Follicular ovarian cyst

The ovarian follicular cyst (cysta ovarii follicularis) is a kind of functional formation in ovarian tissue. A cyst is formed from folliculus ovaricus - the follicle, which did not have time to burst, to burst.

The follicular cyst is considered a benign neoplasm, ranging in size from 2.5 to 8-10 centimeters, consisting of a single chamber cavity, inside of which is an estrogen-rich liquid. Most often this type of cyst develops in young women of reproductive age, but it is also diagnosed in the puberty, menopausal period. The frequency of diagnosed follicular cysts among all other cystic ovarian neoplasms is 80%.

Follicular cysts are able to dissolve independently under certain conditions and can not be malignant, that is, transformed into malignant formations.

[1], [2], [3], [4], [5], [6], [7]

Causes of follicular ovarian cyst

The first description of the pathological condition of the ovaries dates back to 1827, when the cyst was defined as an incurable "water sickness" in women over 40 who had no children. Since then, a more careful study of the pathogenetic properties of cystic formations has begun, but doctors have not developed a single version.

At the beginning of the last century, the causes of the follicular cyst and other functional cystic neoplasms were divided into two categories: 

1. Dysfunction of the hormonal system.
2. Inflammatory process of infectious nature in appendages.

In 1972, the scientific term appeared - apoptosis (self-programming of cell death) and many scientists rushed to study the relationship between apoptosis, steroidogenesis and the functioning of the ovaries. So there was another version of the etiology of follicular cysts, based on the hormone-genetic factor.

Currently, doctors in the development of therapeutic and preventive strategies are trying to take into account all three theories, summarizing the most studied causes of the follicular cyst: 

• Violation of the hormonal balance associated with natural age periods - pubertal, menopausal.
• Pathological disorders of neuroendocrine regulation, provoking hyperestrogenism.
• Inflammatory diseases of appendages.
• Inflammation of the fallopian tubes, accompanied by oophoritis (inflammation of the ovaries) - salpingoophoritis.
• Ovarian dysfunction associated with abortion.
• STDs are sexually transmitted diseases.
• Prolonged treatment of infertility, hyperstimulation of ovulation.
• Psychoemotional stress.

[8], [9]

How is the follicular cyst formed?

A normal monthly cycle, not burdened by treatment with hormonal drugs or other provoking factors, involves the production of follicles. The most active of them is the base for the maturation of the egg, which is released as a result of rupture of the follicle. The oocyte (egg) enters the uterus through the fallopian tubes, and the temporary endocrine gland is formed on the spot of the burst follicle - the yellow body (lutein). Lutein formation produces progesterone until the onset of menstruation or before the formation of the placenta with the onset of conception. If the dominant follicle does not burst, the oocyte remains inside, the follicular fluid does not pour out, a cyst is formed.

Follicular ovarian cyst and pregnancy

The follicular cyst in a pregnant woman is an obvious gynecological phenomenon or a diagnostic error. Indeed, cystic formations are not uncommon during pregnancy, but, as a rule, do not pose a serious threat. This is due to the fact that a pregnant woman, more precisely her body, needs much more progesterone than before, as he participates in the formation of a placental "child's place," and also supports the pregnancy itself. Due to the intensive production of progesterone, the yellow body does not function 10-14 days, but about 3 months, that is, the entire first trimester. It is the luteal body that can be transformed into a cyst, which subsequently resolves itself.

Thus, based on the logic and physiological sequence of formation of the yellow body at the site of the burst follicle, the follicular ovarian cyst and pregnancy in principle can not "neighbor". In addition, the pregnant woman has an increased production of prolactin, which stops the development of new follicles, so as not to allow them the possibility of forming a new pregnancy against the background of the conception that has already been realized.

The cyst during pregnancy, defined as follicular, is more a diagnostic error that needs to be corrected and the presence of potentially dangerous true tumors.

[10], [11]

Symptoms of the follicular ovarian cyst

Symptoms of the follicular cyst depend on its activity in the hormonal sense, as well as on the possible accompanying pathologies of the pelvic organs - endometriosis, salpingitis, myoma, adnexitis and others.

The hormonally active follicular cyst, which intensively produces estrogen, can manifest itself in the form of heavy bleeding during menstruation, early puberty in girls, and pains in the lower abdomen.

Inactive cysts develop asymptomatically and can resolve themselves without a trace so that the woman does not suspect their presence.

In addition, the clinic of follicular formations depends on the size of the cysts. Small follicular cysts do not appear clinically and are diagnosed randomly during clinical examinations. More extensive cysts are shown, which have a pronounced symptomatology.

Symptoms of the follicular ovarian cyst are as follows:

• Periodic feeling of raspiraniya bottom of the abdomen.
• Gravity in the groin area, at the site of cyst localization (right or left).
• Pain in the side, in the lower abdomen with prolonged walking, running, intense physical activity, often during intercourse.
• Painful sensations in the second half of the monthly cycle (15-16 days).
• Decrease in body temperature in the second half of the monthly cycle (up to 36,0).
• Uterine bleeding between menstruation.

The follicular cyst is not as safe as it might seem at first glance, it is fraught with various complications, such as torsion of the legs or rupture of the cyst.

Symptoms of the follicular cyst when the legs are twisted: 

• Strong, sharp pain in the lower abdomen, right or left in the place of localization of the cyst.
• Weakness, dizziness.
• Nausea, right up to vomiting.
• Copious cold sweat, drop in blood pressure.
• Tachycardia.
• Cyanosis, cyanosis of the skin.

Cyst rupture, signs: 

• Body temperature unchanged.
• Nausea and vomiting.
• Fainting condition.
• Dagger pain in the area of cyst localization.

A ruptured capsule of the cyst may be accompanied by internal bleeding: 

• Acute pain, which subsides and causes a state of shock.
• Tachycardia.
• Falling blood pressure, pulse.
• Weakness, drowsiness.
• Pale skin, cyanosis (cyanosis).
• Fainting.

Acute conditions require urgent medical attention, since the torsion of the legs, rupture of the capsule can lead to peritonitis.

Follicular cyst of the right ovary

The question of functional lateral asymmetry of the ovaries remains a subject of discussion, there is no reliable data that would confirm that the right ovary is more susceptible to pathological or benign neoplasms.

The follicular cyst of the right ovary statistically develops as often as the cyst of the left ovary. There are separate reports that say that the right ovary is in principle more active and more often forms dominant follicles. Perhaps this is due to its more intensive blood supply through direct connection of the artery and the main aorta. The left ovary receives nutrition from the renal artery bypass. It is also believed that the anatomically right ovary is somewhat larger than the left in the size, however such information is not clinically or statistically confirmed.

Indeed, right-sided apoplexy occurs two to three times and this is due to a natural cause-intensive blood supply and proximity to the aorta, but otherwise the follicular cyst is formed with the same frequency and according to the same pathogenetic principles as the left ovary.

It should be noted that the peculiarity of the follicular cyst of the right ovary lies in the symptoms of the appendicitis, which is similar to the clinic. Pain in the right side, a typical picture of the "acute abdomen" can cause confusion in the diagnosis, but as a rule, the differentiation of nosologies occurs quickly.

The cyst is not a violation of the general ovulatory function unless there is a rupture of its capsule or torsion of the foot. The information that the "right" ovaries become pregnant more often, that the percentage of the formation of cystic tumors in it is higher, no more than a myth.

Follicular cyst of the left ovary

The follicular cyst of the left ovary is not much different from the right-sided cyst. It is formed as a result of unresolved potential ovulation and growth of the active non-ligated follicle. Symptomatically, the left-sided formation manifests itself in the site of the localization of the cyst in the form of transient pains in the lower abdomen, intermenstrual bleeding. A more serious complication may be rupture of the capsule or torsion of the leg, when the pain becomes acute, dagger, a typical clinic of the "acute abdomen" develops, which requires immediate emergency medical care, surgical intervention.

The follicular cyst of the left ovary, not exceeding 5 centimeters, can develop asymptomatically and just as imperceptibly dissolve. Diagnose such cysts during preventive examinations or during examination for another pathology unrelated to cystic formations. Often, cysts do not require specific therapy, treatment is limited to systematic observation and control of cyst size within 2-3 months.

[12]

Rupture of the follicular ovarian cyst

The rupture of the cyst is accompanied by two kinds of serious complications: 

1. The outflow of the contents of the cyst into the abdominal cavity.
2. Hemorrhage directly into the ovary and its rupture is apoplexy.

The rupture of the follicular cyst occurs spontaneously, more often in the middle of the monthly cycle during the period of ovulation. The cystic follicle grows in parallel with another, normal active follicle that performs the function of forming the oocyte.

The cause of the rupture can be inflammatory processes in the abdominal cavity, in the ovary itself, hormonal disorders, changes in the level of coagulability of the blood. In addition, the provoking factor leading to rupture can be excessive physical activity, exercise, and sexual intercourse.

Signs of rupture of the follicular cyst: 

• Sharp, daggerache on the side, in the lower abdomen, in the zone of cyst localization.
• Tense stomach.
• Cold sweat.
• Pain quickly becomes diffuse, diffuse.
• Nausea, vomiting.
• Falling blood pressure and heart rate.
• A syncope is possible.

To diagnose the complications of follicular cysts, doctors use standard, proven methods: 

• Ultrasound of the abdominal cavity and pelvic organs.
• Puncture to determine possible bleeding and blood sampling for analysis.
• Laparoscopy.
• The rupture of the follicular cyst is treated urgently and only surgically.

The first thing that is done under stationary conditions is to stop bleeding, then the cyst is removed within the limits of healthy tissues. As a rule, the ovary itself is not operated, resection or its removal is possible only in extreme cases.

The dangers of the cyst rupture: 

• Anemia due to blood loss.
• Rarely - adhesive process and infertility. The modern method of laparoscopy practically excludes adhesions.
• Purulent peritonitis.

It should be noted that timely medical care, the operation is literally vital, since with hemorrhagic form of ovarian apoplexy, a lethal outcome is possible (hemorrhage more than 50%).

Diagnosis of the follicular ovarian cyst

Identification of small-sized follicular cysts often becomes an accidental finding during routine or spontaneous gynecological examinations. Small, less than 5 centimeters, cysts develop asymptomatically, which makes it difficult, and sometimes makes timely diagnosis impossible. More often than not, women with follicular tumors undergo an urgent examination of the already formed complications - twisting the legs of the cyst, ripping the capsule.

The standard measures, which involves the diagnosis of the follicular cyst, are as follows: 

• Anamnesis.
• Gynecological examination, palpation (two-hand).
• Ultrasonography.
• Dopplerography.
• Diagnostic emergency laparoscopy.
• UAC is a general blood test.
• Analysis of urine.
• Blood test for hormones (progesterone, estrogen, FSH, LH).
• Blood test for tumor markers.

[13],

Follicular ovarian cyst on ultrasound

One of the most revealing and informative methods for determining the size, condition of the cyst and surrounding pelvic organs is an ultrasound. Yellow body cyst, parovarial cyst, follicular ovarian cyst, - ultrasound can detect almost all cystic formations.

Ultrasound echography is prescribed after 5-7-year of the monthly cycle, usually to assess the function of the ovaries, its follicular properties. Ultrasound is performed several times to see the picture in dynamics - at least three times a month.

Normally, the ovaries in terms of size, structure, maturing follicles should have such parameters (on average): 

• Width - up to 25 mm.
• The thickness is 12-15 mm.
• The length is 28-30 mm.
• Follicles - from 1-30 mm.

The follicular cyst on ultrasound looks like a one-chambered formation more than 25-30 millimeters, it is defined as functional. The dimensions of the non-stalked cystic follicle can reach gigantic sizes - up to ten centimeters in diameter, they have different color and structure, the walls are even, thin enough. The larger the size of the cyst, the more thin the wall of the capsule. The ultrasound shows a clear, cyst-like effect behind the cystic dorsal reinforcement of dorsal ultrasound reflection.

It should be noted that the ultrasound diagnostic method is not unique, since it determines the size, structure, but does not provide information about etiological factors. Therefore, ultrasound should be reassigned to monitor the dynamics of cyst development.

[14], [15]

Follicular ovarian cyst

As a rule, the follicular cyst is diagnosed as a single-chamber cavity in 95% of cases, two-chambered formations from the follicles - this is a great rarity, the actual causes of which have not been fully studied.

Retention or functional cysts, a type of neoplasm, considered the most "harmless" and benign. This cyst has one chamber (cavity) filled with secretory fluid. The walls of the capsule of the cyst are extremely thin, although they consist of multilayer epithelium, this is due to the natural purpose of the follicle and its potential task - rupture and release of the oocyte.

If the bursted follicle does not increase to anomalous dimensions, the wall of the capsule is quickly thinned and held only by the connective outer tissue. It is assumed that the possible proximity to other types of cysts, rapid growth, the fusion of the adjacent walls of the capsule of the two cysts can form such a rare phenomenon as the follicular cyst is a two-chambered cyst.

In addition, the factor that provokes the abnormal structure of the retention cyst may be an inflammatory process in the appendages, the uterus or hyperstimulation as a way of treating infertility. Syndromic phenomena of hyperstimulation are most often observed in women suffering from persistent infertility, seeking to conceive. Such patients are usually asthenic in type of physique and already have a history of polycystic ovaries.

Also, the result of the examination and the diagnosis - a two-chamber follicular cyst may be a mistake of an ultrasound specialist, most likely there is another, more accurate and correct answer - a combination of retention, functional and true cysts that can look like a single, two-chambered formation on ultrasound.

Follicular ovarian cyst 3 cm

The retention cyst is of small size, and this type includes a small follicular ovarian cyst (3 cm), has properties for self-resolution. If a woman reveals a follicular formation up to 5-6 centimeters, the doctor usually chooses a wait-and-see tactic, that is, the cyst is not treated, followed by examination and regular ultrasound. During 2-3 monthly cycles, a small follicular cyst (3 cm) is able to dissolve independently without the use of hormonal agents and other therapies.

The absence of clinical symptoms, complaints from the patient, make it possible to simply observe the condition of the cyst as the only correct method of treatment.

If the cyst persists, that is, it persists for more than 3 months and is not prone to self-resolution, it is treated, and the recurrent follicular cysts, both small and large, also undergo therapy.

A woman who has a diagnosed small functional cyst (3 cm) needs only observance of such rules: 

• Restriction of physical activity, it is impossible to lift weights (more than 4-5 kilograms).
• You can not overheat the back, the pelvic area, take hot baths.
• It is necessary to reduce the activity of sexual contacts (frequency or intensity).

In other respects, as the gynecological practice shows, a small-sized follicular cyst resolves itself without any treatment. The only way to protect yourself from possible complications, which can even give a small three-centimeter cyst, is a regular gynecological examination and compliance with medical recommendations.

[16]

Treatment of follicular ovarian cyst

The choice of tactics for the treatment of functional cysts depends on the parameters of the neoplasm, the dynamics of growth (increase, persistence, relapse) and the patient's age.

As a rule, treatment of the follicular ovarian cyst is not difficult. Such cysts are diagnosed mainly in young women of childbearing age, which determines the treatment strategy and its possible prognosis.

The most common wait-and-see tactics for 3-month cycles, provided that the cyst is small - up to 5 centimeters, it develops asymptomatically and does not cause functional disorders.

Also, as a retention cyst therapy, a doctor can prescribe hormonal medications, most often oral contraceptives, which in the course of 2-3 months (less often - six months) inhibit the activity of the ovaries, respectively, and the formation of new follicular cysts. In addition, oral drugs can reduce the rate of growth of cystic formation and reduce its size, up to complete resorption. Thus, the normalization of the menstrual cycle as a whole, minimizes the risk of malignancy of the ovary, which is possible due to concomitant pathologies (inflammations) and neoplasms. This treatment option is often used if the woman is under the age of 40-45 years.

Patients in the menopause, provided that the follicular cyst does not exceed 5 centimeters, and the analysis on CA125 (oncomarkers) is normal, are also subject to observation, that is, the cyst is not subjected to either medication or surgical treatment. The only thing that is required is a dynamic observation with the help of ultrasound. It is possible to use stimulant therapy with oral contraceptives to speed up the reverse development of the process, physiotherapy - electrophoresis, ultraphoonophoresis, vitamin therapy.

Treatment of the follicular ovarian cyst is surgically performed only for specific indications, such as: 

• Persistent form of the cyst.
• Rapid growth of cysts, progression of the process.
• The diameter of the cyst is more than 7-8 centimeters.
• Cysts large (giant) size - 15 centimeters, which are removed in order to avoid torsion of the legs or rupture of the capsule.
• Emergency cases, complications - rupture of the capsule of the cyst, ovarian apoplexy, clinical picture of the "acute abdomen".

As a surgical method, a modern method is used, called the "gold standard" in surgery - laparoscopy, when the cyst is removed, its walls are sutured, and ovarian resection is possible. Ovariectomy (complete removal of the ovary) in women of childbearing age is only indicated in extreme cases when the patient's life threatens, and it is shown in women over 45 years to reduce the potential risk of ovarian cancer.

How to treat the follicular ovarian cyst?

On the question - how to treat the follicular cyst of the ovary should be answered by the treating gynecologist, as each organism is individual, respectively, and the state of the cyst, its features may have specific properties.

However, the standard methods of treatment of follicular cysts may be such variants: 

• Dynamic observation of cyst development, its growth or persistence. Showing ultrasound and gynecological examination, that is, expectant tactics for 3 months, or until the moment of self-resorption of the cyst.
• Normalization of the hormonal balance with the help of oral contraceptives and other drugs adequate to the condition and age of the patient.
• The appointment of homeopathic, vitamin preparations that strengthen immunity, the general state of women's health.
• Normalization of body weight with excess weight.
• Treatment of concomitant inflammatory diseases and disorders, especially this is important in relation to the endocrine system and the organs of the digestive tract.
• The appointment of physiotherapy procedures, possibly phytopreparations. These methods do not affect the size and structure of the cyst, but they have a general strengthening effect and create the possibility for self-absorption of cystic formation.

Surgical treatment is indicated in cases when the cyst considerably increases in diameter, disrupts the functioning of nearby organs, besides there is a risk of rupture of the capsule of the cyst, twisting of the leg, necrotic tissue, apoplexy of the ovary itself. Cysts in excess of 5-6 centimeters in diameter operate, as well as inflamed formations prone to suppuration. The operation is performed using a gentle method - laparoscopy, in exceptional, complicated situations, a laparotomy is indicated.

How to treat the follicular ovarian cyst should be decided by the doctor after the complex of diagnostic measures. If a woman is diagnosed with a cyst, even a small one, the recommendations of the treating gynecologist should be the reason for their strict implementation. Self-medication, treatment with so-called alternative methods is unacceptable, as it can lead to serious complications and persistent infertility.

Duphaston in the ovarian follicular cyst

The most common reasons for the formation of the follicular functional cyst are a change in the work of the hormonal system and inflammatory processes in the appendages, the uterus, either individually or in combination with each other. The primary follicular cyst, which was formed as a single case as a result of hormonal failure, is able to dissolve independently. However, hyperestrogenism on the background of insufficient progesterone production creates conditions for intensive growth of the cyst or its recurrence. In addition, with such an imbalance, there is a risk of torsion of the cyst leg, rupture of its capsule, disruption of the normal mode of the menstrual cycle, hyperplasia, proliferation of the uterine mucosa, endometriosis. Prolonged over 2 to 3 months, the predominance of estrogens is the reason for the administration of specific hormone balance-equalizing drugs, progestins.

Duphaston - a drug that is a productive analogue of progesterone, that is, taking it, a woman activates the production of the missing hormone, helps the work of the yellow (luteal) body. Duphaston in the ovarian follicular cyst is considered one of the most effective means, which, without suppressing the ovulation process, is able to translate the first phase of the cycle into the secretory, the second. This action leads to the normalization of the synthesis of LH (luteinizing hormones), the collapse of the cyst shell, to a decrease in its size. It is these properties of Dufaston that contribute to the resorption of the follicular cyst (other functional formations).

Duphaston is an oral medication that has a beneficial effect on the condition of the uterine walls, without causing side effects that are typical of synthetic analogues of progestins.

The main indication for the appointment of dyufastone is a disorder, a change in the hormonal balance, as well as any dysfunction in the menstrual cycle. The drug can be taken even by pregnant women, however, like any such remedy, dyufaston with a follicular ovarian cyst requires medical supervision. Dydrogesterone is the main active substance of the drug, developed relatively recently, so Dufaston belongs to the new generation of drugs, it is not a direct derivative of the main androgen - testosterone and does not have such side effects and complications as the previous androgenic agents.

The way Dufaston is administered, the dosage and the regimen are the prerogative of the doctor, contraindications to the prescription of this drug are such conditions and pathologies: 

• Suspicion of onco-process of different localization, malignant neoplasms.
• Rarely - individual intolerance of the main active ingredient - dydrogesterone.
• The pathological condition of the liver, hepatitis, cirrhosis.
• Poor blood coagulation, hemophilia.

It should be noted that Dufaston can not be considered a panacea in the therapy of follicular and other types of cysts. If after 2-3 months of cyst treatment continues to increase, there is no positive dynamics, another treatment option is possible, including a surgical one.

[17], [18], [19], [20], [21]