What Ovarian Cyst?

Sacs that develop within the ovarian tissue and are usually filled with fluid are called ovarian cysts. It is normal for the ovary to develop some small cysts, such as follicular cysts, during the normal functions of the ovary during the menstrual cycle, and these may be part of the reproductive preparation processes. These types of cysts are usually small and disappear on their own over time. However, in some cases, cysts do not disappear on their own and may even tend to grow continuously. Since these cysts can be malignant or benign, they definitely require further investigation. At the same time, even in benign cysts, complications such as explosion (rupture) or rotation of the ovary around itself (torsion) may occur with growth. For this reason, the type of cysts that do not shrink with follow-up should be determined exactly, research should be done for the possibility of cancer, and risky cysts should be removed with the help of surgery.

What are the Types of Ovarian Cysts?
The majority of ovarian cysts consist of cysts that form regularly in the female reproductive system as part of the normal menstrual cycle and disappear when their function is completed. These cysts, which are called functional cysts and are necessary for the continuity of natural processes, are only seen in the reproductive age, but are not possible to be seen after menopause and in childhood. Cysts other than functional cysts are called pathological cysts, and malignant cysts generally consist of cysts in this group.

Functional Cysts
During the egg maturation process, small cysts called follicles form in the ovaries every month. Any disruption in these processes can cause cyst formation in the ovary. Functional cysts, which generally do not cause pain and are harmless, are expected to disappear spontaneously within two or three menstrual cycles. Functional cysts have two subtypes: follicle cysts and corpus luteum cysts.

  • Follicle Cysts
    In the days that fall in the middle of the menstrual cycle, an egg cell must be expelled from the follicle and begin to move towards the fallopian tube. However, when the follicle does not crack due to any problem, it cannot release the egg cell inside and continues to grow as a follicle cyst. Simple cysts seen in the ovaries, most of which are benign, usually form in this way.
  • Corpus Luteum Cysts
    After the follicle cracks and releases the egg cell, the remaining follicle shrinks and begins to synthesize estrogen and progesterone hormones, and the follicle is called corpus luteum. If the egg is fertilized from the corpus luteum, the necessary hormone secretions are continued for pregnancy to begin. In some cases, when the space where the egg is released becomes blocked, fluid or blood accumulation occurs and corpus luteum cysts occur.

Pathological Cysts
Cysts that occur in the ovaries and are not related to menstrual processes are pathological cysts. Pathological cysts are more likely to cause complications such as pain, bleeding and reproductive problems than functional cysts. Dermoid cysts, chocolate cysts (endometrial cysts) and cystadenomas are included in this group. Especially dermoid cysts and cystadenomas can reach very large sizes and cause torsion in the ovaries, blocking blood flow and causing serious complications.

  • Dermoid Cysts
    Dermoid cysts, which originate from the germ cells responsible for egg production in the ovaries, are also called teratomas in medicine. These cysts, which are sac-like structures and are rarely seen to be malignant, may contain different tissues such as fat, skin, hair and teeth.
  • Endometrial (Chocolate) Cysts
    The disease called endometriosis occurs when the cells of the endometrium layer covering the inner surface of the uterus settle in an area outside the uterus and develop tissue. If these tissues form on the surface of the ovary, endometrial cysts, or chocolate cysts as they are popularly known, occur.
  • cystadenomas
    Cystadenomas, which consist of cells on the surface of the ovary, are cysts that may have liquid or mucus-like content. These types of cysts can reach very large sizes.

What are the Symptoms of Ovarian Cyst?
Although the majority of ovarian cysts vary depending on their type, they generally do not cause any symptoms in the early period and are detected incidentally during ultrasound imaging. However, some types of cysts, such as chocolate cysts or cysts that reach large sizes, may present with various symptoms. Common ovarian cyst symptoms seen in such cases include:

Pain in the pelvic area (lower abdomen and groin area)
Abdominal swelling or palpable mass
A feeling of fullness or pressure in the abdomen
Pain that increases in severity during movements such as bending over or moving into the fetal position
Menstrual periods that are extremely painful or have excessive bleeding
Intermittent bleeding and spotting other than menstrual bleeding
Pain during sexual intercourse
Patients who experience symptoms such as above should consult a gynecologist and obstetrician and be examined. When ovarian cysts burst or torsion occurs, sudden stabbing pain may occur on the side where the cyst is located. Therefore, in such a situation, emergency services should be consulted without wasting time.

How to treat ovarian cysts?
The treatment process for ovarian cysts is determined specifically for the person and the disease, taking into account factors such as the type and size of the cyst, the patient’s health condition, and pregnancy status. At the same time, issues such as the patient’s age, whether she has given birth before, and any accompanying diseases may also be effective in the treatment process. Therefore, after taking the patient’s history in detail, a personalized treatment plan should be determined according to the type and size of the cyst. For cysts that are small in size and appear to be functional cysts in women of reproductive age, a new follow-up appointment can be made for the next menstrual period. Treatment options should be evaluated for cysts that are large in size or do not heal spontaneously. The likelihood of malignant cysts in the pre- and post-menopausal period is much higher than in the reproductive age. For this reason, it is necessary to resort to advanced research methods even for small-sized cysts during these periods.

Another question about ovarian cysts is whether ovarian cysts prevent pregnancy. Most ovarian cysts, especially simple and functional cysts, do not interfere with pregnancy. However, cysts that are large in size, damage the ovarian reserve, and completely cover the ovary may pose an obstacle to pregnancy. In addition, some types of cysts, such as chocolate cysts, can negatively affect the ovulation pattern by disrupting the hormonal balance or may pose an obstacle to the continuation of the pregnancy if a pregnancy occurs. In such cases, it would be beneficial for patients planning pregnancy to consult gynecology specialists.

Medication
Drug treatment is usually the first of the treatment options for cysts that occur in the reproductive age, do not heal spontaneously or tend to grow. In such cases, it may be recommended to use birth control pills for a few months to support the spontaneous dissolution of the cyst. For cysts that do not appear to be functional cysts, such as endometrioma cysts and dermoid cysts, it is useful to make treatment planning according to the findings obtained from supportive diagnostic tests such as blood tests.

Surgical treatment
If the cyst poses a health risk, does not disappear within a certain period of time, does not respond to drug treatment, or grows in size, it must be removed through surgical treatment. Before deciding on a surgical operation, a detailed planning should be made, taking into account the location, size and patient-specific characteristics of the cyst. In most cases, the aim of ovarian-preserving surgical measures is to preserve the ovary as much as possible and only remove the cyst. However, in some rare cases, the capsule structure of the cyst may be intertwined with the ovary in a way that cannot be removed alone. In such cases, it may be necessary to remove a single ovary or both ovaries. In response to such possibilities, it should be evaluated before the operation whether the patient has had children before, and the decision for surgery should be made by considering the profit and loss situation.

Ovarian cyst surgery is usually performed using the closed method (laparoscopy). However, if the cyst is very large or a wider field of view and intervention is needed, open surgery can also be used. In closed surgery, the camera and laparoscopy tips are inserted into the abdomen through a few small incisions, such as 0.5-1 cm, on the abdomen, and the operation is performed in a closed environment, monitored by the camera. The patient can return to daily activities in approximately five days and to work life in approximately three weeks. The healing process in cyst surgeries performed with the open surgical method (laparotomy) is 6 months.

Risky pregnancy or high risk pregnancy; These are pregnancies that have an additional disease before or during pregnancy, or where there is a risk of miscarriage or a risk of disability in the baby in the scans.

In cases where normal vaginal birth cannot be performed, the method used is cesarean delivery. In cases where normal birth is considered, a caesarean section can be performed urgently, or a caesarean section decision can be made by prenatal planning. If it is determined that a cesarean section will be performed before birth, the date and time of the procedure can be determined.

Caesarean section is a birth technique performed under operating room conditions and anesthesia. In this procedure, the baby is removed from the mother’s womb by making an incision first in the abdomen and then in the uterus. Then, the incisions are closed with stitches and the birth is completed.

Aginal discharge is the fluid secreted from small glands in the vagina and cervix. This fluid leaks from the vagina every day to flush out old cells and debris, keeping the vagina and reproductive system clean and healthy. Vaginal discharge may occur from normal changes in estrogen levels

In uterine prolapse, the muscle around the vagina, connective tissues, and the nerve that holds the pelvic organs and tissues in place, break as the muscle tissues weaken and prolapse occurs outside the vagina. It occurs due to reasons such as normal birth, insufficient estrogen, and old age.

Sexually transmitted diseases that can be treated are: Syphilis, gonorrhea, chlamydia, and trichomoniasis. The 4 most common sexually transmitted diseases are; hepatitis B, herpes simplex, HIV (AIDS) and HPV cannot be fully treated

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