Ovarian Cyst

In normal conditions, the ovaries produce large amounts of estrogen and progesterone. These occur after ovulation in large quantities as well as during pregnancy. The presence of ovarian cysts might affect in different ways a woman’s hormone profile her appearance and fertility status as well as the integrity of her ovaries.

How are ovarian cysts created?

In younger patients, ovarian endometriosis presents very often as an ovarian cyst that might cause pain during intercourse. Large simple cysts might cause heavy periods. Both of them, depending on their size, should be treated. Treatment prevents cases of ovarian torsion or rupture of the cyst that would offer the patient more likely an emergency surgical procedure with all the risk related to that.
Simple cysts are filled with fluid. Monthly ovulation will often include the formation of cysts, and they are not usually a cause for concern. Most of them don’t persist, and more than 80% of them resolve within three menstrual cycles (almost three months). When they cause no problems, they are called functional cysts.
Complex cysts are less common than simple cysts. Either blood or a hard substance fills complex cysts.

Unlike simple cysts, complex cysts are not related to the typical menstrual cycle.

The formation of ovarian cysts might result from:

1. Ovulation
2. Endometriomas – tissue typically found in the lining of the womb forms blood-filled cysts in the ovaries
3. Dermoid cysts – contain parts of different embryological origin such as teeth, hair, bone tissue, etc
4. Mucinous or serous cysts
5. Polycystic Ovary Syndrome (PCOS) – It affects about 1 in 6 women, and in many cases, coexists with increased body weight and correlates with insulin resistance and diabetes.

Polycystic Ovary Syndrome (PCOS)

At the same time, the secretion of smaller amounts of testosterone (male hormone) might take place. In the case of polycystic ovaries, testosterone (male hormone) blood level might increase
Other features of Polycystic Ovary Syndrome (PCOS) include increased blood insulin and include conventional ovarian ultrasound imaging (increased volume and number of follicular follicles). Standard clinical features are infertility (due to disturbances in ovulation ) and manifestations related to metabolic disorders such as obesity, acne, hair loss, etc.

Diagnosis of ovarian cysts

The diagnosis is made with the history and gynecological examination and confirmed by ultrasound and hormonal screening. Assessment will reveal the number of cysts as well as their composition. If in doubt your doctor might order an MRI scan or blood tests. Every woman has her profile and fertility potential, so the treatment is personalized.

What are the symptoms of ovarian cysts?

Most women have no symptoms. It might be an incidental finding during a routine physical exam or ultrasound.

Some symptoms might be:

• Increase of abdominal girth
• pressure or bloating in the abdomen
• generalized pain or right or left pain in the lower abdomen
• abnormal – irregular vaginal bleeding
• frequency or urgency of urination
• in case the cyst ruptures it is going to cause substantial and stabbing pain, prompting emergency room consult
• vomiting or nausea or discomfort if the ovarian cyst or twists

Endometriotic cysts / Endometrioma

In the case of endometriomas, a patient may have the following additional symptoms that may include:

• infertility
• constipation
• diarrhea
• painful intercourse (called dyspareunia)
• nausea
• pain during periods (called dysmenorrhea)
• fertility problems
• pain during bowel movements (called dyschezia)You should seek immediate consult if you experience severe pain in the abdomen, fever, and vomiting.

In every patient, thorough consultation about the features of ovarian cysts and personalized treatment should be performed before any treatment. Especially in older patients, specific preoperative evaluation should be conducted and results evaluated by multidisciplinary team meetings.

Treatment of ovarian cysts

At the same time, the way to remove an ovarian cyst causing minimal thermal or surgical damage to the healthy ovarian tissue is vital. When discussing ovarian cysts, we have to bear in mind that most often patients are young women. Ovarian reserve should be protected by preserving healthy ovarian tissue and avoiding adhesion formation that could cause infertility. Robotic surgery, through its extremely precise equipment as well as through its magnification and stability of the surgical field, can offer considerable advantages in the treatment of ovarian cysts.