Ovarian Cyst Bypass

PCOS and Ovarian Cyst Removal

 

Overview

Does PCOS cause ovarian cysts that need to be removed?
Polycystic Ovary Syndrome
is a rather widespread disease from which 5-10 % of women suffer. PCOS represents the emergence of a large number of cystous non-malignant formations both in ovaries and outside of them. A cause of illness is usually a complex of endocrine disorders including the violations of ovaries’ functioning, pancreatic and thyroid glands, hypothalamuses and hypophysis.

There are many different causes for ovarian cysts so treatment needs to consider factors such as lifestyle, diet, emotional stress and in the case of PCOS hormone and blood insulin levels. Determining the type of cyst (functional or non-functional) as well as identifying all the various triggers for the ovarian cysts are very important for deciding on a treatment. Some non-traditional treatment routes that have had some success with ovarian cysts include naturopathic medicine, Ayurveda, Chinese medicine and homeopathy.

However, these cysts can also rupture, bleed, twist and become large enough in some cases to pressure other organs. When there are complications surgery or a biopsy can be the recommended treatment.

SYMPTOMS

What are the symptoms of ovarian cysts?
The development of this disease is revealed by a number of symptoms, violations in an organism the emergence of which can be found by any woman. Such symptoms include: violation of a menstrual cycle (delays or absence of the menstrual cycle), obesity (up to 15 kg), emergence of acne on a body, the increased hairiness on a body, pain in the bottom of a belly, and infertility.
Symptoms that may occur with ovarian cysts include:

  • Fullness and bloating
  • Lower abdominal pain or discomfort
  • Pain during menstruation or intercourse
  • Irregular periods
  • Frequent urination or difficult bowel movements
  • Ovarian cysts can rupture, twist or become infected which can cause severe pain and nausea.

 

Causes

What causes ovarian cysts and what are the types of cysts
There are several different kinds of ovarian cysts which are categorized as functional cysts or non-functional cysts. Functional cysts are usually considered to be harmless and part of a normal menstrual cycle unless they enlarge or cause pain. Non-functional cysts are benign or cancerous tumours in the ovaries. Both types of cysts are usually filled with fluid and can form on the surface or inside the ovaries.

Functional Cysts
The ovaries are organs that are part of the female reproductive system which release an egg each month which moves into the uterus to be fertilized. The eggs are formed in structures called follicles inside the ovaries. During the menstrual cycle the maturing egg stays inside the follicle until the egg is released. During this process one of two types of functional ovarian cysts may develop called follicular cysts or luteal cysts.

  • Follicular cysts are formed when the follicle does not release an egg and the follicular sac fills up with the liquid that usually nourishes the developing egg. The follicle becomes swollen and forms a cyst. Follicular cysts can be as large as 2 inches in diameter and usually resolve themselves.
  • Luteal or corpus luteum cysts are the most common ovarian cysts which occur when the sac reseals after the egg is released and continues to fill with fluid. This corpus luteum secretes progesterone and estrogen for two weeks after the egg is released to prepare the uterine wall for pregnancy. If a pregnancy does not occur the cyst collapses and is gone. Small luteal cysts form every month in most women.

Both types of functional ovarian cysts can become abnormal. They can grow larger due to contributing factors and cause serious issues. Luteal cysts can be 3 inches in diameter and when ruptured cause bleeding and severe pain. If this bleeding lasts longer than a few days or the cyst does not rupture at all surgical treatments might be the best course of action.

Non Functional or Pathological Ovarian Cysts
Non-functional cysts may present as solid or may be filled with fluid or blood. These cysts are found outside, under the surface or inside the ovaries. The possible causes of non-functional ovarian cysts are not completely understood and many factors can come into play. Some possible contributing factors include health, weight, personal history, lifestyle, stress, hormone imbalances and high blood insulin levels. There are several types of non-functional ovarian cysts which should all be watched closely by a doctor whenever possible.

  • Dermoid cysts form from the cells that ordinarily create eggs. Eggs have the ability to form any type of cell so these cysts can contain a disturbing range of tissue types including hair, blood, fat, bone and even teeth. Dermoid cysts can grow to be quite large (up to 6 inches in diameter) and can cause considerable pain. This type of cyst usually has to be removed surgically and in most cases is not cancerous.
  • Cystadenomas are the most common type of non-functional cysts in women over 40 years old and are rarely cancerous. These ovarian cysts develop from cells outside of the ovary and are characterized by a thick gel like substance that contributes to its growth. This cyst has two types which are mucinous and serious cystadenomas. Both types can grow quite large and cause pain if they rupture; however, mucinous cystadenomas can reach 12 inches in diameter which can put pressure on other organs.
  • Endometriomas cysts form due to a condition called endometriosis which is when the inner lining of the uterus grows outside the uterus on surfaces like the pelvic wall, bladder and intestines. This rampant growth can cover the ovaries causing blood filled cysts to form which can become quite painful especially during menstruation.
  • Polycystic ovarian cysts form when matured eggs are not released and the sacs continue to grow producing multiple cysts. There is also a condition known as polycystic ovarian syndrome (PCOS), which manifests in a similar fashion with multiple small cysts forming under the ovary surface.PCOS also includes other symptoms in addition to ovarian cysts such as irregular periods, infertility and hirsutism. PCOS is quite common and obesity, hormonal imbalances as well as high blood insulin levels have been linked to the development of this condition.

 

Treatment Options

How are ovarian cysts treated?
Cysts of ovaries (a follicular cyst of ovary, a cyst of a yellow body, an endometrium cyst of ovary, etc.) are non-malignant processes in ovaries. Laparoscopic interventions at cysts of ovaries are “a golden standard” of surgery at PCOS as it is accompanied by the minimum trauma of a belly wall and does not lead to the formation of commissures in the field of a small basin.

The indications to operative treatment are: any formation in ovary (a tumor, a cyst), existing within 3 months and not undergone to return development is independent or under the influence of hormonal, or anti-inflammatory therapy, tumor or a cyst which appeared in a menopause, development of complications, such, as, torsion of tumor pedicle, hemorrhage in a cyst, a rupture of a cyst, cyst suppuration, and also suspicion on the malignant process.

The volume of the performed surgery is solved individually: both at an inspection stage, and during intervention – Cystectomy, a resection of an ovary’s part, an ovarioectomy (removal of the whole ovary), an adnexectomy (removal of appendages of a uterus – an ovary + a uterine pipe). Duration of surgery makes from 15 to 40 minutes. An operation finishes at non-malignant histology of a cyst. If there is a suspicion on a malignant hystology, the volume of operative intervention extends – from the removal of appendages and histological research of another ovary before uterus removal with appendages and a big epiploon which is also made laparoscopically.

The features of equipment of operative interventions include the minimum use of electrosurgery for a cyst removal (it does not cause a burn of ovary’s tissues, further his function thereby is not broken), work with the 2 mm tools, the use of modern gels for successful healing (decrease in a risk of formation of commissures) and a complete sanitation of all diseases of bodies of a small basin during operation. Doctors try to conduct surgery and to preserve bodies (to preserve healthy tissues of ovaries) as a hormonal health of a woman depends on the function of ovaries.

It should be noted that sometimes because of the severity of the process (the big sizes of a cyst) there are no healthy tissues in ovary; therefore, it is necessary to delete it entirely. However, even removal of one ovary in the reproductive period does not have any essential hormonal violations, does not cause violations of a menstrual function and preserves the possibility for a woman to give rise to a healthy child.

Patients from first day start to get up from a bed and eat a liquid food. They are discharged from a hospital on the 1st – 6th day, depending on the severity of a disease and the volume of the executed operative intervention. The working capacity is restored on the 10th -14th day after operation. Sexual life is undesirable within a month. Further dynamic supervision of a gynecologist and ultrasonography – in 1, 3 and 6 months; further – 1 time every half a year is necessary. As a rule, hormonotherapy is indicated for the patients of the reproductive period about 3 – 6 months after operation for the normalization of ovaries functions.
Tactics of treatment of patients with depends on:

  • Expressiveness’s of symptoms;
  • Risk of malignant tumors;
  • Age;
  • Desires to preserve a reproductive function.

Conservative therapy is possible only in the presence of functional cysts of ovaries without complications (suppuration, a rupture of a capsule, infertility, etc.).
“Even after a simple diagnostic laparoscopy, we find that it can take you up to a week to feel quite normal again. You should be realistic and not plan any major work or social commitments for at least a few days, until you are sure that you feel up to it. Sexual intercourse can usually be resumed as soon as vaginal bleeding stops, but if you don’t feel like it, feel free to use the surgery as an out. After the more major procedures, such as removal of an ectopic pregnancy, or treatment of an Ovarian cyst or fibroid, it may be two or three weeks before you can resume normal activities and sexual intercourse”.

The main method of treatment of tumors on ovaries is surgical. Thus, at first, at histological research of a cyst’s nature is specified and the existence of malignant process is excluded, the cyst removal is carried out. It is considered that laparoscopy is possible for carrying out only provided that the existence of a cancer in ovaries is completely excluded, at any suspicion on a malignant the laparotomy with urgent intraoperational (during operation) histologic research is indicated.
Surgeries on cysts formations are divided into several types:

  1. Cyst removal with the preservation of a healthy tissue of ovary (Cystectomy). In this case a careful enucleating of a cyst’s capsule within healthy tissues is carried out. Thus, an ovary is preserved. A cut on an ovary is skinned over, and an ovary continues to fulfill its functions. The more the cyst in ovary is, the less the probability of a healthy tissue remains, the less the probability of its high-grade work in the future is.
  2. Wedge-shaped resection of an ovary. At this type of operative intervention the removal of a cyst from an ovary is carried out in the form of a wedge, thus there is less healthy tissue of ovary than at Cystectomy.
  3. Ovary biopsy. In certain cases at suspicion on malignant tumors it is necessary to receive a tissue of a healthy second ovary for research. The biopsy (that is sampling of a small part of a suspicious tissue of the second ovary is taken for research) is carried out for this purpose. In case of the cyst existence in an ovary in a post menopause or at women of a late reproductive age the performance of several options of operative treatment is possible.

Laparoscopy in the volume of removal of appendages from the “sick” side, a biopsy of a healthy ovary is possible at the presence of normal indicators of onkomarker and data of clinical and ultrasonic check-up.

“In addition to appendectomies, the gel can have applications to many other procedures, including heart surgery and ovarian cyst removal. Usage in gynecological surgery would be especially important because post-operative adhesions can compromise fertility, Hubbell notes. “Every time you manipulate the ovary, it heals to other organs in the pelvis or to the pelvic wall itself. If the fallopian tube is involved, it can result in a bent tube that is not meant to be bent, and the scar tissue can result in infertility”

In this case it is possible to specify the diagnosis and to exclude malignant tumors after fulfillment of histological research. In the case of identification of a cancer of ovary the performance of expanded volume of operation on uterus removal with appendages will be necessary.

In certain cases, especially, in the presence of the combined pathology of a uterus (for example, myomas of a uterus or adenomyosis) and the existence of ovary’s tumor uterus removal with appendages for the purpose of an exception of risk of the repeated operation is indicated at identification of malignant cells by the results of histological research.

 

Natural Therapies

What else can be done to treat PCOS?

Hormonal preparations are usually used for treatment of PCOS. If a patient has obesity, treatment is surely accompanied with a special style of life and a diet: physical activity, restriction of daily caloric content of food, exception of alcohol, smoked products and spices, consumption of mainly protein food.

Ovarian cysts usually don’t cause any symptoms and are often detected for the first time during routine pelvic exams and ultrasounds. The location, type and size of the cyst can be determined by an ultrasound. Doctors will examine cysts carefully to rule out fibroid tumours and cancer and then a wait and see management plan will often be put in place. Cysts can be watched for months to see if they shrink on their own. Most functional ovarian cysts will resolve themselves without any treatment beyond over the counter pain medication and perhaps applied heat. Sometimes birth control pills are prescribed to stop ovulation which in turn stops the growth of new cysts.

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