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Does a hysterectomy cause ovarian cysts? I never had cysts prior to my hysterectomy, but I have them now.

A hysterectomy does not directly cause ovarian cysts, but they can and do occur after a hysterectomy.

During the monthly menstrual cycle, even after a hysterectomy, a functional ovarian cyst forms on the surface of a woman’s ovary. During ovulation, the cyst opens and releases the maturing egg. If the cyst does not open to release the egg, it can fill with fluid forming a follicular cyst.

A corpus luteum cyst can occur if the egg has been released but the cyst closes again. This type of cyst often contains a small amount of blood.

Most cysts are harmless and resolve on their own, but some may cause symptoms and pain and require medical or pharmaceutical intervention. In some cases, surgery may be required to remove the cyst.

For some women, it does seem like having a hysterectomy has opened the door to ovarian cysts. There are a couple plausible explanations for why this might seem to occur.

One, the blood supply to the ovaries can be interrupted during a hysterectomy, which can cause the ovaries to malfunction. Ovary malfunction can create a hormone imbalance and, therefore, more cysts.

Two, if you used some type of hormonal treatment prior to your hysterectomy that stopped ovulation, this could have stopped the cysts from forming as well. When those hormonal treatments are discontinued after your hysterectomy, the ovaries should return to their normal cycle of ovulation and the formation of functional cysts.

In general, functional cysts should not be painful. However, there are a variety of cysts, so talk to your doctor if you experience symptoms such as pelvic fullness, pressure, or discomfort. Other symptoms of an ovarian cyst can include sudden sharp pain accompanied by nausea and pain with intercourse.

The earlier the cyst is found, the less invasive the treatment might be and the higher the chance of a complete recovery.

This content was written by staff of HysterSisters.com by non-medical professionals based on discussions, resources and input from other patients for the purpose of patient-to-patient support.

08-09-2011 – 07:05 PM

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Lauren Streicher, M.D. Gynecologic Specialists of Northwestern, S.C 680 N. Lake Shore Dr., Suite 117 Chicago IL 60611 (312)654-1166	Ted Lee, M.D. Magee Womens Hospital 300 Halket Street Pittsburgh PA 15213 412 641 6412	Lori Warren, M. D. 3900 Kresge Way Suite 30 Louisville KY 40207 502-891-8700
Joseph S. Valenti, M.D. 2805 S. Mayhill Road Denton TX 76208 940 591-6700	Arnold Advincula, M.D. Columbia Ob/Gyn Midtown 51 West 51st St, 3rd FL New York NY 10019 (855) 75-OBGYN	Ellen Wilson, M.D. 5323 Harry Hines Blvd – Dept of OBGYN Dallas TX 75390 214-648-4747
Debra Richardson, M.D. Gynecological Oncology Clinic – SW Med 2201 Inwood Road Suite 106 Dallas TX 75390 214-645-4673	Mayra J. Thompson, M.D. 5323 Harry Hines Blvd Dept OBGYN Dallas TX 75290 214-645-3888	Ken Sinervo, M.D. 1140 Hammond Dr., Ste. F6220 Atlanta GA 30328 770-913-0001

Case Report and Concise Review of the Reported Cases

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AbstractIntroductionCase PresentationDiscussionEthical ApprovalConsentConflicts of InterestReferencesCopyrightRelated Articles

Ovarian torsion after hysterectomy is a rare event. The diagnosis of ovarian torsion is challenging because symptoms are nonspecific. We present a case of ovarian torsion 2 years after laparoscopic hysterectomy (LH). Furthermore, we performed a literature review about ovarian torsion after hysterectomy. This case shows that, in cases of acute onset pelvic pain in patients with history of hysterectomy, the adnexal torsion must be kept in mind in the differential diagnosis, especially in those women who had undergone LH.

1. Introduction

Ovarian torsion accounts for 2-3% of all acute gynecological emergencies. It remains a clinically difficult diagnosis as the symptoms are usually nonspecific. Ovarian torsion can occur at any age and also after hysterectomy [1]. Although hysterectomy with ovarian conservation is not a risk factor for torsion [1], it seems to be more frequent after laparoscopic hysterectomy [2]. Therefore, despite it is a rare event, its prevalence could increase in the future with the widespread use of laparoscopic approach. We present a case of ovarian torsion after a laparoscopic hysterectomy and performed a literature review about reported cases.

2. Case Presentation

A 41-year-old woman, gravida 3, para 3, was admitted to our institution with a 12-hour history of acute onset pelvic pain, nausea, and vomiting. She had undergone total laparoscopic hysterectomy 2 years previously. The abdominal exam revealed mild distention and tenderness over the right lower quadrant. Vaginal examination revealed exquisite pain in the right vaginal fornix and the finding of a painful adnexal mass in the rectovaginal pouch of Douglas. Transvaginal ultrasonography showed a 60-mm cystic lesion in the right ovary with moderate ascites. We performed an exploratory laparoscopy and found a right adnexal torsion (Figure 1) and a right adnexectomy was successfully performed. Since the left ovary was normal a left ovariopexy was also performed.

3. Discussion

Ovarian torsion after hysterectomy is a rare event with a prevalence of 7. 91/1000 hysterectomies [2]. Although hysterectomy is not a risk factor for ovarian torsion [1], it has been estimated that approximately 8% of adnexal torsions occur in patients with previous hysterectomy [3, 4]. To date, there are no data on how different hysterectomy techniques may affect the risk of future ovarian torsion. However, several cases of ovarian torsion have been reported after laparoscopic hysterectomy (LH) (Table 1), while to our knowledge, only one case has been published after abdominal approach [6]. This could be explained by the fact that laparoscopic approach has been associated with both fewer postoperative adhesions [7] and less adhesion-related complications [8] when compared to laparotomy, in both gynecologic and pelvic surgery. The latter could be a direct consequence of the lesser peritoneal trauma and less inflammatory response during laparoscopy [9, 10]. Moreover, our technique of LH [11] includes a wide fenestration of the broad ligament, which is left open after surgery. Based on our observations, the ovaries remain much more movable after LH when compared to open approach (due to the skeletonization of infundibulopelvic ligament). For that reason, we perform prophylactic oophoropexy after hysterectomy only when the infundibulopelvic ligament has been excessively skeletonized and the ovaries remain too much mobile. However, in agreement with other authors [12, 13], we perform systematic oophoropexy in cases of recurrent torsion, excessive length of utero-ovarian ligament, torsion of a solitary adnexa, or contralateral pexy in case of adnexectomy of the twisted adnexa.

This case shows that, in cases of acute onset pelvic pain in patients with history of hysterectomy, the adnexal torsion must be kept in mind in the differential diagnosis, especially in those women who had undergone LH. In addition, we encourage that, during LH with ovarian conservation, the fenestration of the broad ligament should be performed in the direction of the uterine artery and not towards the infundibulopelvic ligament, in order to keep the ovary more fix to the pelvic sidewall.

Ethical Approval

The retrospective observational nature of the study did not necessitate the local Institutional Ethics Committee approval. Institutional Review Board exemption was obtained.

Consent

Written informed consent was obtained from the patient for publication of the case report and accompanying images.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this article.

References

1. V. Asfour, R. Varma, and P. Menon, “Clinical risk factors for ovarian torsion,” Journal of Obstetrics & Gynaecology, vol. 35, no. 7, pp. 721–725, 2015.

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2. R. Mashiach, M. Canis, K. Jardon, G. Mage, J.-L. Pouly, and A. Wattiez, “Adnexal torsion after laparoscopic hysterectomy: description of seven cases,” The Journal of the American Association of Gynecologic Laparoscopists, vol. 11, no. 3, pp. 336–339, 2004.

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3. D. Houry and J. T. Abbott, “Ovarian torsion: A fifteen-year review,” Annals of Emergency Medicine, vol. 38, no. 2, pp. 156–159, 2001.

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6. A. Elhjouji, O. Zahdi, H. Baba et al., “Adnexal torsion after abdominal hysterectomy: a first observation,” Pan African Medical Journal, vol. 22, article 9, 2015 (French).

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Copyright

Copyright © 2018 Demetrio Larraín et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Medlux gynecologist talks about hysterectomy and ovarian cyst

Why the uterus is removed and the importance of regular examinations: Medlux gynecologist about women’s health

For example, gynecologists advise to undergo an examination at least once a year, but how many follow this recommendation, especially if nothing bothers you? The gynecologist of the medical center “Medlux” Elena Alexandrovna Koshmeleva in today’s material tells what gynecological diseases are most common in women, what signals of your body you should pay attention to and what symptoms you should visit the dentist.

Of the most common diseases and discharges

The most common diseases encountered in my practice are uterine fibroids, endometriosis, ovarian cysts, bleeding and menstrual irregularities.

Also, quite often, patients are treated with the fact that they are concerned about the discharge. In most cases, this is normal, there should be discharge, as they are associated with the menstrual cycle. At the beginning of the cycle, they are insignificant, in the middle their number increases and by the end it decreases again. They should be transparent, white, odorless, the main thing is not to bring discomfort. In inflammatory diseases of the pelvic organs, women are concerned about discharge with an unpleasant odor, uncharacteristic color and texture. In such cases, a consultation with a gynecologist is required.

Lack of natural secretions tends to be more common in women aged 35–45 and closer to 50 years. Often, patients are concerned about itching, burning, discomfort in the vagina in everyday life or during intercourse, bleeding. As a rule, the reasons in this case may be hormonal changes in the woman’s body or the side effects of medications taken, as well as the use of certain hygiene products. If there is no discharge for a long time, then this is an occasion to contact a gynecologist to restore the vaginal microflora.

About uterine fibroids

Uterine fibroids is a benign tumor of the muscular and connective tissue of the uterus. Predisposing factors for the development of this disease are usually hormonal disorders, menopause, intrauterine interventions (curettage, abortion, miscarriages), as well as the absence of a history of childbirth.

Uterine fibroids can be accompanied by pain in the lower abdomen and lower back, sensations of a foreign body in the abdomen, frequent urge to urinate, heavy menstrual bleeding and bleeding in the middle of the cycle. As a result, hemoglobin may decrease, which negatively affects the general state of health and worsens the quality of life of a woman.

If a fibroid is detected on an ultrasound, you should immediately contact a gynecologist, since a timely visit to a doctor solves the problem with minimal trauma. Depending on the location and size of the myomatous node, the doctor will determine the tactics of treatment. If single nodes are located in the thickness of the uterus and up to 3-3.5 centimeters in size, it is enough to observe them twice a year on ultrasound.

Surgery for fibroids is prescribed when the symptoms that were mentioned earlier appear. Removal of fibroids surgically with preservation of the uterus occurs using laparoscopy, hysteroscopy or hysteroresectoscopy. As a rule, in the reproductive age up to about 48 years, we try to save the uterus in patients who have not realized their reproductive function, in order to prepare for pregnancy. But again, it all depends on the patient and indications for surgical treatment.

About hysterectomy

Removal can be prescribed for fibroids when the uterus has reached a sufficiently large size – corresponds to 12 weeks of pregnancy or more. If the myomatous nodes grow in menopause, there is onco-alertness and the tumor can become malignant, then the removal of the uterus will also be required.

After the removal of the uterus, the woman stops menstruating, she will not be able to endure and give birth to a child. If the ovaries are preserved, they continue to function, maintain youth and female beauty, and all cyclical monthly changes in the body are also preserved. And menopause occurs not after the removal of the uterus and the disappearance of menstruation, but upon a change in the functioning of the ovaries.

There is a myth that after the removal of the uterus, a void remains, but this is not so, the abdominal organs fill the space. There is also an opinion that after such an operation a woman will age dramatically, but this, as a rule, can happen after the removal of the ovaries. Many patients think that if they have their uterus removed, they will no longer be a woman. But after all, the feminine principle is not concentrated in the uterus at all.

Removal of the uterus in no way affects intimate life – the uterus does not affect orgasm, sexual desire or arousal, especially sensations.

Prolapse of the uterus

Women under 40 may experience incontinence during exercise, coughing, sneezing – these may be signs of uterine prolapse. Also, the symptoms include squelching sounds during bathing, sexual contact, and the partner’s changed sexual behavior – a longer achievement of orgasm. All this may indicate changes in the anatomy of the pelvic organs.

After 40 years, the prolapse of the uterus can be signaled by heaviness in the lower abdomen, sensations of protrusion of the vagina, impaired defecation and urination. With all of the above symptoms, you should immediately consult a doctor.

The reason for the prolapse of the uterus lies in connective tissue dysplasia, that is, in a weak ligamentous apparatus and muscular frame. Provoking factors for the occurrence of this disease can be childbirth, which was accompanied by ruptures and injuries of the perineum, excessive physical activity with weight lifting, overweight, a sedentary lifestyle, chronic diseases (chronic bronchitis, chronic obstructive pulmonary disease, bronchial asthma, and others), which lead to an increase in intra-abdominal pressure.

At a young age and in the initial stages, the disease can be eliminated with the help of pelvic floor muscle training and, of course, lifestyle changes. He often plays a major role in correcting the situation, because overweight, sedentary lifestyle and excessive exercise can provoke a relapse.

About ovarian cysts

There are corpus luteum cysts and functional ovarian cysts, which are formed in the course of their natural work. They can appear due to hormonal disorders and be asymptomatic.

Functional cysts and cysts of the corpus luteum, as a rule, dissolve on their own in 2-3 menstrual cycles. If a cyst is found on an ultrasound examination, it is necessary to prescribe it again after 2-3 months in order to observe the condition – the cyst has resolved or not. If not, then this may be a reason for an in-depth study, the delivery of tumor markers and surgical treatment.

There are also benign cysts – serous, endometrioid, dermoid. The latter, as a rule, contain fat, hair, cartilage and are subject to surgical treatment, since over time they can increase and affect the tissues of the ovary. As for serous and endometrioid cysts, depending on age, tumor size, reproductive plans, treatment can be conservative and operative. If conservative therapy fails, then surgical treatment is prescribed.

Cysts can lead to ovarian oncology and reproductive dysfunction, it all depends on the specific clinical situation, the age of the patient. Therefore, if a cyst is detected on an ultrasound examination, you should immediately contact a gynecologist. The doctor will tell you how to be, perhaps it is worth limiting physical activity, ensuring sexual rest, so as not to cause a rupture or twisting of the cyst, and promote resorption.

About prevention

In what cases should you contact a gynecologist? I will list the main ones: pain in the lower abdomen, a change in the nature and duration of menstruation, the appearance of unusual discharge, a feeling of discomfort, a foreign body in the perineum. If a change in the size of the abdomen is suddenly discovered, if pregnancy does not occur during the planning year.

In general, it is advisable to visit a gynecologist for a preventive examination once a year, even in the absence of complaints. This, as a rule, allows you to identify diseases at an early stage or to make sure that they are absent.

You can sign up for a consultation by calling 8(3022)200-300

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postoperative period and recovery after surgery, rehabilitation after cyst removal

An ovarian cyst is a benign neoplasm filled with fluid and prone to accumulation of secretions. With prolonged development of a cyst, women experience pain, menstruation is disturbed, and other signs of the disease appear. Laparoscopy of an ovarian cyst, after which rehabilitation is faster, allows not only to eliminate the tumor, but also to preserve women’s health.

Multidisciplinary Yusupov Hospital is a modern medical institution where a woman can not only be examined and receive the necessary treatment, but also undergo rehabilitation after surgery. Recovery after laparoscopy of an ovarian cyst is carried out according to programs individually developed by a team of doctors.

Recovery after laparoscopy of an ovarian cyst

Laparoscopy is a minimally invasive procedure used by Yusupov hospital specialists in the treatment of various diseases, in particular, the removal of an ovarian cyst. This operation is performed under general anesthesia, during which three punctures are made in the abdomen, through which a small camera and instruments are inserted. For the convenience of performing the operation, the abdominal cavity is inflated with a special gas.

The next step is to recover from the removal of an ovarian cyst. The duration of early rehabilitation in the hospital does not exceed 7 days. Patients of the Yusupov hospital are accommodated in comfortable wards equipped with the necessary furniture, communications and necessary accessories.

After the removal of the ovarian cyst by laparoscopy, the postoperative period in the Yusupov hospital passes under the guidance of experienced oncologists, rehabilitation specialists, and surgeons. Particular attention is paid to the patient during the period of recovery from anesthesia, when she is at her weakest.

Complications after laparoscopy of an ovarian cyst

The laparoscopic method is the most gentle in comparison with other methods, therefore, subject to medical recommendations, recovery is carried out in the shortest possible time. However, due to various circumstances, patients may experience complications after removal of an ovarian cyst.

Negative consequences that may occur after laparoscopic intervention are:

• damage to neighboring tissues and organs as a result of insufficient visibility;
• heavy bleeding;
• vascular injury;
• allergic to anesthesia or gas;
• fever;
• the development of infectious diseases as a result of the weakness of the body.

Specialists of the Yusupov hospital are fluent in the technique of laparoscopy, during the removal of the tumor they make precise movements without damaging nearby tissues. If a patient of the Yusupov hospital has an ovary pain after laparoscopy of a cyst, specialists not only take the necessary measures to improve the woman’s condition, but also find out the causes of the pain.

Pain after removal of an ovarian cyst

Patients most often experience pain after laparoscopy of an ovarian cyst, which can last up to 7 days. This symptom is a natural reaction of the body to damage, it is carried out after the healing of the sutures.

If the patient has pain in the ovary after removal of the cyst, she is shown bed rest, in addition, it is recommended not to make sudden movements and adhere to certain dietary rules. Medicines are prescribed by the attending physician with increased pain.

Menstruation after laparoscopy of ovarian cyst

Women who have undergone laparoscopy may start their periods on time or be up to two months late, depending on the individual patient. However, if menstruation began without delay, then the chances of conception increase significantly. After laparoscopy of an ovarian cyst, the nature of menstruation may change, the danger for a woman is prolonged and heavy bleeding.

Discharge after laparoscopy of an ovarian cyst

After laparoscopic ovarian cyst removal, many women experience intense vaginal discharge of mucus, blood and clots that can last up to two weeks. After laparoscopy of the ovarian cyst during the week, the discharge is intense, but in the second week the discharge decreases.

Pathological discharge arising from complications is characterized by an unpleasant odor, green or yellow tint. Curdled abnormal discharge indicates the development of an infectious process in the genital tract.

Specialists of the Yusupov hospital are attentive to each patient, therefore, when pathological signs and complications appear, their signs are identified and therapeutic measures are prescribed, the condition after laparoscopy of the ovarian cyst is assessed. Diagnostics carried out at each stage of treatment makes it possible to identify possible disorders and determine the effectiveness of therapy.

Sports after laparoscopy of an ovarian cyst

Recovery after laparoscopy of an endometrioid ovarian cyst requires a moderate activity regimen. So, in the first days after the operation, physical activity is strictly limited. After a week of recovery and bed rest, a woman can take short walks and do light gymnastics. Motor activity helps to eliminate stagnant processes in tissues and strengthen muscle tissue.

Training and serious sports activities in a woman who underwent laparoscopy of an ovarian cyst should be postponed for 4 months in the postoperative period. The specialists of the rehabilitation clinic, together with the patient’s attending physician, draw up an individual recovery program, one of the components of which is physiotherapy exercises.

Rehabilitation after removal of an ovarian cyst in Moscow

Some patients underestimate rehabilitation after removal of an ovarian cyst by laparoscopy.