Facts About the Ovarian Cyst

The ovarian cyst is a sac containing liquid, solid material or both, that has attached on the surface of the ovary or has developed inside of it. The ovarian cyst is not a rare disease and seems to affect women aged from 30 to 60. Both ovaries get be affected at the same time or at a distance of years one from another and they can have one or more cysts attached. These cysts are mostly non cancerous but 15 % of them transform into cancerous ones.

Once a month, in the process of ovulation, the women's body produces hormones which help the follicles grow. These follicles are shaped as a sac and contain the eggs and fluid. After the egg has grown the follicle normally ruptures in order to set the egg free. After that the follicle will become a smaller sac known as luteum. The ovarian cysts are forming due to the failure of the follicles rupturing or due to not releasing the egg. Scientists have classified the cysts into five: functional cysts, endometrial cysts, polycystic ovaries, cystadenomas and dermoid cysts. The functional cysts contain the follicle cyst and corpus luteum cyst which are a part of the normal process that is performed in the ovary.

The follicle cyst measures 2 inches and forms when the egg is sent to the fallopian tube or if the follicle fails to rupture. Most of them disappear in one to three months.

Generally after the egg is removed from the follicle and if the woman is not pregnant the follicle has to transform into luteum, a smaller sac and then disintegrate. If this small sac gets filled with liquid it will form the corpus luteum cyst which will remain inside the ovary.

The polycystic ovarian syndrome is another disease I which the ovaries get filled with intact follicles. It seems that normally the pituitary hormones like progesterone are controlling the egg production process. In some women the pituitary gland does not work properly and so, a lot of follicles are being produced and then stockpiled under the ovaries' surface. This way the ovaries grow in size, become enlarged and are filled with tiny cysts.

The endometrial cysts refer to the cysts that are formed out of endometrial tissue and blood. The endometrial tissue normally is found in the uterus but in this case it grows in other places too and bleeds, forming the cysts. These cysts can grow for a long time until they reach the size of a grapefruit.

The cystadenomas are neoplasms which appear from the tissue of the ovary and are classified in two: the serous cystadenoma and the mucous cystadenoma. The first one contains liquid and can reach the diameter of 6 inches. The second one contains a gelatinous substance and can get to 12 inches in diameter.

Generally cysts are 'silent' and they do not give any symptoms until the get ruptured during sexual intercourse or childbirth. When this happens, the woman will complain of intense abdominal pain, problems with menstruation like bleeding between periods or heavy menstrual flow and infertility which happens in polycystic ovaries. In endometrial cysts, internal bleeding can occur, menstrual cramps, painful sexual intercourse, and weight gain.

If the woman senses a sharp pain it means that the cyst had ruptured or twisted. It is important to go to the hospital as soon as possible as an infection can be produced and the woman's life can be in danger.
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About The Hemorrhagic Ovarian Cyst

According to medical research nearly all women and especially those of child-bearing years have been inflicted with a hemorrhagic ovarian cyst also known as a hematocyst or a blood cyst in some stage of their lives.

The hemorrhagic cysts of ovaries are viewed by medical professionals as so-called functioning cysts. That means that those cysts are affected by hormones, occur during a normal menstrual cycle, and also they are not caused by any specific disease. As a matter of fact, the hemorrhagic ovarian cysts are the most common type o-f cyst. They are most likely happened to be benign, which means they are probably non-cancerous.

Most hemorrhagic ovarian cysts are diagnosed through CT scans, ultrasounds and are quite often found during bi-annual and annual gynecologist visits.

Although the hemorrhagic ovarian cyst symptoms may vary in between females, a woman who suspects of having those type of cyst must be aware that there are some symptoms that overblown or even not true.

The first indication of existing cyst may come as a sudden dull but steady pain in the lower abdomen located either to the right or left of the intestines. This pain may sometimes intensify during the menstrual cycle or during strenuous exercise.

Additionally irregular menstrual periods as well as abnormal spotting and increased pain during menstruation could be caused by hemorrhagic ovarian cyst. Other common symptoms are excessive bloating or tenderness in the lower abdomen that does not lessen after a finished monthly cycle as well as nausea or vomiting and fatigue. An affected woman may occasionally suffer from fever; however the raised body temperature is mostly not present. The truth is, the hemorrhagic cyst will go unnoticed most of the time because the women might take an anti-inflammatory medication or pain reliever, which reduce or keep the fever down.

Depending on the severity of the cyst most hemorrhagic ovarian cyst treatments require very little medical attention such as recurring office visits and at home treatment is all that is needed. Over-the-counter pain relievers are advised for the occurring pain; however if the pain is severe and persistent, the physician might prescribe some stronger.

A common heating pad or hot water applied to the sore area is quite often applied to alleviate localized pain and bloating. Normally the sufferer is not restricted to exercise her usual daily routines; however she might be advised to avoid few strenuous activities at least until the pain decreases.

In case the pain persists for an extended period of time or if there has been ovarian cancer present in the medical history of the woman, the doctor will order a biopsy or a Laparoscopy.

Depending on the size and growth of the cyst some may require surgical removal.
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Polycystic Ovary Syndrome (PCOS)

The endocrine disorders among females are of various types but the most common one is the polycystic ovary syndrome (PCOS) which is basically an inherited disorder and can be received from either parent. The chances of occurrence of this disorder vary from 5-10% among the females of age group of 12-45 resulting in female sub-fertility. This endocrine disorder can be identified by anovulation which is diagnosed by irregular menstruation, amenorrhea, polycystic ovaries, ovulation-related infertility, excessive secretion of androgenic hormones that cause hirsutism and acne. High cholesterol level, type 2 diabetes, insulin resistance are other known symptoms. All these symptoms vary among different individuals. The disorder is known by a number of other names like polycystic ovary disease, functional ovarian hyperandrogenism, ovarian hyperthecosis and Stein-Leventhal syndrome. A polycystic ovary has abnormal number of eggs that can be viewed near its surface resembling cysts.

Polycystic ovary syndrome is generally described by two definitions. First definition was given by NIH or NICHD in 1990 which suggests that if a female is suffering from oligoovulation, shows signs of androgen excess and other entities that result in polycystic ovaries then the female is suffering from this endocrine disorder. The second definition was given in a workshop sponsored by ESHRE/ASRM held in Rotterdam in 2003 which predicts that if a female is suffering from oligoovulation or anovulation, has excess androgen activity and symptoms of polycystic ovary then she is suffering from polycystic ovary disease. The second definition appears to be wider and acceptable. The chief symptoms of the polycystic ovary syndrome include menstrual disorders chiefly amenorrhea and oligomenorrhea but other menstrual disorders may also crop up. Chronic anovulation results in infertility. High levels of androgens result in acne and hirsutism. Hypermenorrhea and other symptoms can also make their appearance. About three quarters of the females suffering from this endocrine disorder generally suffer from hyperandrogenemia. Central obesity and insulin resistance are also noticed. Serum insulin and homocysteine levels are significantly higher in females with this disease.

It is not always necessary that the women suffering from polycystic ovary syndrome (PCOS) may have polycystic ovaries and similar is the condition that all the women with polycystic ovaries may not suffer from this syndrome. The syndrome can be easily diagnosed by the pelvic ultrasound but other diagnostic tools are also available. History of the individual based on menstrual pattern, obesity, hirsutism and absence of breast development can help the medical professional. Gynecologic ultrasonography can be performed which helps in the detection of small ovarian follicles. These small follicles are believed to be formed due to disturbed ovarian function where ovulation has failed to take place due to absence of menstruation. In a normal menstrual cycle a single egg is released from the dominant follicle. After ovulation, the remnant of the follicle is converted into a characteristic structure known as corpus luteum formed by the action of progesterone. This structure finally disappears after 12-14 days. In polycystic ovary syndrome, although a number of follicles are formed but none of them grows more than 5-7 mm in length and fail to enter the preovulatory stage of the menstrual cycle. According to the Rotterdam criteria there must be 12 or more than 12 small follicles detected in the ultrasound. These small follicles are generally present near the periphery of the ovarian wall giving it the appearance of string of pearls. The ovary enlarges and attains a size which is 1.5 to 3 times greater than the normal size and this is due to the presence of these abnormal follicles.

Laparoscopic examinations depict the presence of a white, smooth outer surface of ovary. The serum (blood) levels of androgens specifically androstenedione and testosterone are elevated. The levels of dehydroepiandrosterone sulphate are also higher. The free testosterone levels are also high and it gives the best clue about the presence of this syndrome. The free androgen index of the ratio of testosterone to sex hormone binding globulin (SHBG) is generally higher but it is a poor indicator. Some blood tests are also suggested but they are not good indicators of the diagnosis of the polycystic ovary syndrome. The ratio of LH (Luteinizing Hormone) to FSH (Follicle Stimulating Hormone) is greater than 1:1 as tested on the third day of menstruation. Among the obese women the levels of the sex hormone binding globulin (SHBG) is generally low. Fasting biochemical screening and lipid profiling of the individual can be carried out while searching for this syndrome. A 2-hour oral glucose tolerance test (GTT) of the suspected individuals can be carried out which indicates impaired glucose tolerance in 15-30% patients of this syndrome. Insulin resistance is very commonly noticed in the patients of polycystic ovary syndrome. Other clinical disorders may also be associated with menstrual abnormalities namely Cushing's syndrome, hypothyroidism, congenital adrenal hyperplasia and pituitary disorders.

Polycystic ovary syndrome (PCOS) is a generically inherited condition. It is inherited in an autosomal dominant system with higher risk of occurrence in females. The chances of inheriting the gene responsible for this syndrome are 50% if the parent is carrying the gene. The gene responsible for this syndrome can although be inherited either from the father or the mother and the gene can be passed to the sons but the symptoms may arise only in the daughters. The gene responsible for this disorder has not been yet identified. Polycystic ovaries generally develop when the ovaries are stimulated to produce excessive amounts of the male hormones particularly testosterone. This may happen due to release of excessive amounts of the luteinizing hormone (LH) from the anterior pituitary gland or elevated levels of insulin in the blood of women who are sensitive to insulin or reduced levels of sex hormone binding globulin (SHBG) in blood which results in increased level of free androgens. The syndrome has acquired its name polycystic due to resemblance of the small follicles with the cysts. The follicles develop from the primordial follicles but their development ceases at the antral stage due to the disturbed ovarian function. These cysts like follicles get arranged at the periphery of the ovarian wall. Majority of the patients with this disorder in general show insulin resistance and this can cause abnormalities similar to those observed in the hypothalamic-pituitary-ovarian-axis.

The symptoms of the polycystic ovarian disease are very complex and may not be same for all the patients. In many cases it can be characterized by hyperandrogenism and insulin resistance. Majority of the cases of this disease have a genetic basis. The excessive amounts of the adipose tissue in the obese individuals also increase levels of androgens and estrogens. Adipose tissue carries an enzyme identified as aromatase that participates in the conversion of androstenedione to estrone and testosterone to estradiol. Hyperinsulinemia causes an increase in the GnRH pulse frequency, increased ovarian androgen production, decreased follicular maturation and decreased sex hormone binding globulin levels that ultimately result in polycystic ovary disease. Chronic inflammations may also result in this syndrome. A study carried out in the United Kingdom indicated that the incidence of polycystic ovary disease is higher in the lesbian women than the heterosexuals. The medications given to the patients of this disease generally focus on lowering of insulin levels, fertility restoration, hirsutism or acne treatment and prevention of endometrial hyperplasia, endometrial cancer and restoration of regular menstrual cycle. Cases where the disease is associated with obesity, weight loss is the effective strategy for the commencement of regular menstruation. Low carbohydrate diet and regular exercise may help in weight loss.

All the females with the polycystic ovary disease may not face the difficulty of becoming pregnant only those suffering from anovulation may face the problem. Patients with the problem of anovulation may be treated with clomiphene citrate and FSH injections. The patients who fail to give positive results with clomiphene and FSH treatments are treated with assisted reproductive technology procedures like controlled ovarian hyperstimulation with follicle stimulating hormone (FSH) injections followed by in vitro fertilization (IVF). Surgery is generally not performed in case of the polycystic ovary but a laparoscopic procedure known as ovarian drilling is generally carried out. Hirsutism can be treated by using an effective standard contraceptive pill. The key ingredient of the contraceptive pills is cyproterone acetate which is a progestogen. This compound is anti-androgenic in action and blocks the activity of male hormones that are responsible for acne and unwanted hair growth on face and over body. Other drugs that carry anti-androgen effects include flutamide and spironolactone that can effectively reduce hirsutism. Spironolactone is the most commonly used drug in the United States. Menstrual problems can be regulated by the use of contraceptive pills but these drugs can cause additional problems if continued for a long time. Two inositol isomers namely D-chiro-inositol and myo-inositol have given promising results against this syndrome.

Women suffering from polycystic ovary syndrome are at the risk of getting affected with endometrial hyperplasia and endometrial cancer. These clinical manifestations may crop up due to over accumulation of the uterine lining and absence of progesterone which is responsible for the prolonged stimulation of the uterine cells by estrogen. These symptoms set a positive background for the appearance of other health problems like obesity, hyperinsulinemia, hyperandrogenism, type-2 diabetes and insulin resistance. A study conducted in 2010 spotlighted that the women suffering from polycystic ovary disease are at an elevated risk of getting affected with type-2 diabetes and insulin resistance. High blood pressure, depression or depression with anxiety, miscarriage, excessive weight gain, cardiovascular disease, acanthosis nigricans, autoimmune thyroiditis are other risks associated with this syndrome.
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