Cyst of the right ovary in women: causes, signs, what to do

An ovarian cyst is a benign neoplasm, a cavity containing fluid of varying consistency and structure depending on the cause of formation and the type of cyst. If secretory fluid accumulates in the cyst, its size increases and causes clinical symptoms, while small neoplasms do not provoke discomfort and can remain in the ovarian tissues for many years without symptoms.

The ovaries are a paired organ that performs many functions, among which the main and extremely important ones are reproductive and hormonal. Laterality and asymmetry of the ovaries are still being studied and give rise to numerous discussions between gynecologists, practitioners and theorists. Some specialists are convinced that the right ovary is more active in terms of follicular activity than the left, therefore it is more vulnerable and susceptible to the development of tumors and cysts of various types. However, such a statement does not have a scientifically substantiated evidence base, therefore, a cyst of the right ovary and a cyst of the left have the same causes, pathogenetic mechanism of development, symptoms and methods of treatment.

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Causes of right ovarian cyst

The etiology and causes of the right ovarian cyst can be varied and depend on many external and internal factors. It should be noted that even with the availability of modern methods, technologies and a fairly large statistical base, the etiology of the formation of BOTs (benign ovarian tumors) is still unclear. There are several hypotheses generally accepted by the world medical community, among which the most popular is the theory of changes in hormonal levels. According to this version, the causes of the right ovarian cyst, as well as the left one, are rooted in the imbalance of LH (luteinizing peptide hormone), FSH (follicle-stimulating hormone), that is, pituitary hormones. Accordingly, a possible cause of cystic formations may be chronic stress, nervous tension or exhaustion.

It is believed that functional cysts are formed due to abnormal ovulation, while other types of neoplasms may be a consequence of chronic hormonal imbalance and ovarian dysfunction.

In addition, it is customary to identify the following factors that provoke cysts:

• Inflammatory processes in the uterus and fallopian tubes.
• Venereal diseases, STDs (sexually transmitted diseases).
• 35-40% of cysts are formed after abortions.
• The causes of a cyst in the right ovary may be associated with a malfunction of the thyroid gland (hypothyroidism).
• Menstrual cycle disorders.
• Metabolic disorders, overweight (obesity) or underweight (anorexia).

Symptoms of a right ovarian cyst

Signs and symptoms of a right ovarian cyst may not be apparent if the neoplasm is functional and does not exceed 2-3 centimeters in size. In the case of persistent hormonal imbalance, gynecological diseases, inflammations and other pathological factors, the cyst may increase in size, become purulent and cause the following symptoms:

Uncomplicated cyst:

• Transient pain in the lower abdomen.
• A feeling of heaviness in the lower abdomen.
• Menstrual cycle disorders – delay, absence, long or too short cycle.
• Pain in the lower abdomen during intense physical activity.
• Pain in the lower abdomen or right side during and after sexual intercourse.
• Painful sensations after urination.
• Subfebrile body temperature that has no other objective causes.
• Periodic bleeding.

Complications, exacerbations of the cyst formation process:

• A sudden increase in body temperature.
• Sharp pain in the lower abdomen.
• Nausea, vomiting.
• Dizziness, weakness.
• Atypical vaginal discharge.
• Tense abdominal muscles.
• Enlargement of the abdomen without objective reasons.
• Drop in blood pressure, tachycardia.
• Dysfunction of urination (frequent urge to urinate, scanty urination).
• Constipation.
• Abdominal asymmetry.

It should be noted that hormone-dependent cysts provoke disturbances in the menstrual regimen, cycle, when menstruation may be out of schedule and be scanty, excessively heavy or absent altogether.

Right ovarian cyst: if there is no period?

Menstrual cycle disorders can be caused by hormone-dependent cysts – these are follicular and corpus luteum cysts.

If the gynecologist suspects that a woman is developing a cyst of the right ovary based on the complaints presented, there is no menstruation, then it is necessary to exclude the possibility of a luteal formation, which often develops in the early stages of pregnancy. During the process of bearing a fetus, the hormonal system in the female body begins to work differently, estrogen is produced in smaller quantities, and much more progesterone is required to consolidate and maintain the pregnancy. The active ovary, from which the dominant follicle was released, must function more intensively, which often leads to the development of a cyst on it. A luteal cyst of the right ovary is considered functional and, as a rule, resolves on its own in the 12-14th week of pregnancy. This is due to the fact that the necessary progesterone no longer begins to be produced by the ovary, it accumulates in the placenta. If another cyst of the right ovary is diagnosed, there is no menstruation, that is, pregnancy has occurred, but without a preserved corpus luteum, then there is a threat of termination of gestation, spontaneous abortion. In addition, a cyst of another type, non-functional, in a pregnant woman can pose a serious danger both to the development of the fetus and to the health of the mother herself.

Also, a corpus luteum cyst can cause other menstrual irregularities. In addition to absence, menstruation causes minor pain in the lower abdomen and may be out of rhythm. For an accurate diagnosis, to exclude an ectopic pregnancy or more serious pathologies of the pelvic organs, in addition to ultrasound, blood tests for chorionic gonadotropin are required.

Right ovarian cyst during pregnancy

Most often, pregnant women are diagnosed with a corpus luteum cyst; if the conclusion states a follicular cyst, this is most likely an unfortunate mistake, since this type of neoplasm cannot develop in principle when conception has already occurred. This is prevented by both prolactin and the mechanism of fertilization of an active follicle.

A cyst of the right ovary during pregnancy is explained by the fact that the duration of the corpus luteum activity increases from two weeks to three months, up until the moment of placenta formation. A woman needs much more progesterone to fix and preserve the fetus, and the corpus luteum takes on this function, working more intensively and actively. In such a situation, the corpus luteum can transform into a cyst-like cavity, which resolves on its own in the second trimester and does not cause discomfort to the expectant mother.

All other types of neoplasms, such as a dermoid cyst of the right ovary during pregnancy, endometriosis or paraovarian, are subject to systematic observation. If the cyst does not interfere with the course of pregnancy and does not provoke functional disorders in the woman's body, it is not touched, but removal is necessary in any case, after childbirth or during them during a cesarean section.

A large cyst or neoplasm due to the proliferation of endometrial tissue - an endometrioid cyst, a more serious tumor - a cystadenoma require frequent control ultrasound examinations, since complications are possible - torsion of the cyst stalk, rupture of its capsule, hemorrhage into the peritoneum. In addition, a large cyst of the right ovary often causes symptoms similar to those of appendicitis, so at the first opportunity the neoplasm is removed laparoscopically. The optimal time for a planned operation on a cyst in a pregnant woman is the second trimester.

Corpus luteum cyst of the right ovary

A corpus luteum cyst or luteal cyst is considered a functional neoplasm that forms from a ruptured, ovulated follicle. When the follicle ruptures, the blood is resorbed (absorbed) and loses its typical color, it acquires a yellowish tint, just like with a hematoma - a bruise, from red to yellow, bypassing blue and green. The formation of the corpus luteum is a temporary gland that is designed to adapt the body to possible conception. If it does not occur, the corpus luteum regresses after 2 weeks, but can continue to fill with fluid due to disruptions in the hormonal system or pregnancy.

A corpus luteum cyst of the right ovary, like the left, is always one-sided, located towards the abdominal wall and, as a rule, small in size. The contents of the cyst are liquor serosus (serous fluid), often with an admixture of blood (hemorrhagic fluid). Such cysts are practically safe and in 90% of cases have the property of self-resorption within two menstrual cycles. The danger of a luteal cyst lies in the potential for hemorrhage into the peritoneum, especially critical in this sense are the 20th-27th days of the monthly cycle.

Usually, a corpus luteum cyst of the right ovary is asymptomatic; if it is detected by ultrasound, the doctor chooses a wait-and-see approach, i.e. observation. A cyst rupture requires emergency measures – surgery. It should be noted that a luteal cyst is diagnosed as such if its size exceeds 2.5-3 centimeters; all neoplasms of a similar structure of a smaller size are defined as the corpus luteum itself.

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Follicular cyst of the right ovary

Follicular cyst of the right ovary is the most common type of BOT (benign ovarian tumors); according to statistics, follicular formation occurs in 83-85% of cases among all cystic tumors in women.

This type of cyst is considered benign in 99% of cases, and follicular cysts almost always resolve on their own without medication.

A follicular cyst of the right ovary is formed as a result of abnormal ovulation of the most active follicle. It does not burst, does not release the oocyte (egg cell) and begins to overflow with fluid, growing in this process from 2 to 15 centimeters in diameter. Follicular cysts can persist in the ovaries for many menstrual cycles practically asymptomatically, provided that the size of the neoplasm does not exceed 3 centimeters.

The true causes of the appearance of a follicular cyst are not clear, but gynecologists claim that this is how the ovary reacts to a malfunction of the hormonal system, as well as to a possible inflammatory process in the pelvic organs. Also in gynecological practice, there is an opinion that the right ovary is anatomically somewhat larger than the left and is much more actively involved in ovulation, therefore, it is more susceptible to cystic formations. Therefore, according to data not confirmed by scientific research, it is the follicular cystic formation that is most common, in the left it is diagnosed 15-20% less often.

Diagnosis of follicular cystic formations usually occurs during a medical examination, a gynecological examination aimed at identifying a completely different pathology or condition.

Statistics on the dynamics of follicular cyst development:

• Cysts up to 5-6 centimeters in diameter resolve on their own within 2-3 months, during which they are subject to regular monitoring through examinations and ultrasound.
• Spontaneous resolution during the first menstrual cycle occurs in 25% of women.
• Follicular cyst resolves after 2 cycles in 35% of women.
• Resorption of the cyst after 3 menstrual cycles occurs in 40-45% of cases.

If after 4 months the follicular neoplasm continues to persist but does not increase in size, the doctor decides to treat it with hormonal oral contraceptives. If the cyst grows over 6-7 centimeters, it is recommended to remove it to avoid twisting the stalk, which is long and mobile in this type of cyst. During the operation, the cyst is enucleated, the walls are sutured, and partial resection of the ovary is possible. Surgical treatment of follicular cysts is most often performed using laparoscopy, that is, the surgeon does not resort to a large abdominal incision.

Endometrioid cyst of the right ovary

An endometrioid cyst of the right ovary most often forms in a pathological combination with endometriosis, the main disease that provokes the cyst.

Cystic formation of this type is the growth of introduced endometrial cells into the ovarian tissue. The endometrium implanted into the ovary goes through all stages of the monthly cycle with it, including the release of blood. During the abnormal development, adhesions of the ovary itself with the adjacent tissue of the abdominal wall and nearby organs can form. As a rule, in the initial stage, endometrioid cysts develop asymptomatically, slowly, if temporary, transient pain in the lower abdomen appears, this indicates a possible adhesive process due to the constant leakage of the cyst contents into the peritoneum.

The pain most often radiates to the rectum, less often to the perineum, is acute, but quickly transient. Also, an endometrioid cyst of the right ovary can be large in size, when constant hemorrhage from the primary endometrioid focus forms a cavity with dark, thick blood. Such cysts are called "chocolate" because their contents really resemble dark chocolate in color. In addition, the symptoms of endometrioid growth in the form of a cyst can be the following signs:

• Subfebrile body temperature against the background of periodic radiating pain in the lower abdomen.
• Increased pain at the beginning of the menstrual cycle.
• Clinical symptoms of "acute abdomen" with rupture of the cyst capsule and hemorrhage into the peritoneum.

Endometrioid cysts are treated surgically, and hormonal drugs are also included in the treatment complex. During the surgical intervention, the cyst is removed, coagulation of endometrioid foci in the abdominal cavity, ligaments and fallopian tubes is performed. Hormonal therapy is aimed at restoring the normal interaction of the pituitary gland and ovaries. The prognosis with timely and adequate complex treatment is favorable.

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Parovarian cyst of the right ovary

Parovarian cysts are one of the types of retention formations, that is, those that form against the background of an inflammatory process in the pelvic organs.

A parovarian cyst of the right ovary is a cyst that develops near the fallopian tube or ovary, its distinctive feature is that it is not attached to tissues. Such a neoplasm is always small in size (rarely up to 2 centimeters), it is formed from embryological or remaining, "unused" eggs. A parovarian cyst is completely harmless and persists without any clinical manifestations. Most often, it is detected during a medical examination, a gynecological examination or an ultrasound scan by chance.

Symptoms may manifest when the paraovarian cyst of the right ovary begins to develop rapidly and reaches a large diameter, squeezing the fallopian tube, intestine or pushing the ovary, bladder. Such cases in gynecological practice are extremely rare and are a sign of multiple chronic pathology of the pelvic organs. As a rule, paraovarian formations are treated using surgical laparoscopy to minimize the risk of adhesions and further infertility. Unlike a follicular cyst, a paraovarian cyst is not capable of self-resorption or reduction, so enucleation and dissection of the leaflet connecting the cyst and nearby organs is inevitable.

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Functional cyst of the right ovary

If a woman is diagnosed with a cyst of the right ovary, whether it is functional or inflammatory, non-functional, is determined by the doctor using ultrasound and additional examinations - blood tests for LH and FSH, biochemical examination and histology.

The functional category includes uncomplicated follicular and luteal cysts (corpus luteum cysts), which are formed as a result of ovulation disorders or changes in hormonal balance.

Unlike other types of BOTs (benign ovarian tumors), a simple cyst of the right ovary, functional - follicular or luteal, is generally considered safe, since it almost never becomes malignant. However, just like other cysts, functional cysts can be complicated by suppuration, capsule rupture or torsion of the stalk.

A large or complicated functional cyst causes the following symptoms:

• Pain in the lower abdomen on the right, often similar to symptoms of appendicitis.
• Violation of the monthly cycle - regime, schedule.
• Periodic vaginal discharge, often mixed with blood.
• Increased body temperature.
• Pain during sexual intercourse.
• Clinic of "acute abdomen" with rupture of the capsule, twisting of the leg or hemorrhage into the abdominal cavity.

Treatment of functional cysts usually involves dynamic observation, since such neoplasms tend to resolve on their own. Complicated situations require surgical intervention, including emergency intervention. The prognosis with timely detection and seeking medical help is favorable in 95% of cases.

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Retention cyst of the right ovary

A retention cyst (from Latin - retentio, to preserve, to hold) is a neoplasm that forms when fluid accumulates in a secretory cavity or organ. A retention cyst of the right ovary can be either congenital or acquired as a result of fusion, adhesion of nearby walls and glands.

The pathogenetic mechanism of formation of a true retention cyst is as follows:

• As a result of the pathological process, the gland (duct) becomes blocked, most often by the thickened secretion itself.
• Obstruction of the duct can also be caused by pressure on it from the tumor.
• The accumulated, unexcreted fluid stretches the cavity and forms a cyst.

A retention cyst of the right ovary is a follicular or luteal cyst, which is usually diagnosed by chance, since it tends to persist for a long time without symptoms. Most often, a retention cyst is unilateral and its symptoms manifest when the neoplasm increases in size. Treatment is not required in 50% of diagnosed retention cysts; complications such as torsion of the pedicle, suppuration of a large cyst, and the potential risk of its rupture dictate the need for surgical intervention.

The prognosis for the treatment of retention tumors is favorable; such cysts never transform into malignant ovarian tumors.

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Hemorrhagic cyst of the right ovary

When a hemorrhagic cyst of the right ovary is diagnosed, confusion may occur in the definition of the formation, in terminology. Any cyst in principle can be considered hemorrhagic, since all types of cysts are prone to bleeding, hemorrhage due to their structure. However, most often potential hemorrhagic cysts are functional formations, that is, corpus luteum cysts or follicular cysts.

Corpus hemorrhagicum – hemorrhagic cyst of the right ovary is much more common than the left-sided one, most likely due to its more intensive blood supply. The right ovary is directly connected to the important, central aorta, and the left is supplied through the renal artery, that is, more slowly.

Ovarian hemorrhage develops in two stages:

• Ovarian hyperemia.
• Hemorrhage.

In a clinical sense, bleeding is more dangerous, which can be limited - only into the follicle, into the corpus luteum, or widespread, diffuse - into the ovarian tissue with leakage into the peritoneum.

Hemorrhagic cyst of the right ovary most often develops in the middle of the period between menstruations and depends on the timing of the follicle rupture. Local hemorrhage into the cyst cavity is considered more favorable than diffuse hemorrhage, which can occur against the background of persistent hyperemia, thinning the cyst capsule. Also, factors provoking diffuse hemorrhage into the peritoneum can be excessive physical activity, lifting weights, active sexual intercourse, fibroids.

According to statistics, hemorrhage is more often diagnosed in the right ovary, which is due to its vascular architecture.

If a hemorrhagic cyst ruptures, an anemic form of apoplexy may develop, when surgery becomes inevitable. If the cyst is small and the symptoms of internal hemorrhage are just beginning to manifest, conservative treatment is possible.

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Dermoid cyst of the right ovary

A dermoid cyst of the right ovary is a congenital neoplasm that forms in utero as a result of pathological embryogenesis. A dermoid, unlike other types of cysts, contains cells of all three germ layers in various combinations. Such cysts are considered benign, but they are not capable of resolving like follicular cysts, since elements of bone, cartilage, adipose tissue, hair, tooth particles, skin scales do not dissolve in principle. A dermoid cyst of the right ovary is diagnosed as often as a dermoid of the left ovary, laterality in this type of neoplasm is not statistically noted. The etiology of dermoid formations has not yet been clarified, there is a version concerning the genetic factor, a hypothesis is also accepted about the pathological influence of bad habits, inflammation, venereal diseases on normal embryogenesis.

A dermoid can persist in the ovary for many years without any clinical symptoms. About 3 percent of dermoid cysts are prone to malignancy, so they are removed at the first opportunity.

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Cyst on the right ovary: is there a reason to worry?

Benign cysts are the most common of all ovarian tumors. A cyst on the right ovary, like all types of cysts, is classified in a certain way, depending on the structure of the capsule and the composition of the cavity contents:

1. Functional, that is, one that forms in the ovarian tissue as a result of its functional cyclical activity. Functional cysts are follicular and luteal cysts (corpus luteum cysts). Most often, a follicular cyst of the right ovary, a corpus luteum cyst is formed in the body of women of childbearing age and develops asymptomatically; during ovulation and the monthly cycle, such cysts are capable of self-liquidation without a trace. A follicular or corpus luteum cyst is localized on the side or in front of the uterus.
2. A non-functional cyst is a dermoid, paraovarian, mucinous, endometrioid, serous cyst. These neoplasms develop as a result of genetic changes, as well as due to pathological processes occurring in the pelvic organs.

In addition, a cyst of the right ovary, like neoplasms of the left, is classified according to the following characteristics:

Quantity:

• Single, solitary cyst.
• Multiple ovarian cysts.

According to the development and course of the process:

• Uncomplicated, simple.
• Complicated (purulent, with torsion of the pedicle).

By etiology, origin:

• Follicular – as a result of ovulation.
• Luteal - reverse development (regression) of the corpus luteum.
• A dermoid cyst is a neoplasm of embryonic germ cells (leaflets).
• Parovarian – a cyst that forms from the appendage located above the ovary.
• Endometrioid – proliferation of endometrial tissue into ovarian tissue.

In fact, the classification of ovarian neoplasms, which include the right ovarian cyst, is more extensive and detailed, it includes a list of both benign and malignant neoplasms. In gynecological practice, WHO definitions are used, proposed at the end of the last century, but have not lost their relevance and significance to this day.

Consequences of a right ovarian cyst

Complications and consequences of an untimely diagnosed or untreated cyst can be quite serious. The main reason for complications is self-medication using so-called folk methods, as well as the unwillingness to undergo regular gynecological examinations.

Gynecologists name the following consequences of a cyst of the right ovary:

• Risk of malignancy of some types of cysts – dermoids, endometrioid, mucinous cysts.
• Torsion of the cyst stalk, follicular cysts are especially prone to such consequences. Necrosis of the ovarian tissue, its apoplexy, further infertility due to adhesions - this is a far from complete list of the risks of torsion of the cyst stalk.
• Suppuration of the cyst, inflammation of the pelvic organs.
• Rupture of a large cyst capsule, release of cyst contents into the peritoneum, inflammation, suppuration. Most often, a cyst of the right ovary is subject to such a complication, the consequences can be extremely unfavorable.
• Bleeding into the abdominal cavity, peritonitis.
• An increase in the size of the cyst leads to disruption of the functioning of nearby organs.
• Persistent infertility.

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Rupture of the right ovarian cyst

Rupture of the cyst of the right ovary statistically exceeds apoplexy of neoplasms in the left ovary, this is due to the features, specificity of blood supply. The right ovary, in addition to being more active, is supplied with blood from the main aorta much more intensively, faster, it connects with the vessels of the ovary directly.

The risk of cyst rupture exists with the following provoking factors:

• A sharp increase in the size of the cyst.
• Abdominal trauma – fall, blow.
• Active, excessively intense sexual intercourse.
• Active sports training.
• Physical fatigue.
• Weight lifting.
• A combination of the above factors with a concomitant inflammatory disease.

Hemorrhage during apoplexy can be either internal, into the cyst cavity or directly into the abdominal cavity, or external, through the vagina.

Most often, apoplexy, a ruptured cyst of the right ovary, is accompanied by bleeding inward - into the peritoneum, which causes a typical picture of "acute abdomen" and requires immediate surgical intervention.

• Symptoms of bleeding:
• A sharp pain spreading throughout the entire abdominal cavity.
• The pain radiates to the perineum and rectum.
• The pain is often similar to symptoms of appendicitis.
• Drop in blood pressure.
• Pale skin.
• Symptoms of anemia include cyanosis, dizziness, nausea, fainting, and cold sweat.

Treatment of apoplexy is only surgical, during which blood and fluid are removed (aspirated) from the abdominal cavity, washed and drained. The cyst is removed at the same time. As a rule, the operation is performed using laparoscopy, but the technique may also depend on the patient's condition, the size and structure of the cyst. With timely assistance, the prognosis is favorable, moreover, all functions - fertility, reproduction, are restored. If the operation is performed as a complete, abdominal and the ovary is completely removed, there is a risk of infertility or difficulties with conception.

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Right ovarian cyst with hemorrhage

A hemorrhagic cyst of the right ovary with hemorrhage differs little in symptoms and pathogenesis from apoplexy of the entire ovary. Moreover, in the diagnostic criteria there are no specific differences between cyst hemorrhage and "OA" - ovarian apoplexy. Thus, ovarian hematoma, cyst apoplexy, ovarian infarction, cyst rupture are practically synonyms that combine the following stages of the process:

• Dystrophic changes in ovarian tissue and cysts.
• Inflammatory processes in the pelvic organs.
• Fragility of blood vessels, changes in the structure of the cyst capsule tissue.
• Filling of the cyst with fluid, enlargement.
• Compression by nearby organs.
• Trauma or physical overexertion.
• Capsule rupture.

A cyst of the right ovary with hemorrhage develops in three directions:

Painful form without clinical signs of hemorrhage into the abdominal cavity:

• The pain in the lower abdomen is dull and transient.
• Dizziness, nausea for a week or more.
• Drop in blood pressure.

Anemia as a symptom of peritoneal bleeding:

• Tachycardia.
• Drop in blood pressure.
• Cyanosis.
• Weakness.
• Chills, cold sweat.
• Vomiting – once.
• Dryness of the oral mucosa.
• Dull, diffuse pain throughout the abdomen.
• Fainting is possible.

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Mixed form

Diagnosis of a cyst with hemorrhage can be difficult, since the clinical symptoms are very similar to signs of inflammation of the abdominal organs. As a rule, patients are admitted to hospital with a preliminary conclusion - "acute abdomen", the diagnosis is clarified on the spot, often during surgery. Conservative treatment, even in case of suspicion of a mild form of hemorrhage, is ineffective, since in 90% of cases there are relapses.

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Diagnosis of right ovarian cyst

Diagnostic measures if a cyst of the right ovary is suspected:

• Collection of anamnestic information, including hereditary and family information.
• Clarification of subjective complaints in terms of localization, nature, and frequency of pain.
• Bimanual examination.
• Ultrasound – transabdominal, transvaginal – echoscopic picture of the condition of the pelvic organs and abdominal cavity, including neoplasms.
• A puncture of the vaginal vault may be performed to determine the presence of blood in the peritoneum.
• Diagnostic laparoscopy, during which direct removal of the cyst is possible.
• OAC – complete blood count, blood biochemistry.
• Blood test for CA-125 (tumor markers).
• Determination of LH and FSH hormones.
• Computed tomography to determine the structure of the capsule, the contents of the cyst, the presence of adhesions and the relationship with nearby organs.
• Exclusion or confirmation of possible pregnancy.

Diagnosis of a right ovarian cyst depends on the type of neoplasm, the period, the term of its development and the timeliness of seeking help. As a rule, complex diagnostic measures are carried out on an outpatient basis, urgent cito-diagnostics is indicated in emergency cases when there are complications - cyst rupture, torsion of the pedicle, ovarian apoplexy.

Echo signs of a right ovarian cyst

Ultrasound is the most informative method for detecting cystic neoplasms; as a rule, accurate conclusions can be made during transvaginal examination. The accuracy of this method reaches 90%.

Most often, follicular cysts are detected in women randomly during a medical examination. The norm for follicles in the ovary, which are visualized on ultrasound, is from one millimeter to 30 millimeters. Any follicle larger than 30 mm can be diagnosed as a functional cyst.

Ultrasound identifies the following cysts depending on the structure of the capsule and the color of the contents:

• Functional cysts – follicular and luteal.
• Endometrioid cyst.
• Teratoma, dermoid cyst.
• Cystadenoma.

Echo signs of a cyst of the right ovary or signs of a neoplasm of the left ovary do not differ from each other and represent a dark, anechoic formation with a rather thin capsule wall. The structure and composition of the contents may be different - both homogeneous and multilayered - in dermoids.

• In addition, the following parameters may be differential echo signs of a cyst:
• Clear outline (as opposed to the outline of a tumor).
• Anechoicity within the boundaries of solid neoplasms due to possible hemorrhage into the cavity.
• Smooth round shape.
• Pseudo-amplification effect.
• Clear connection of the cyst with ovarian tissue.
• Increased echogenicity in the posterior wall may indicate a multi-chambered cyst.
• Cysts located behind the uterus or behind the bladder are poorly visualized on ultrasound.
• Dermoids have good echogenicity and are defined as solid cysts. It is also important to examine the dermoid tubercle, which is a specific feature that allows separating a dermoid from an endometrioid cyst. The tubercle is more rounded and has high echogenicity. This type of cyst requires additional radiography to clarify the nature of the contents.
• Endometrioid cysts located on the side or behind the uterus have medium or increased echogenicity. Such cysts have a visible double capsule contour, the contents are visualized as a finely dispersed suspension.

A clarifying diagnosis is made using histology, since echo signs of a right ovarian cyst are not always specific.

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Right ovarian cyst 5 cm

The method of treatment most often depends on the size of the cyst; it can be a wait-and-see approach using dynamic monitoring, or conservative treatment using medications, or possibly surgical intervention to remove the cyst.

A 5 cm right ovarian cyst can go away on its own if it is a follicular cyst. If a woman is diagnosed with a dermoid (mature teratoma) of this size, cyst removal is inevitable, since a dermoid cyst is not capable of self-resorption due to its specific structure - embryonic tissue.

If a woman is diagnosed with a 5 cm cyst of the right ovary, treatment, depending on the type, may be as follows:

• A follicular cyst over 5 centimeters is dangerous due to twisting of the stalk, which is longer in such cysts than in other types of neoplasms. In addition, a cyst of 5-6 centimeters is prone to rupture, so it must be treated. Unlike smaller follicular cysts, which are subject to observation, large cystic formations are treated with oral contraceptives for 2-3 months.
• A corpus luteum cyst up to 4-5 centimeters most often develops asymptomatically. A luteal cyst of the right ovary 5 cm is already a fairly large cyst that causes discomfort in the form of pain in the lower abdomen, pain during sexual intercourse. Such a cyst is easy to visualize on ultrasound and is treated with conservative methods.
• A dermoid cyst, as already indicated above, no matter what size it is, requires removal in the nearest favorable period, since all dermoids are prone to malignancy.

In general, a 5-centimeter cyst is classified as a medium-sized neoplasm, but such cysts can grow, so, as a rule, they require not only observation, but also complex treatment. In addition, even with surgical intervention, a five-centimeter cyst of the right ovary is removed using a gentle method - laparoscopy and has a favorable prognosis.

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Two-chamber cyst of the right ovary

The etiology of the formation of two-chamber cysts has not yet been clarified, however, as well as the true cause of the formation of cysts in principle. The generally accepted hypothesis is the version of hormonal disorder, and the breakdown of the interaction of the pituitary gland and the hormonal system.

A two-chamber cyst of the right ovary is a benign neoplasm, which, unlike typical cysts, consists of two cavities - chambers. Most often, a paraovarian cyst is two-chambered, which develops as a congenital pathology, when the cyst is located between the ovary and the fallopian tube and is formed from the tissue of the appendage. Also, a follicular cyst is sometimes recognized as two-chambered, although this is more likely a diagnostic error, when a true functional cyst and an enlarged follicle located nearby are recognized as a two-chamber formation. Or a combination of a true cystic tumor and a functional cyst can also look like a two-chamber structure. In addition, echogenic structures not associated with neoplasms can look like two-chamber formations on ultrasound, that is, any ultrasound diagnostics requires additional clarification. It should be noted that two-chamberedness is not polycystic disease, which is a separate pathology that often leads to persistent infertility.

Treatment of right ovarian cyst

Treatment of a right ovarian cyst is directly related to the following factors:

• The nature and type of the cyst.
• The degree of severity of symptoms.
• The woman's age, her potential desire to conceive and give birth to a child.
• Risk of complications – rupture, suppuration, inflammation, and so on.
• Risk of malignancy.
• Associated pathologies.

Expectant tactics in the form of dynamic observation and control using ultrasound are indicated for many functional cysts - follicular, luteal, especially if they are small in size. Larger functional cysts are treated conservatively with hormonal drugs, oral contraceptives. Vitamin intake, homeopathy, diet, physiotherapy and even a visit to a psychotherapist are also indicated, since one of the reasons for the formation of cysts is stress, psychoemotional disorder.

If there is no result within 2-3 months after conservative therapy, and also if the cyst increases and there is a risk of complications, surgical removal of the cyst within healthy tissues is indicated. The operation is most often performed using a laparoscopic gentle method, after which the woman's reproductive function is restored within 6-12 months.

Dermoid cysts and paraovarian cysts must be removed; these types of cysts are not capable of resolving on their own in the same way as endometrioid cysts.

Options for cyst removal surgery:

• Cystectomy or enucleation of the cyst within the healthy ovarian tissue. The capsule is enucleated, the cyst walls are sclerosed, all ovarian functions are gradually restored.
• Resection of a part of the ovary, when the cyst is removed using wedge resection – excised together with a part of the ovary.
• Ovariectomy is the removal of the cyst and ovary.
• Adnexectomy – removal of a cyst, ovary and appendages. Such operations are indicated for women in menopause to avoid the risk of developing an oncological process.
• The sooner an accurate diagnosis is made, the more effective the treatment of the right ovarian cyst will be.

How to treat a right ovarian cyst?

Only a doctor can decide how to treat a cyst of the right ovary after receiving the results of a comprehensive examination.

Treatment options for right ovarian cyst:

• Conservative therapy is indicated if the patient has a follicular cyst larger than 5-6 centimeters. Small functional cysts are subject to observation, as a rule, they resolve on their own without any treatment.
• A corpus luteum cyst is also not treated if it is small. Moreover, during pregnancy, such a cyst is considered acceptable. However, therapy may be prescribed in case of an increase in the luteal cyst or the risk of its rupture.
• Surgical treatment is suggested if a woman is diagnosed with a dermoid cyst or mature teratoma. Such types of cysts do not resolve and are not amenable to drug treatment. Their removal is not difficult, gentle laparoscopy is performed, complications, as a rule, do not occur, as well as relapses.
• Also, suppurating cysts, cysts that grow rapidly and can cause ovarian apoplexy and hemorrhage into the abdominal cavity are removed surgically.
• Sparing surgeries, in which the cyst is removed without resection of the ovary, are indicated for all women of childbearing age. Patients over 40-45 years of age will most likely undergo surgery in a different version - with wedge resection of ovarian tissue or with its complete removal to avoid the risk of possible age-related complications.
• After the operation, the woman is prescribed hormonal therapy for 3-6 months to speed up the process of restoring ovarian function.

In general, the question of how to treat a cyst of the right ovary can only be answered after a series of studies and tests. Sometimes such diagnostics are prescribed 2-3 times to track the dynamics of changes in the condition of the cyst and the body as a whole against the background of several menstrual cycles.