic production of hormones is disrupted. Luteinizing hormone (LH) and follicle-stimulating hormone (FSH) are produced in too much or too little, or their ratio is disturbed.Accordingly, the maturation of the follicle is disrupted, the egg cell either does not mature at all, or is not viable.

The easiest way to control the formation of follicles is an ultrasound examination (ultrasound) of the ovaries, which is performed on the seventh to ninth day of the menstrual cycle. At least several follicles should form in one ovary.

Early climax

Early menopause is rarely the reason for the lack of ovulation. The usual age for a woman’s menopause is 45-55 years, but in some women, the reserves of eggs, for unclear reasons, are depleted earlier, menstruation stops before the age of 45.Many doctors are not inclined to consider this condition the norm and speak of ovarian failure syndrome. In some cases, this condition can be overcome with the help of hormonal treatment, physiotherapy, even the activation of sexual activity.

Polycystic ovary

Polycystic ovary disease is a hormonal change that results in the production of many dysfunctional (non-functional) follicles.

Among several follicles, one must mature – the dominant one, that is, surpassing the others in size and directly involved in ovulation.This happens closer to the middle of the menstrual cycle (on the 11-13th day). And this can be observed during the ultrasound examination. Late and inadequate maturation of the dominant follicle can be the cause of infertility. This problem of infertility, called polycystic ovary disease, is common.

Polycystic ovary disease leads to both disturbances in the exchange of hormones and changes in the ovaries. Outwardly, it is manifested by increased hair growth, menstrual irregularities or even amenorrhea, lack of ovulation, infertility.In polycystic disease, production of (FSH) is reduced, although levels of (LH), estrogen and testosterone are normal or elevated. It is believed that low FSH levels cause permanent underdevelopment of ovarian follicles and therefore a lack of mature eggs. At the same time, a lot of follicular cysts up to 6-8 mm in size are formed, which can be easily seen using ultrasound examination (ultrasound). The affected ovary is usually enlarged 2 times, its surface is covered with a smooth white capsule, through which even a mature egg cannot pass.This disease can be successfully and adequately treated.

Inflammatory process in the ovaries

The matured dominant follicle should rupture the ovarian membrane. With inflammation, the wall thickens significantly, respectively, the follicle cannot leave the ovary. This is another reason for infertility. Before you start trying to get pregnant, it is necessary to analyze for the presence of latent infections, including genital, because it is they that most often cause a sluggish inflammatory process in the ovaries and affect both conception and the course of pregnancy.

Damage to the fallopian tubes

Damage to the fallopian tubes – their complete obstruction, as well as altered tube mobility.

The egg that has emerged from the dominant follicle and is ready for fertilization is sent to the fallopian tubes and is there, waiting for the sperm. Naturally, if the patency of the tubes is impaired, fertilization will be extremely difficult.

Most often, the tubes are damaged as a result of inflammation caused by sexually transmitted infections.At the same time, violations in the tubes can be very different – from damage to the cilia lining the tubes from the inside to the formation of hydrosalpinx (accumulation of fluid in the fallopian tube, sealed as a result of inflammation).

To determine the patency of the fallopian tubes, hysterosalpingography is used. The essence of this method is that a contrast agent is injected into the uterine cavity, and under X-ray control, the movement of the contrast along the fallopian tubes and its penetration into the abdominal cavity is checked, there is also a sonohysterography method – checking the patency of the fallopian tubes using ultrasound.

Disorders of the structure of the uterus

Any formations that deform the uterine cavity act like an intrauterine device, preventing the egg from attaching to the endometrium. Such diseases include polyps of the uterine mucosa, uterine fibroids, endometrioid formations, as well as congenital anomalies in the development of the uterus – saddle, bicornuate uterus, uterus with incomplete septum, complete doubling of the uterus, and others.

Many diseases affect the quality of the cervical mucus.If it is too thick, then the sperm cannot overcome it. If the mucus is poisonous to sperm (by chemical composition or due to immune characteristics), then they will simply die.

True cervical erosion , as well as cervical polyps of the cervical canal can cause infertility due to changes in mucus, and therefore require mandatory removal before starting fertility treatment.

Endometriosis

Normally, endometrial cells form the inner surface of the uterus, help the embryo to feed, and in the absence of pregnancy participate in menstruation.In endometriosis, endometrial cells grow, forming something like polyps or deep “pockets” in the thickness of the uterus, can penetrate into the fallopian tubes, ovaries and even into the abdominal cavity. Endometriosis disrupts the maturation of the egg, interferes with the fusion of the egg and sperm, and also disrupts the attachment of the fertilized egg to the uterine wall.

Psychological reasons

Psychological reasons also cause infertility. Known conditions such as wartime amenorrhea, stressful amenorrhea, even examination amenorrhea, when stress disrupts the functioning of hormone-dependent organs.

The psychological causes of idiopathic infertility (infertility of unknown origin). A woman (less often a man) subconsciously developed a negative attitude towards a possible pregnancy, and therefore the body itself does not automatically allow the processes leading to conception to occur.

If all those causes of infertility, which have already been mentioned, are absent in a married couple, then in this case, infertility treatment is not required. For conception, then a significant factor is the synchronization of the time of the “meeting” of the sperm with the egg.A ripe egg can “wait for a meeting” with a sperm from 12 hours to several days.

Absolute female infertility (IVF indication)

Absolute female infertility – the absence or persistent obstruction of the fallopian tubes – is an indication for in vitro fertilization with subsequent transfer of embryos into the mother’s uterus (IVF).

With all types of infertility, except for absolute, as a rule, it is possible to carry out treatment that allows you to become pregnant naturally and prepare the body for the normal course of pregnancy and childbirth.

Make an appointment with a gynecologist by phone +7 (495) 150-60-01

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