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Ovarian Cysts - Causes, Sign & Symptoms, Diagnosis And Treatment - Information on Ruptured Ovarian Cyst

Usually ovarian cysts are nonneoplastic sacs on an ovary that contain fluid or semisolid material. Although these cysts are usually small and produce no symptoms, they require thorough investigation as possible sites of malignant change.

Common ovarian cysts include follicular cysts, lutein cysts (granulosalutein [corpus luteum] and thecalutein cysts), and polycystic (or sclerocystic) ovarian disease. Ovarian cysts can develop anytime between puberty and menopause, including during pregnancy. Granulosalutein cysts occur infrequently, usually during early pregnancy. The prognosis for nonneoplastic ovarian cysts is excellent.

Causes of ovarian cysts

Follicular cysts are generally very small and arise from follicles that overdistend instead of going through the atretic stage of the menstrual cycle. When such cysts persist into menopause, they secrete excessive amounts of estrogen in response to the hypersecretion offollicle-stimulating hormone and luteinizing hormone that normally occurs during menopause.

Granulosa-lutein cysts, which occur within the corpus luteum, are functional, nonneoplastic enlargements of the ovaries caused by excessive accumulation of blood during the hemorrhagic phase of the menstrual cycle.

Theca-lutein cysts are commonly bilateral and filled with clear, straw­colored fluid; they are often associated with hydatidiform mole, choriocarcinoma, or hormone therapy (with humaly chorionic gonadotropin [HCG] orclomi­phene citrate).

Polycystic ovarian disease is part of the Stein-Leventhal syndrome and stems from endocrine abnormalities

Signs and symptoms of ovarian cysts

Small ovarian cysts (such as follicular cysts) usually don't produce symptoms unless torsion or rupture causes signs of an acute abdomen (abdominal tenderness, distention, and rigidity). Large or multiple cysts may induce mild pelvic discomfort, low back pain, dyspareunia, or abnormal uterine bleeding secondary to a disturbed ovulatory pattern. Ovarian cysts with torsion induce acute abdominal pain similar to that of appendicitis.

Granulosa-lutein cysts that appear early in pregnancy may grow as large as 2" to 2M" (5 to 6 cm) in diameter and produce unilateral pelvic discomfort and, if rupture occurs, massive intraperitoneal hemorrhage. In non pregnant women, these cysts may cause delayed menses, followed by prolonged or irregular bleeding. Polycystic ovarian disease may also produce secondary amenorrhea, oligomenorrhea, or infertility

Diagnosis of ovarian cysts

Generally, characteristic clinical features suggest ovarian cysts. Visualization of the ovaries through ultrasound, laparoscopy, or surgery (often for another condition) confirms ovarian cysts.

Extremely elevated HCG titers strongly suggest theca-lutein cysts.

In polycystic ovarian disease, physical examination demonstrates bilaterally enlarged polycystic ovaries. Tests reveal slightly elevated urinary l7-ketosteroid levels and anovulation (shown by basal body temperature graphs and endometrial biopsy). Direct visualization must rule out paraovarian cysts of the broad ligament, salpingitis, endometriosis, and neoplastic cysts

Treatment of ovarian cysts

The type of cyst dictates the treatment method.

Follicular cysts

This type of cyst generally doesn't re­quire treatment because it tends to disappear spontaneously within 60 days. However, if it interferes with daily activities, administration of oral clomiphene citrate for 5 days or I.M. progesterone (also for 5 days) reestablishes the ovarian hormonal cycle and induces ovulation. Oral contraceptives may also accelerate involution of functional cysts (including both types of lutein cysts and follicular cysts).

Granulosa-lutein and theca-lutein cysts

If granulosa-lutein cysts occur during pregnancy, treatment is symptomatic because they diminish during the third trimester and rarely require surgery. The calutein cysts disappear spontaneously after elimination of the hydatidiform mole, destruction of chorio carcinoma, or discontinuation of HCG or clomiphene citrate therapy.

Polycystic ovarian disease

Treatment of polycystic ovarian disease may include the administration of such drugs as clomiphene citrate to induce ovulation, medroxyprogesterone acetate for 10 days of every month for the patient who doesn't want to become pregnant, or low-dose oral contraceptives for the patient who needs reliable contraception.

Surgery, in the form of laparoscopy or exploratory laparotomy with possible ovarian cystectomy or oophorectomy, may become necessary if an ovarian cyst is found to be persistent or suspicious.

Natural herbal home remedies for ovarian cysts

  • The herb Red Clover (which specifically thins the walls of cysts and encourages the cysts to rupture much earlier in their cycle) along with the herbs Pulsatilla, Phytolacca, Chamomile, Blue Flag, St Mary's Thistle and Chaste Berry. To these I add the Bach Flower Remedies Walnut, Honeysuckle, Red Chestnut, Wild Oat and Impatiens. This mix is taken three times daily, preferably in a glass of cold Rosehips Tea, and continued for 3 to 6 cycles to clear all existing ovarian cysts and to discourage the formation of new ones. Some women are best remaining on this mix for much longer and there is absolutely no harm in doing so.
  • Echinacea appears to be more effective when taken on a slightly infrequent basis. Take it for 10 days, take a three-day break, and then repeat for another 10 days.
  • The B-complex vitamins are needed by your liver to convert excess oestrogen into weaker and less dangerous forms. B vitamins are, therefore, essential, when you are working to balance your hormone levels.
  • Ovarian Cyst Tincture : -1 teaspoon each tinctures of burdock root, vitex berries, red raspberry leaves and motherwort leaves. ½ teaspoon each tinctures of prickly ash bark and ginger rhizome. Combine these ingredients. Take half a dropperful 2 or 3 times a day.

Special considerations

Carefully explain the nature of the particular cyst, the type of discomfort­if any-that the patient is likely to experience, and how long the condition is expected to last.

  • Preoperatively, watch for signs of cyst rupture, such as increasing abdominal pain, distention, and rigidity. Monitor vital signs for fever, tachypnea, or hypotension, which may indicate peritonitis or intraperitoneal hemorrhage. Administer sedatives, as ordered, to ensure adequate rest before surgery.
  • Postoperatively, encourage frequent movement in bed and earlyarnbulation as ordered. Early arnbulation effectively prevents pulmonary embolism.
  • Provide emotional support. Offer appropriate reassurance if the patient fears cancer or infertility.

CLINICAL TIP Before discharge, advise the patient to increase her activities at home gradually - preferably over 4 to 6 weeks. Tell her to abstain from intercourse and to use tarmpons and douches during this period.

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