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.
Continue reading after the cut.....
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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