Ovarian cysts in menopause

Against the background of decreased ovarian activity during the transition of the female body to menopause, a fairly common formation is an ovarian cyst during menopause. As a rule, this formation is benign, however, since the greatest risk factor for the development of ovarian cancer is the mature age of a woman, any cyst should be taken seriously.

Epidemiology

According to some screening studies, the probability of detecting an ovarian cyst on ultrasound during menopause in women over 50 years of age (without any symptoms) is 14-17%.

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Risk factors

Experts see certain cause-and-effect relationships in the process of cyst formation:

• with a history of severe pelvic infections and sexually transmitted diseases;
• with inflammation of the appendages;
• with polycystic ovary syndrome (the appearance of multiple cysts due to a disruption in the synthesis of androgens by a woman’s ovaries);
• with a history of endometriosis (women with endometriosis may develop a type of ovarian cyst called an endometrioma);
• with genital papillomatosis (HPV infection);
• with the appearance of cystadenomas (benign growths on the surface of the ovaries);
• with ascites in the pelvic or abdominal cavity after diagnostic procedures or surgical interventions;
• with hypothyroidism (deficiency of thyroid hormones);
• with idiopathic dysfunctions of the pituitary gland (secreting gonadotropic hormones) or the adrenal cortex (producing estrogens and androgens).

Pathogenesis

The synthesis of sex hormones during menopause decreases, so doctors believe that the key causes of ovarian cysts during menopause are rooted in age-related hormonal imbalances, since, as is known, the tissues of all organs of the female reproductive system, controlled by hormones, are extremely sensitive to any changes in their ratio.

The pathogenesis of ovarian cysts, which are the result of long-term metabolic imbalance, remains a poorly understood area of gynecology.

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Symptoms ovarian cysts in menopause

In most cases, cysts are painless and do not cause any symptoms, so women do not even suspect their existence. As gynecologists note, some women may feel the first signs in the form of discomfort in the pelvic area.

However, the formation can be quite large, and then the following symptoms of an ovarian cyst during menopause appear:

• periodic or constant painful sensations in the lower abdomen (if there is a cyst of the left ovary during menopause, the pain is localized on the left, and if a cyst of the right ovary has formed during menopause - on the right side);
• aching pain in the pelvic area and lower back;
• abdominal distension;
• a feeling of pressure on the bladder and the resulting increased urge to empty it.

Complications and consequences

There may be complications of the cyst in the form of its twisting (if the cyst is mobile) and perforation (rupture). Twisting of the cyst leads to intense pain in the lower abdomen, fever, nausea and vomiting, as well as vaginal discharge of a bloody nature.

If the cyst ruptures, the pain is sudden and sharp, and internal bleeding is inevitable. According to statistics, almost 3% of all urgent gynecological surgeries are needed to eliminate the consequences of ovarian cyst rupture. Frequent consequences of cyst rupture are the formation of scar tissue and adhesions of the ovary with nearby organs.

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Diagnostics ovarian cysts in menopause

Today, the diagnosis of ovarian cysts during menopause includes blood tests: general, for hormone levels and for the CA125 antigen.

A blood test for the CA-125 tumor marker is necessary for ovarian cancer screening to help the doctor determine the risk of developing oncology. At the same time, an elevated CA125 level is non-specific and can be present in many common benign tumors, as well as non-ovarian tumors (stomach, liver, or colon cancer).

But, according to oncologists, in women over 50 years of age, the accuracy of predicting malignant ovarian tumors increases significantly: in half of the patients, an increase in the level of CA125 indicates that the ovarian cyst has become malignant during menopause.

Instrumental diagnostics of ovarian cysts is performed by ultrasound of the pelvic organs, and in case of uncertain results of ultrasound sonography, CT or MRI is used. Preference is given to transvaginal ultrasound, which provides more detailed information compared to transabdominal.

Aspiration biopsy is not recommended for ovarian cysts in women during menopause. First of all, because cytological examination of ovarian cyst fluid does not provide grounds for differentiating benign and malignant tumors. In addition, there is a risk of cyst rupture during the procedure.

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Differential diagnosis

To distinguish an ovarian cyst from acute appendicitis, endometriosis and other diseases with similar symptoms, differential diagnostics are carried out.

Treatment ovarian cysts in menopause

Three factors determine the treatment of ovarian cysts during menopause: ultrasound results, blood test for tumor markers and the intensity of symptoms.

If the cyst is not cancerous (based on CA125 analysis), it is monitored with repeat examinations every three to four months for one year.

If CA125 levels are elevated or the cyst is growing (or its external changes are observed), and the patient is at risk of developing cancer, surgical treatment is strongly recommended - removal of the cyst or the entire ovary (oophorectomy) by laparoscopy. But if the malignancy of the cyst is suspected, laparotomy and total abdominal hysterectomy with bilateral removal of the uterine appendages are more often practiced.

Surgical treatment may also be necessary when the cyst causes constant pain or pressure, or may lead to rupture, and also if the size of the formation exceeds 5 cm.

It should be borne in mind that ovarian cysts during menopause are not treated with hormonal agents (as is practiced in younger women), and there are no medications for “resolving” cysts.

Therefore, medications may be limited to the prescription of systemic enzymes with immunostimulating, fibrinolytic and analgesic properties, in particular, the drug Wobenzym. This drug is available in tablets that are taken orally 5-10 pieces (whole) - three times a day, half an hour before meals, with a glass of water. Among its side effects, the possibility of an individual reaction in the form of skin rashes is noted, among the contraindications, only decreased blood clotting is noted.

Folk remedies

Considering the existing risks of malignancy, doctors do not recommend using any folk treatment for ovarian cysts during menopause.

As folk methods of treating this pathology, a decoction of walnut partitions (which contain a significant amount of iodine) and a decoction of leaves (containing ellagic acid, active against tumors) are used. A decoction of partitions is prepared at the rate of a tablespoon of raw material per 250 ml of water (boil for a quarter of an hour and insist for half an hour in a closed container); drink a few sips three times a day. A decoction of fresh walnut leaves is also prepared and taken. It is better not to use this remedy if you have stomach problems.

Beetroot juice (from raw beets) with aloe juice (1:1) is recommended to be taken once a day – before breakfast.

Traditional treatment with castor oil is carried out in the following way. Fold a cotton cloth in several layers (so that it covers the entire abdomen); pour two tablespoons of castor oil onto the cloth (to distribute the oil evenly, fold the cloth in half and then unfold it). Lie down on a large towel, put the cloth with oil on your abdomen, cover it with a plastic film on top, and then with a towel. Put a hot water bottle on top, and then wrap yourself in a warm blanket. Hold for 30 minutes; repeat the procedure three times a week for three months.

Herbal treatments include:

• decoction of black cohosh root (Actaea racemosa, black cohosh): 10 g per 200 ml of water.
• An infusion of angelica roots (Angelica Sinensis) helps with hormonal imbalance.
• Infusion and alcohol tincture of milk thistle seeds (silybum marianum) – maintains hormonal balance by improving liver function. The infusion is prepared at the rate of one teaspoon of crushed seeds per 200 ml of water; it is recommended to take 80-100 ml (morning and evening).
• ground part of yarrow (Achillea millefolium): a tablespoon is poured with a glass of boiling water, boiled for 5-7 minutes and infused under a lid to room temperature. Take two tablespoons three times a day.

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Homeopathy

Common homeopathic remedies suggested for the treatment of ovarian cysts include Arsenicum, Apis mellifica, Mercurius corrosivus and Belladonna (if the cyst is causing pain).

For pain and swelling, Hamamelis is used (in the form of hot compresses). If there is a cyst of the left ovary during menopause, homeopathic doctors recommend such remedies as Lachesis, Zincum, Graphites, Argentum metallicum (for a feeling of distension on the left), and Thuja.

A cyst of the right ovary in menopause is an indication for the use of Podophyllum, Arsenicum, Colocynth. Dosage and method of administration are determined individually.

Prevention

While there is no specific way to prevent ovarian cysts from growing, some prevention of the pathological process can be achieved by eating cruciferous vegetables (all types of cabbage), which contain indole-3-carbinol. According to Biochemical Pharmacology, this nutrient can shift estrogen metabolism toward less estrogen-active derivatives and balance sex hormone levels in the body.

Forecast

Since, according to statistics, 1% of cases of ovarian cysts during menopause become the source of a malignant tumor, the prognosis of the disease depends on timely seeking qualified medical help.

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