Monday, October 12, 2015


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This is one problem that is not always a disease. Ovarian cysts develop in many women who do not even realise that they have them. The reason for this is that at about the period of menstruation, the ovary which has released a follicle, the very structure that is responsible for fertility occurring, would have developed such a swelling. Many of these cysts would regress on their own causing the woman no harm at all, and no obvious signs.

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What often makes a woman become aware of these problems is the fact of having some difficulty with getting pregnant or frank infertility. It is thus an important topic for many women.
In all normal women, the ovary is a part of the reproductive system located in the pelvis. There is also the uterus, fallopian tubes and vagina. None is able to guarantee a pregnancy without the other and all must work in tandem to bring a pregnancy about. As a result, there is a point at which an ovarian cyst passes from a harmless growth into a problem. The usually harmless swellings mentioned above are things which would usually resolve on their own. This is the story all through the child-bearing years during which a follicle is released into the adjacent fallopian tube for onward transportation into the uterus, about once a month.
This describes the normal menstrual cycle. With modern ultrasound machines, this activity can be monitored and timed precisely so that those couples who have challenges with fertility can be advised accurately about when to try for a conception, failing which the timing is seen as equally vital to be successful in assisted reproductive efforts.
If a follicle develops and fails to release its egg into the fallopian tube, it can form a cyst which should disappear within a few weeks at the most. Sometimes, a different kind of cyst forms after a follicle has been released. This is called a corpus luteum cyst. Such cysts bleed a bit into a cavity in the pelvic region and would cause some pain for several days that are not usually serious. The pain and the spilled blood tend to resolve spontaneously. Sometimes, the pain is complicated by the presence of other features such as fever and nausea. The presence of cysts especially, when they are large, is determined by a pelvic examination done in a gynaecologist’s office. It is confirmed by a pelvic ultrasound scan or more specifically by a trans-vaginal ultrasound scan.
The nature of such a scan is what will determine what kind of treatment would be offered. The presence of nausea and fever would usually indicate the presence of an associated infection and such is liable to be treated with appropriate antibiotics.
At other times, a large cyst is liable to twist on its stalk, called a pedicle. This shuts off the blood supply to the ovary and may eventually kill it off if the problem endures and not exceeding six hours. There is severe lower abdominal pain of sudden onset. The pain is associated with profuse sweating and there may be vomiting too. Sometimes, there may be associated bleeding into the pelvis. And the person may even be unable to walk due to the severity of the pain. This represents an emergency and urgent surgery must be performed to relieve the pain and possibly save the ovary. This malady is called the torsion of an ovarian cyst. Sometimes, the features are so severe that it may be confused with something else like a ruptured ectopic pregnancy. The operation can also be performed laparoscopically. Whichever option is chosen in the end will depend on the kind of equipment available and the presence of the required personnel. Either method of treatment is usually done under general anaesthesia.
Another complication of an ovarian cyst occurs when the cyst fails to stop growing in size. Instead, it begins to divide even without being fertilised. The onset of this kind of cell division is such that the growth becomes truly abnormal and unregulated. Since the cells within the cyst contain genetic material, this kind of unprovoked division leads to the formation of hair, nails, lots of mucus and even teeth within the cyst.
Sometimes, an entire tongue may be found as well or an eye. This is known as a dermoid cyst. Dermoid cysts can grow into huge dimensions. They can usually be felt in the abdomen in the course of an examination and confirmed by conducting an ultrasound scan. The solution to this situation as well is to operatively remove the growth. That is because it can potentially continue to grow without stopping. It causes a lot of pain because of the pressure it exerts on neighbouring organs. The pain it causes is of a constantly worsening kind.
Ovarian cysts may be single as seen in most cases or they may be multiple. The multiple variant is seen in the phenomenon called polycystic ovary disease. It is, however, called a syndrome because of the constellation of features which are associated with it. These include the deepening of the voice, failure to get pregnant, irregular periods and an increase in body hair. This is thus a hormonal problem and its presence can be determined by a combination of certain facts; a history of the above complaints, a hormonal profile which is determined by a blood test and a pelvic ultrasound scan which can actually see the cysts. The treatment of this condition is often challenging. If you are not in a race to get pregnant, your doctor may choose to wait it out and monitor the cysts periodically with a series of ultrasound scans. If pregnancy is desired, as is often the case, not least because it is most often diagnosed as part of the screening for infertility, then treatment is necessary. Very often, medications which supress ovulation are the drugs of choice. These are often birth control pills and are thus hormonal preparations. Sometimes, they treat the polycystic ovaries and create another hormonal problem. Their use must thus be properly regulated under the direction of a gynaecologist or a pharmacist.
Ovarian cysts do not only occur in women in the reproductive years. In some women who are past the menopause, cysts can also develop. Sometimes, these cysts are harmless and at other times, they are cancerous. Ovarian cancer is the fifth most common cause of death in women. Any post-menopausal woman who presents with an ovarian cyst or mass found during the cause of an abdominal examination should be ready to be presented with some very unpleasant news. This is because the risk increases with age as with all other cancers. That risk peaks at about 60 years of age and it is thus a major milestone for the development of this particular cancer. As has been emphasised before on this page, prevention is better than cure. Women in this age group should not shy away from performing annual medical examinations even if the only aspect of it they can afford is the physical examination. It is acknowledged here that the other aspects of a medical examination may be too expensive for the struggling woman to afford but a physical examination which is a part of the process can always be affordable.

- Dr. Sylvester Ikhisemojie/Punch

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