Endometrioid cyst during pregnancy

Diagnosis of the endometrioid cyst during pregnancy means that an ultrasonic examination revealed a tight capsule with hemorrhagic contents located outside or inside the ovary.

This cystic formation is a consequence of the growth beyond the uterus cells of its internal mucosa (endometrium).

The detection of this pathology during pregnancy testifies that - despite the violation of reproductive functions in 30% of women with an endometrioid cyst - this patient managed to become pregnant. That is, the size of the cyst was negligible, and its development did not manage to disrupt the normal operation of the ovaries.

[1], [2], [3], [4],

Causes of the endometrioid cyst during pregnancy

The list of possible causes of the formation of the endometrioid cyst is very extensive and somewhat hypothetical. There is evidence that the causes of the endometrioid cyst during pregnancy, which occurs when a woman has this benign neoplasm, can be directly related to these or other hormonal disorders. This, in particular, the excessive production of estrogen and prolactin, as well as a deficiency of the hormone of the yellow body of progesterone.

It is assumed that the causes of the endometrioid cyst during pregnancy can be covered in genetic mutations, immunodeficiency states, surplus fatty tissue in the body, in the endocrine reaction to stress, and in the abnormalities of menstruation (the so-called retrograde menstruation). In the latter case, there is a reverse flow of menstrual blood and endometrial cells - through the fallopian tubes into the ovaries. Most likely, such anomalies can appear after surgical intervention, traumatizing the mucous womb abortion or prolonged protection with the help of the IUD (intrauterine device).

[5], [6]

Symptoms of the endometrioid cyst during pregnancy

It should be borne in mind that, with insignificant amounts of these pathological formations, the symptoms of the endometrioid cyst during pregnancy, as well as the symptoms of the endometrioid cyst in non-pregnant women, in most cases do not have clinical manifestations.

However, if the cyst acquires an impressive size, pregnant women may have pains in the lower abdomen of a pulling character. And in women outside of pregnancy - plus pain - there is a violation of the monthly cycle, constipation, pain in the lower abdominal cavity (giving back) during menstruation, after physical exertion, urination, defecation or intimacy.

Diagnosis of the endometrioid cyst during pregnancy

The main methods of diagnosis of the endometrioid cyst during pregnancy include:

• examination by a doctor on a gynecological chair;
• ultrasound examination (ultrasound) of pelvic organs;
• biochemical blood test for the level of hormones;
• a blood test for ovarian cancer markers (CA-125);
• computed tomography (CT), which is assigned to clarify the localization of the cyst and to identify the involvement of other organs in the pathological process.

[7], [8], [9]

Treatment of the endometrioid cyst during pregnancy

Treatment of the endometrioid cyst during pregnancy is different from the treatment given to nonpregnant women.

According to the data of long-term clinical observations, small endometrioid cystadenomas, which do not cause discomfort in a woman, do not have a negative effect on the course of pregnancy and fetal development. Moreover, in pregnancy, the placenta produces a large amount of progesterone, the lack of which contributes to the appearance of cysts. In addition, from the first days of pregnancy in the female body begins the production of another hormone - human chorionic gonadotropin, which stimulates the thyroid gland and the secretion of its hormones. And this, in turn, helps to accelerate the metabolism in the body and the renewal of all cells.

That's why experienced gynecologists and endocrinologists recommend that women who are diagnosed with insignificant endometrioid cysts during pregnancy should bear and give birth to a child without waiting for the growth of the cyst. In this case, the doctor responsible for pregnancy should regularly monitor the condition of the cyst with ultrasound.

To correct the hormonal background during the treatment of the endometrioid cyst during pregnancy, "light" hormonal drugs can be prescribed. For example, with a lack of endogenous progesterone, a doctor can prescribe the use of the drug Utrozestan, the active ingredient of which is the ovarian's yellow body hormone. Utrozhestan (capsules of 100 and 200 mg) causes changes in the endometrium, which contribute to the retention and development of the embryo. During pregnancy, this drug helps to reduce the excitability of the muscular tissues of the uterus and the fallopian tubes, and is usually used in a habitual spontaneous abortion. The doctor determines the dose individually - according to the results of a blood test to the level of hormones: 400-800 mg per day (divided into two doses).

In the case of an increase in the endometrioid cyst during pregnancy, the previously mentioned laparoscopic removal is assumed. This endoscopic operation is usually performed at the term from 14 to 25 weeks, that is, in the second trimester of pregnancy.

Removal of a cyst is considered mandatory if its size reaches 6 cm or more; with the corresponding indicators of the oncomarker: with a strong pain syndrome. And in emergency cases - with suppuration or breakthrough of the cystic capsule, and also when the cyst is twisted. Although the latter is rare in the endometrioid cyst: most often its capsule is tightly fixed by surrounding tissues.

Prophylaxis of the endometrioid cyst during pregnancy

If the main activity aimed at the prevention of endometrioid cyst in non-pregnant women is a regular visit to the gynecologist (and not only if reproductive function is impaired), the prevention of endometriosis cyst during pregnancy is reduced to observing all the recommendations of a doctor observing a pregnant woman with a similar diagnosis.

Increased attention to any changes in your state of health will help your expectant mother successfully cope with her task and produce a healthy child.

Prognosis of the endometrioid cyst during pregnancy

As already noted, to become pregnant, to bear a child and give birth to an endometrioid cyst of small size is possible. Therefore, the prognosis of the endometrioid cyst during pregnancy can be called positive. But it must be borne in mind that this disease must be treated. Further growth of education can cause adhesions in the pelvic organs and cause the formation of other types of cysts, for example, follicular.

As a result, the endometrioid cyst during pregnancy - without the intervention of medicine after childbirth - leads not only to ovarian dysfunction and degeneration of the oocytes, but also to significant disturbances in the functioning of the bladder and large intestine.

Pregnancy after endometrioid cyst

Endometrioid cyst occurs in women of childbearing age and is often diagnosed in those who seek medical advice about infertility. According to gynecologists, if the size of the cyst is small, the woman can become pregnant. But in the course of bearing a child there is a threat of various complications, since it is not possible to predict the further "behavior" of the endometrioid cyst. So, hormonal changes in the body during pregnancy can lead to the disappearance of the cyst. However, under the influence of the same hormones, the cyst can enter the stage of active growth, which can lead to spontaneous abortion. Therefore, the state of such pregnant women is under close medical supervision.

When the cyst is of considerable size, the functioning of the ovaries and the biosynthesis of hormones are disturbed. In addition, inflammation can begin in the ovaries, and its effects do make pregnancy impossible. In such a situation, pregnancy should be planned after removal of the endometrioid cyst.

In gynecology it is considered that only the removal of the endometrioid cyst will help a woman with this pathology to find the joy of motherhood. A modern minimally invasive method for the removal of the endometrioid cyst is laparoscopy. When carrying out laparoscopy, three punctures are made on the abdominal wall and the cyst is removed with the help of special instruments. And the place (the bed of the cyst), where she was, is processed by the way of coagulation (that is, "cauterized"). Given the small size of the ovaries themselves (no more than 30 mm in width), one should not exclude a large share of the probability of injuring healthy tissues and the appearance of adhesions. In addition, after this operation, the woman also has to undergo a special therapeutic course to normalize the hormonal background. This is due to the fact that in many cases the removal of the endometrioid cyst, which is a hormone-dependent formation, leads to its repeated appearance, moreover, repeatedly.

Nevertheless, physicians are convinced that pregnancy after endometrioid cyst - in case of its timely removal - is more likely than with conservative treatment of this pathology. By the way, the effectiveness of drug treatment, in the opinion of doctors themselves, in many cases is very low.