Women of childbearing age are subject to frequent changes in hormonal levels. As a result, a number of diseases may develop. One of these are ovarian cysts.
A cyst is a benign, round-shaped formation that has a capsule and a cavity filled with fluid (serous fluid, blood, pus, and others).
Mechanisms of development and types of cysts
Depending on the presence of the epithelial lining, cysts can be true or false. Based on their origin, cysts are classified into congenital and acquired cysts.
Ovarian cysts have their own classification:
- Functional cyst. Develops from follicles or corpus luteum. No treatment required.
- Hemorrhagic cyst. Occurs as a result of hemorrhage into a functional cyst.
- Dermoid cyst. Cartilage tissue, hair, teeth and other tissues are often found in it. Can reach large sizes.
Women under the age of 50 with an irregular menstrual cycle, suffering from infertility, obesity, and hormonal imbalances are at risk for the formation of ovarian cysts.
Most often, ovarian cysts are asymptomatic. But, in rare cases (for example, if it is a hemorrhagic ovarian cyst), patients complain:
- for abdominal pain, relieved by taking analgesics. The pain is intense, not radiating;
- for painful and heavy menstruation;
- heaviness in the lower abdomen;
- for an irregular cycle;
- nausea, sometimes vomiting;
- for pain in the lower abdomen during physical activity, urination, after sexual intercourse.
Hemorrhagic cyst. Diagnostic methods
The diagnosis of hemorrhagic ovarian cyst is made on the basis of:
- the patient complains of pain, a pulling sensation in the lower abdomen, nausea;
- examination by a gynecologist. The abdomen is painful on palpation of the iliac regions and above the pubis, the pain does not radiate. The appendages are enlarged and may be painful;
- ultrasound examination. Signs of a round formation in the ovary;
- laparoscopic examination. On examination, the ovaries are lumpy and their contents may be visible. There may be fibrin deposits near the ovaries if the hemorrhagic cyst is accompanied by an inflammatory process;
- magnetic resonance imaging.
Treatment of functional ovarian cysts
The choice of treatment method depends on many factors, in particular on the patient’s complaints and clinical picture of the disease, on the risk of complications, on age and the need to preserve her reproductive function.
Treatment can be conservative or surgical. Conservative treatment is resorted to if the cyst is functional and uncomplicated. Resorption of the cyst occurs when oral contraceptives are prescribed. If the patient is overweight, then to normalize hormonal levels and the menstrual cycle, it should be reduced. Monitoring of conservative treatment is carried out using ultrasound. If hormonal therapy is ineffective, surgical treatment is considered.
Hemorrhagic ovarian cyst. Treatment
If the cyst is hemorrhagic, treatment is only surgical. After removal of the affected ovary or enucleation of the cyst, the pathological tissue must undergo histological examination in order to exclude a tumor process. Most often, the ovary is removed if the hemorrhagic cyst is complicated by bleeding or rupture. Enucleation of the cyst is prescribed in cases where a woman is of childbearing age and it is necessary to preserve the maximum amount of intact tissue. After surgery, hormonal, antibacterial and restorative therapy is prescribed.
Hemorrhagic ovarian cyst is a pathology that is dangerous due to its complications. Among the many gynecological diseases, the ovarian cyst is one of the most mysterious formations. Once it arises, it can disappear on its own or rupture. The latter process is called a cyst with hemorrhage or hemorrhagic cyst.
An ovarian cyst is a benign formation that forms on the surface of the gonad. Inside it is filled with bloody fluid or blood clots.
An ovarian cyst with further hemorrhage has its own characteristics:
- gynecologists most often diagnose this pathology in women of childbearing age and in girls during the period of establishing the menstrual cycle;
- is considered as a type of functional cyst. It may be a complication that occurs when a corpus luteum cyst or follicular cyst develops on the ovary. Formed as a consequence of the cyclical activity of the ovaries;
- this benign tumor never degenerates into a malignant form;
- it is an avascular formation that does not have arteries or veins. As a result, it has no blood supply;
- When an ovarian cyst ruptures, the blood passes into the peritoneum and gonads. This indicates the occurrence of complications and danger;
- occurs in the second period of the monthly cycle. Occurs when hemorrhage occurs inside the corpus luteum of the ovary or follicle:
- capable of self-resorption.
As a rule, in 97% of cases the cyst is unilateral. However, if the dominant follicle matures in two ovaries, a bilateral lesion is formed. Since the right ovary is anatomically closer to large vessels, a right-sided cyst is diagnosed in most cases. The occurrence of left-sided pathology is similar in symptoms and treatment to the right-sided form.
Symptoms of an ovarian cyst followed by hemorrhage
When hemorrhagic pathology appears, the patient experiences characteristic symptoms:
- menstrual irregularities, heavy menstruation. During the period between monthly bleedings, dark brown spotting appears;
- in the period from 11 to 23 days after menstruation, pronounced nagging pain suddenly appears in the side or lower abdomen. Irradiation of pain to the leg or anus is typical;
- false urge to have a bowel movement and frequent urination;
- burning in the abdomen;
- heaviness in the suprapubic region.
These cyst symptoms are characteristic of a pathological reaction.
Dangerous complications of pathology
A hemorrhagic cyst is dangerous because it leads to complications. They threaten the patient's life. First of all, perforation of the capsule is possible. Which will lead to exudate leaving the cyst cavity. Twisting of the leg of the node, which connects it to the gonad, may occur. Massive bleeding, which occurs most often, can lead to death of the patient.
Such conditions require immediate surgical intervention. Otherwise, peritonitis and blood poisoning may occur, which will subsequently lead to shock and death.
According to research, these complications are most often provoked by heavy physical activity. This is especially true for girls. Because the legs of the cyst are longer than those of an adult woman. In this regard, it is necessary to carefully consider the child’s complaints of pain in the lower abdomen.
The complications listed above are characterized by the appearance of the following symptoms:
- cold sweat;
- the pain increases quickly, the patient cannot take a body position that can relieve pain;
- drop in blood pressure. Darkening of the eyes, possible fainting;
- cardiopalmus;
- temperature increase;
- excitement followed by lethargy;
- vomit.
Etiological factors playing a leading role in cyst formation
The reasons why this pathology occurs are not fully known to medicine. Researchers believe that a major role in this case is played by changes in hormonal levels in cases of endocrine diseases.
Among the possible factors provoking cysts, gynecologists identify:
Taking emergency contraceptive medications and ovulation stimulants is the most common cause of dysfunction of the reproductive organs.
What diagnostic methods exist to determine pathology?
Timely diagnosis during the menstrual cycle will help avoid surgery. In modern gynecology, the following diagnostic methods are used to identify hemorrhagic nodes:
- examination by a gynecologist. When palpating the lower abdomen, the specialist identifies tension in the abdominal wall. Increase in the volume of the gonad. When examined by a doctor, the patient will feel pain;
- Ultrasound. Helps determine the density and size of the cyst contents. If there is fresh blood, the structure will not reflect ultrasound. Echogenicity indicates high density. This indicates the presence of coagulated blood clots in the cyst;
- MRI. A method that is intended to determine the type of pathological formation and the degree of hemorrhage;
- laparoscopy. Rarely used, it often leads to surgical intervention.
If a cyst is diagnosed during diagnostic procedures, the attending physician will determine the method of treatment.
Treatment of hemorrhagic ovarian cyst
Treatment methods for benign neoplasms are divided into 2 groups: medication and surgery. The method is determined by a specialist who takes into account the size and density of the hemorrhagic node. It determines how severe the symptoms are and the possibility of life-threatening complications.
Drug therapy
If the pathological condition occurs without severe symptoms and the risk of complications tends to zero, then the gynecologist opts for drug therapy with hormonal drugs. In this regard, the following may be prescribed:
- duphaston. It is prescribed only in cases where the cyst is caused by hormonal changes;
- contraceptives, combined type of action, for example, Janine. Effective in treating small cysts. Helps reduce the size of the node and prevents the return of the pathological condition. Thanks to these medications, the ovaries perform a minimal amount of functions.
During therapy, the patient must be constantly monitored by a specialist and undergo an ultrasound scan to monitor any changes that occur.
If an inflammatory reaction is detected, the patient is prescribed anti-inflammatory and antimicrobial drugs. In this case, the woman needs help. Be sure to consult your doctor.
Surgery
Surgical intervention is presented in the following cases:
- a complication of the pathological condition has occurred;
- A cystic formation was detected in a patient under the age of 15 years. Due to the anatomical and physiological characteristics, there is a high risk of complications;
- if drug therapy has led to an increase in the node by more than 10 cm.
Main types of surgical operations:
- laparotomy. It is carried out in case of complications or detection of malignant neoplasms in the uterus. With a large hemorrhagic node;
- laparoscopy. A gentle method of surgical intervention, due to small access. Prescribed for small cysts and in the absence of complications.
Scope of surgery
When choosing a surgical method, specialists aim to preserve as much healthy ovarian tissue as possible. Most often, surgeons choose cystectomy when performing surgery. This is an operation in which the cyst is completely removed from the ovary. To avoid hemorrhage into the peritoneal cavity, the capsule of the node is not opened. The ovary itself is also not affected. After surgery, it retains its functions, which allows a woman to become pregnant.
If suppuration or hemorrhage occurs, the doctor cuts out the affected areas on the ovary along with the node. In rare cases, bleeding appendages are completely removed. If only one gonad was removed, fertility is preserved.
For any surgical intervention on the ovary, after completion of the operation, a biopsy is taken for histological examination. Thanks to it, it is possible to exclude the development of cancer cells in the affected organ.
After the operation, the patient must register with the attending physician. This is necessary to monitor the condition and exclude recurrence of the pathological condition.
Cyst formation during pregnancy
If a hemorrhagic formation in the ovary appeared while a woman was carrying a child, then the doctor acts based on the size of the cyst. If it is small in size, it will not interfere with the normal course of pregnancy.
If complications occur, urgent surgery is necessary. Modern medicine makes it possible to remove a benign formation without risking the life of the fetus or mother. Over time, the patient's condition stabilizes. The prognosis for further bearing a child is favorable.
Possibility of conception
After laparoscopy, pregnancy can be planned only 4 months after surgery and six months after laparotomy. This is necessary in order for the entire body and ovarian tissue to fully recover. The stitches should heal completely.
For modern medicine, an ovarian cyst is a pathological condition. It can be cured if the patient consults a doctor in time. Surgical intervention, as a rule, occurs using a gentle method. This allows the woman to become pregnant in the future and successfully bear the fruit.
An ovarian cyst (ICD -10 N83.0) is a benign neoplasm that looks like a special cavity filled with fluid. In fact, this is a fairly common disease that can occur in the ovaries or in any other organ. More often, a person initially develops functional cysts; they can be asymptomatic and disappear over time. Although, if they form in the ovaries, there may be pain in the lower abdomen, radiating to the anus.
It is important to know: if a cyst begins to develop in an organ filled with blood vessels, effusion may occur into its cavity and a hemorrhagic form may form. In most cases, tumors of this type form on the ovaries. If the disease develops more actively, immediate surgical treatment may be required.
In medical terms, a hemorrhagic cyst is a follicle (capsule with liquid) that has not burst. Normally, it should rupture on the 12th-14th menstrual cycle and release a mature egg. But if for some reason it does not burst, the size of the follicle increases quite quickly. Its cavity is filled with blood, which, if it penetrates the peritoneum, can cause severe and sometimes fatal consequences. Is it possible to get pregnant with a hemorrhagic ovarian cyst? The answer to the question, as well as the symptoms of the disease, are described below.
Reasons for development
The appearance of hemorrhagic cysts on the ovaries is usually associated with a pathological change in a woman’s hormonal levels, for example, with weight loss, severe anorexia, or impaired functioning of the thyroid gland. In addition, the following factors that provoke this disease are known:
- abortions, miscarriages;
- current pregnancy;
- early menstruation;
- psycho-emotional disorders;
- genetic pathologies;
- prostration;
- frequent stress;
- long-term use of certain hormonal drugs;
- ARVI, for the treatment of which antipyretics were used;
- some diseases of the genitourinary system, especially chronic ones;
- surgeries on reproductive organs;
- age-related changes.
Such a cyst, after some time without adequate treatment, can degenerate into a hemorrhagic one, and this is influenced by the following factors: prolonged hypothermia of the body, excessive physical activity in the form of lifting and carrying heavy objects, improper treatment of viral infections.
There are cases in which this type of cyst was diagnosed in women who had not completely cured sexually transmitted infections and inflammations. The development of a disease of this type can occur as a result of an existing formation, accompanied by a delay in menstruation and a change in the condition of the hair and skin.
Symptoms of the disease
The neoplasm begins to form at the initial stage of the menstrual cycle and is a functional disease of the female body. The symptoms practically do not bother the patient at all, the state of health remains at the same level. Mild discomfort can be attributed to fatigue or bad weather.
If a hemorrhagic cyst develops on the right side, the woman usually experiences quite serious complications, since the blood flow in this area is associated with the location of the peritoneal aorta. Because of this, blood fluid begins to circulate more actively than on the left side.
As a result, blood can penetrate into the cyst cavity. It is noteworthy that for each patient the symptoms of this disease may differ significantly. If a very large amount of blood accumulates inside the cyst, there is a danger that at some point it may rupture. With this outcome, the cyst increases significantly, and the pain becomes more pronounced and noticeable. The following symptoms also appear:
- soreness (dull, nagging, prolonged pain) in the lower abdomen, which can be relieved with painkillers;
- anemia;
- increased pain during menstruation;
- dizziness, headache, loss of consciousness;
- significant increase in menstrual flow;
- elevated temperature, which is difficult to bring down;
- cycle irregularity;
- decrease in pressure;
- frequent feeling of heaviness in the perineum;
- mucous discharge and uterine bleeding;
- in some cases, vomiting and nausea appear.
In certain cases, women “attribute” pulling sensations in the lower abdomen to stress, since the above symptoms usually appear, for example, after urination or during intimate relationships.
Only a doctor is obliged to prescribe treatment for ovarian cysts (left and right) after identifying the symptoms. Self-medication in this case can be fraught with consequences.
Diagnosis of the disease
Initially, to establish a diagnosis, the patient must be carefully examined by a gynecologist. Typically, the patient is diagnosed with enlargement and tenderness of the uterine appendages, as well as abdominal pain. Palpation of the fallopian tubes and ovaries through the abdominal wall will confirm the presence of this diagnosis.
During the study, it is important to perform a gynecological ultrasound with transvaginal and transabdominal sensors, as well as Doppler ultrasound of the affected ovary. These methods will help determine the characteristics of its blood circulation.
Hemorrhagic ovarian cysts are often examined by MRI. It provides more information about the tumor.
The sonographic picture of a hemorrhagic cyst can be very different; it depends on the blood levels in the lumen of the cavity. Also, the neoplasm can be anechoic (with clear edges) or echogenic (with a denser structure). In general, a cyst can be multi-chamber, combined, homogeneous, or even divided into certain boundaries between its contents.
Laboratory research
In addition, the gynecologist may prescribe laboratory tests: blood tests, tumor markers, hormonal status, as well as a test that will help exclude or confirm pregnancy.
If indicated, magnetic resonance imaging and computed tomography can be performed. It will also be effective to perform a diagnostic laparoscopy to determine its location and size, try to remove the hemorrhagic cyst and view its contents.
Treatment Options
When treating a hemorrhagic ovarian cyst without surgery, the patient needs to apply a cold compress to the lower abdominal cavity and lie down more. The doctor usually prescribes treatment with anti-inflammatory and antibacterial drugs, agents that produce a resolving effect. But if there are complications and regression of the cyst, it is necessary to immediately perform one of the following types of surgical treatment.
Enucleation of the cyst
If a small tumor is detected during an examination in a woman and there are no cancerous tumors, an operation to remove it is usually prescribed.
This method of therapy is used in almost every case, since it makes it possible to preserve the normal functioning of the ovary and its intact tissues without affecting nearby healthy areas and without affecting reproductive function. This is especially important for girls who have not given birth.
Wedge resection
With long-term development of a hemorrhagic cyst (more than 3 months), the doctor may detect, during an examination, altered tissue on the ovaries that occurs due to compression of the growing tumor. By performing a wedge resection, the doctor can completely remove the cyst and all damaged organ fragments. The cutting is done in the form of a triangle, which is where the name of the surgical intervention comes from.
The functionality of the ovary is preserved as much as possible, and a woman can even become pregnant after some time. After the tumor is removed, the patient must undergo certain histological studies to exclude the possibility of developing a malignant process.
Surgical removal of cyst and ovary
It is noteworthy that this surgical intervention is performed very rarely, and complete removal is performed on women over 45 years of age, when reproductive function is fading, and also if several neoplasms are diagnosed simultaneously or there is a threat of cyst rupture.
For this problem, in most cases, surgery is performed. If a woman had one ovary removed during the procedure, it is possible that after some time she will be able to carry a child. When performing an operation on a patient during menopause, the doctor also removes the fallopian tube.
Excision of hemorrhagic cysts is carried out using modern technologies using minimally invasive methods without blood loss, scars, stitches and complications, through small punctures.
Recovery period
Usually the prognosis after removal of this type of cyst is favorable. If treatment is carried out correctly and on time, there may be no complications. Approximately on the second day after the intervention, the woman’s body begins to work as before.
Healing after laparoscopy occurs quite quickly, but in order to prevent the sutures from coming apart, doctors recommend not taking a hot bath for a while.
Some consequences and complications may occur if the tumor ruptures and blood enters the abdominal area. Blood fluid should be immediately pumped out, and disinfection and antiseptic measures should be carried out. This will make it possible to prevent further inflammation.
What to do next?
In the future, the patient should be regularly examined by her doctor, and also undergo a course (about 2 months) of therapy with vitamin complexes and antibacterial drugs, the goal of which is to restore ovarian function as much as possible.
At this time, it is necessary to follow a special diet to improve your health after surgery and your liver after anesthesia. First of all, you should eat foods that are easy on the stomach and eat in small portions. To heal internal wounds faster, you need to consume fruits and vegetables with plenty of vitamins.
What should not be done with a hemorrhagic ovarian cyst?
First of all, you should not delay examination by a gynecologist, and also self-medicate. We looked at the symptoms of ovarian cysts in women and the reasons for its appearance. This is a rather dangerous disease for reproductive function. If the tumor ruptures and fluid leaks out, the patient may experience peritonitis. But, as noted above, the symptoms of an ovarian cyst of this type are characteristic, it is difficult not to notice them, therefore the further development of the disease will depend solely on the woman.
The main task of the gynecologist is to diagnose the onset of the formation of a hemorrhagic cyst as early as possible and, if it develops, to carry out effective treatment so that the patient can become pregnant in the future and give birth to a healthy child!
Content
Hemorrhagic ovarian cyst is considered a type of functional neoplasm of the ovarian glands. This pathology usually does not pose a serious threat to a woman, but indicates a malfunction of the reproductive system in a given cycle. However, in some cases, even hemorrhagic tumors can become complicated, causing serious conditions that require immediate surgical correction.
Causes
Hemorrhagic cysts are classified as complicated functional formations. There are two types of functional tumors: follicular and corpus luteum. A follicular cyst is formed when ovulation fails in a particular cycle. In the absence of an egg release, the dominant follicle continues to increase in size and a neoplasm is formed. With increasing fragility of blood vessels, instead of liquid contents, blood accumulates in the formation and a left ovarian cyst with hemorrhage occurs.
The corpus luteum is formed monthly at the site where the egg leaves the follicle. This is a glandular structure that ensures the production of progesterone in the second phase of the cycle. Normally, during the process of ovulation, a small amount of blood is released, the main part of which enters the retroperitoneal space. In some cases, blood retention occurs in the follicle capsule. In its place, a hemorrhagic formation of the corpus luteum appears.
There is no single reason for the formation of such formations. However, among the predisposing factors the following are distinguished:
- genetic predisposition;
- young reproductive age (up to 35 years, when increased production of sex steroids is noted);
- stress;
- endocrine disorders;
- taking oral contraceptives, especially for short periods of time with frequent breaks;
- past inflammatory and infectious diseases of the reproductive system.
Direct hemorrhage into the cyst is provoked by hypothermia, trauma, excessive physical exertion, too active, rough sexual intercourse.
These same reasons come to the fore in the formation of complications. Therefore, if functional tumors of the appendages are detected, it is necessary to refrain from active sex and heavy lifting for a month until a control ultrasound is performed to determine further treatment tactics.
Symptoms
Some patients are unaware of the existence of a neoplasm of ovarian tissue. In most cases, especially when a hemorrhagic cyst occurs, a woman notes:
- pain on the affected side (usually associated with active movements, sports, sex);
- heaviness, bloating, discomfort in the lower abdomen;
- nausea;
- decreased performance;
- increased bleeding during menstruation;
- irregular, painful periods.
Hemorrhage into the cyst occurs against the background of existing disorders.
Often, hormonal disorders are accompanied by rashes on the skin of the face, increased glandular glands, and mood lability.
It is believed that a hemorrhagic cyst of the right ovary is more severe. This is due to increased blood supply to the right appendages. As a result, a larger volume of blood enters the pathological formation, and complications occur more often.
Possible consequences
Functional cysts themselves, including hemorrhagic ones, are not dangerous. The reasons leading to the formation of such formations cause changes only in one specific cycle. When examining the ovaries next month, the functional cysts resolve and decrease in size. This is the main difference from true ovarian cysts.
A cyst with hemorrhage of the right ovary is dangerous if it ruptures or torsions. Hemorrhagic tumors are subject to rupture more often: their wall is already thinned, and the contents are filled with blood. In a similar variant, the clinic of acute abdomen develops. The patient usually requires surgery to prevent serious bleeding and shock.
Functional ovarian formations with hemorrhage almost never become malignant, that is, they do not develop into a malignant tumor.
Diagnosis
The presence of a neoplasm in the ovaries can be suspected based on the patient’s complaints and the results of a gynecological examination. To confirm the diagnosis, the doctor usually prescribes an ultrasound.
During an ultrasound examination of the pelvis, a hemorrhagic cyst is defined as a hypoechoic round formation with a thin wall. Right-sided localization of the tumor is more common. When an inflammatory process occurs, fibrin filaments are usually found in the cyst cavity.
If the pathology picture is unclear on ultrasound, diagnostic laparoscopy and MRI are additionally performed.
Treatment options
A hemorrhagic cyst of the left ovary usually does not require treatment. More often, the functional formation resolves on its own when the triggering unfavorable risk factors are eliminated in the next menstrual cycle. However, tumors must be monitored: ultrasound is repeated every month. If the study reveals repression of the process, then the woman does not need therapy.
In the absence of dynamics, the tumor is located on the right side due to the increased risk of complications: rupture and torsion, many gynecologists prefer to start treatment. To eliminate the pathology, drug hormone therapy or surgical treatment is used.
Medication
In most cases, functional formations regress on their own. If the tumor is large enough, a woman needs to limit her sex life and sports to prevent rupture. In order to speed up the process, patients are prescribed hormonal contraceptives for 1–2 cycles. Then the dynamics of the pathology is monitored.
Long-term hormone therapy is indicated for patients who are not planning pregnancy in the near future. This is due to the fact that long-term treatment is required to obtain a lasting result. Some experts are convinced that there is a risk of recurrence of the hemorrhagic cyst after discontinuation of drugs in a short cycle of use. Surgical removal of the formation is considered more effective.
Surgical intervention
Laparoscopy is usually used to remove cysts. During the intervention, uncomplicated tumors are removed and the ovary is practically not injured.
A serious situation occurs when there is suppuration or rupture of the lesion. In this case, it is not always possible to save the ovary. After excision of the appendages on one side, a woman may well become pregnant and carry a child.
Removed tissues are always sent for histological examination to study the cellular structure and exclude tumor transformation.
Prognosis and possibility of getting pregnant
A hemorrhagic ovarian cyst usually does not cause serious harm to a woman’s health. With timely diagnosis and monitoring of the dynamics of the process, the prognosis is favorable.
The formation of functional hemorrhagic cysts does not affect reproductive function. In an uncomplicated course, even with the presence of a cyst, the patient can become pregnant. Situations when the integrity of the cyst is compromised pose a threat. Depending on the woman’s age, the volume of ovarian tissue rupture and the amount of blood loss, the issue of the type of tumor correction to be performed is decided intraoperatively. In the worst case scenario, the appendages have to be completely removed. However, even in such a clinical situation, the patient’s reproductive functions are not lost - pregnancy and childbirth are possible.
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