Follicular cyst of the ovary

A follicular ovarian cyst (cysta ovarii follicularis) is a type of functional formation in ovarian tissue. The cyst is formed from the folliculus ovaricus - a follicle that has not had time to rupture or burst.

A follicular cyst is considered a benign neoplasm, ranging in size from 2.5 to 8-10 centimeters, consisting of a single-chamber cavity containing estrogen-rich fluid. Most often, this type of cyst develops in young women of reproductive age, but it is also diagnosed in puberty and menopause. The frequency of diagnosed follicular cysts among all other cystic neoplasms of the ovaries is 80%.

Follicular cysts are capable, under certain conditions, of resolving on their own and cannot become malignant, that is, transform into malignant formations.

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Causes of ovarian follicular cyst

The first description of the pathological condition of the ovaries dates back to 1827, when the cyst was defined as an incurable "hydrocele" 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 yet developed a single version.

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

1. Disruption of the hormonal system.
2. An inflammatory process of an infectious nature in the appendages.

In 1972, the term apoptosis (self-programming of cell death) appeared in scientific circulation and many scientists rushed to study the relationship between apoptosis, steroidogenesis and ovarian function. Thus, another version of the etiology of follicular cysts appeared, based on the hormonal-genetic factor.

Currently, when developing a therapeutic and preventive strategy, doctors try to take into account all three theories, summarizing the most studied causes of follicular cysts:

• Hormonal imbalance associated with natural age periods – puberty, menopause.
• Pathological disorders of neuroendocrine regulation that provoke hyperestrogenism.
• Inflammatory diseases of the appendages.
• Inflammation of the fallopian tubes, accompanied by oophoritis (inflammation of the ovaries) - salpingo-oophoritis.
• Ovarian dysfunction associated with abortion.
• STDs are sexually transmitted diseases.
• Long-term treatment of infertility, ovulation hyperstimulation.
• Psycho-emotional stress.

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How does a follicular cyst form?

A normal monthly cycle, not burdened by hormonal treatment or other provoking factors, involves the production of follicles. The most active of them is the basis for the maturation of the egg, which is released as a result of the rupture of the follicle. The oocyte (egg) enters the uterus through the fallopian tubes, and in place of the ruptured follicle, a temporary endocrine gland is formed - the corpus luteum (luteal). The luteal formation produces progesterone until the onset of menstruation or until the formation of the placenta in the event of conception. If the dominant follicle does not rupture, the oocyte remains inside, the follicular fluid does not flow out, and a cyst is formed.

Follicular ovarian cyst and pregnancy

A 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, or rather her body, requires much more progesterone than before, since it participates in the formation of the placental "baby's place" and also supports the pregnancy itself. Due to the intensive production of progesterone, the corpus luteum functions not for 10-14 days, but for about 3 months, that is, the entire first trimester. It is the corpus luteum that can transform into a cyst, which subsequently resolves on its own.

Thus, based on the logic and physiological sequence of the formation of the corpus luteum at the site of a ruptured follicle, a follicular ovarian cyst and pregnancy cannot "coexist" in principle. In addition, a pregnant woman has an increased production of prolactin, which stops the development of new follicles to prevent them from forming a new pregnancy against the background of an already completed conception.

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

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Symptoms of Follicular Ovarian Cyst

Symptoms of a follicular cyst depend on its hormonal activity, as well as on possible concomitant pathologies of the pelvic organs - endometriosis, salpingitis, fibroids, adnexitis and others.

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

Inactive cysts develop asymptomatically and can resolve on their own without leaving a trace, so that the woman does not even suspect their presence.

In addition, the clinical picture of follicular formations depends on the size of the cysts. Small follicular cysts do not manifest themselves clinically and are diagnosed randomly during a medical examination. Large cysts are more pronounced and have pronounced symptoms.

Symptoms of a follicular ovarian cyst include:

• Periodic feeling of distension in the lower abdomen.
• Heaviness in the groin area, at the location of the cyst (right or left).
• Pain in the side, lower abdomen during long walks, running, intense physical activity, often during sexual intercourse.
• Painful sensations in the second half of the monthly cycle (15-16 days).
• A decrease in body temperature in the second half of the monthly cycle (to 36.0).
• Uterine bleeding between periods.

A follicular cyst is not as safe as it may seem at first glance; it is fraught with various complications, such as torsion of the pedicle or rupture of the cyst.

Symptoms of follicular cyst with torsion of the stalk:

• Severe, sharp pain in the lower abdomen, on the right or left side at the location of the cyst.
• Weakness, dizziness.
• Nausea, even to the point of vomiting.
• Profuse cold sweat, drop in blood pressure.
• Tachycardia.
• Cyanosis, bluish discoloration of the skin.

Ruptured cyst, signs:

• Body temperature remains unchanged.
• Nausea and vomiting.
• Fainting state.
• A stabbing pain in the area where the cyst is located.

Rupture of the cyst capsule may be accompanied by internal bleeding:

• A sharp pain that subsides and causes a state of shock.
• Tachycardia.
• Drop in blood pressure and pulse.
• Weakness, drowsiness.
• Pale skin, cyanosis.
• Fainting.

Acute conditions require emergency medical care, as twisting of the stalk and rupture of the capsule can lead to peritonitis.

Follicular cyst of the right ovary

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

Follicular cyst of the right ovary, according to statistics, develops as often as cyst of the left ovary. There are some reports saying that the right ovary is generally more active and more often forms dominant follicles. This may be due to its more intensive blood supply due to the direct connection of the artery and the main aorta. The left ovary receives nutrition from the renal artery bypassing. There is also an opinion that anatomically the right ovary is somewhat larger than the left in size, however, such information is not clinically or statistically confirmed.

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

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

A cyst is not a violation of the general ovulatory function, unless its capsule ruptures or the stalk twists. The information that women often "get pregnant" with the right ovary, that the percentage of cystic tumors in it is higher, is nothing more than a myth.

Follicular cyst of the left ovary

A follicular cyst of the left ovary differs little from a right-sided cyst. It is formed as a result of unresolved potential ovulation and the growth of an active unruptured follicle. Symptomatically, a left-sided formation manifests itself at the site of the cyst localization in the form of transient pain in the lower abdomen, intermenstrual bleeding. A more serious complication may be a rupture of the capsule or torsion of the pedicle, when the pain becomes sharp, stabbing, a typical clinical picture of "acute abdomen" develops, which requires immediate emergency medical care, surgical intervention.

A follicular cyst of the left ovary, not exceeding 5 centimeters, can develop asymptomatically and also resolve unnoticed. Such cysts are diagnosed during preventive examinations or during examination for other pathologies not associated with cystic formations. Often, cysts do not require specific therapy; treatment is limited to systematic observation and control of the cyst size for 2-3 months.

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Rupture of ovarian follicular cyst

Rupture of a cyst is accompanied by two types of serious complications:

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

Rupture of a follicular cyst occurs spontaneously, most often in the middle of the monthly cycle during ovulation. The cystic follicle increases in size in parallel with another, normal active follicle, which performs the function of oocyte formation.

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

Signs of a ruptured follicular cyst:

• Sharp, stabbing pain on the side, in the lower abdomen, in the area where the cyst is located.
• Tense stomach.
• Cold sweat.
• The pain quickly becomes diffuse and spread out.
• Nausea, vomiting.
• Drop in blood pressure and pulse.
• Fainting is possible.

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

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

The first thing they do in a hospital setting is to stop the bleeding, then remove the cyst within the healthy tissues. As a rule, the ovary itself is not operated on, resection or removal is possible only in extreme cases.

The dangers of a cyst rupture:

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

It should be noted that timely medical care and surgery are literally vital, since the hemorrhagic form of ovarian apoplexy can be fatal (blood loss over 50%).

Diagnosis of ovarian follicular cyst

Small follicular cysts are often detected by chance during routine or spontaneous gynecological examinations. Small cysts, less than 5 centimeters, develop asymptomatically, which complicates and sometimes makes timely diagnostics impossible. More often, women with follicular neoplasms undergo urgent examination due to already formed complications - torsion of the cyst stalk, rupture of the capsule.

Standard measures that are involved in diagnosing a follicular cyst are as follows:

• Collection of anamnesis.
• Gynecological examination, palpation (two-handed).
• Ultrasound examination.
• Dopplerography.
• Diagnostic emergency laparoscopy.
• OAC – complete blood count.
• Urine analysis.
• Blood test for hormones (progesterone, estrogen, FSH, LH).
• Blood test for tumor markers.

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Follicular ovarian cyst on ultrasound

One of the most indicative and informative methods for determining the size, condition of the cyst and surrounding pelvic organs is ultrasound. Corpus luteum cyst, paraovarian cyst, follicular ovarian cyst - ultrasound can detect almost all cystic formations.

Ultrasound echography is prescribed after 5-7 years of the monthly cycle, as a rule, 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, and maturing follicles should have the following parameters (on average):

• Width - up to 25 mm.
• Thickness – 12-15 mm.
• Length – 28-30 mm.
• Follicles – from 1-30 mm.

A follicular cyst on ultrasound looks like a single-chamber formation of more than 25-30 millimeters, it is defined as functional. The size of an unruptured cystic follicle can reach gigantic sizes - up to ten centimeters in diameter, they have different colors and structures, the walls are smooth, quite thin. The larger the size of the cyst, the thinner the wall of the capsule. Ultrasound shows a clear, characteristic for cysts, effect of amplification of the dorsal reflection of ultrasound behind the cystic formation.

It should be noted that the ultrasound diagnostic method is not the only one, since it determines the size, structure, but does not provide information on the etiological factors. Therefore, ultrasound should be prescribed repeatedly to monitor the dynamics of the cyst development.

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Follicular ovarian cyst, two-chambered

As a rule, a follicular cyst in 95% of cases is diagnosed as a single-chamber cavity; two-chamber formations from follicles are 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. Such a cyst has one chamber (cavity) filled with secretory fluid. The walls of the cyst capsule are extremely thin, although they consist of multilayered epithelium, this is due to the natural purpose of the follicle and its potential task - rupture and release of the egg.

If an unruptured follicle grows to abnormal sizes, the capsule wall quickly becomes thinner and is held in place only by the outer connective tissue. It is assumed that possible proximity to cysts of another type, rapid growth, and fusion of adjacent capsule walls of two cysts can form such a rare phenomenon as a two-chamber follicular cyst.

In addition, the factor provoking the abnormal structure of the retention cyst may be an inflammatory process in the appendages, uterus, or hyperstimulation as a method of treating infertility. Syndromic phenomena of hyperstimulation are most often observed in women suffering from persistent infertility, striving to conceive. Such patients, as a rule, are asthenic by body type and already have a history of polycystic ovary disease.

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

Follicular ovarian cyst 3 cm

A small retention cyst, and a small follicular ovarian cyst (3 cm) belongs to this type, has the ability to resolve on its own. If a woman is diagnosed with a follicular formation up to 5-6 centimeters, as a rule, the doctor chooses a wait-and-see tactic, that is, the cyst is not treated, it is monitored by examination and regular ultrasound. Within 2-3 monthly cycles, a small follicular cyst (3 cm) can resolve on its own without the use of hormonal agents and other types of therapy.

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

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

A woman diagnosed with a small functional cyst (3 cm) only needs to follow these rules:

• Limit physical activity; do not lift heavy objects (more than 4-5 kilograms).
• You should not overheat your back, pelvic area, or take hot baths.
• The activity of sexual intercourse (frequency or intensity) should be reduced.

Otherwise, as gynecological practice shows, a small follicular cyst resolves on its own without any treatment. The only way to protect yourself from possible complications that even a small three-centimeter cyst can cause is a regular gynecological examination and following doctor's recommendations.

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Treatment of ovarian follicular cyst

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

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

The most common tactic is expectant management over 3-month cycles, provided that the cyst is small in size – up to 5 centimeters, it develops asymptomatically and does not cause functional disorders.

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

Patients in the climacteric period, provided that the follicular cyst does not exceed 5 centimeters, and the analysis for CA125 (tumor markers) is normal, are also subject to observation, that is, the cyst is not subjected to either drug or surgical treatment. The only thing that is required is dynamic observation using ultrasound. It is possible to prescribe stimulating therapy using oral contraceptives to accelerate the reverse development of the process, physiotherapeutic procedures - electrophoresis, ultraphonophoresis, vitamin therapy.

Surgical treatment of ovarian follicular cysts is performed only for specific indications, such as:

• Persistent form of cyst.
• Rapid growth of the cyst, progression of the process.
• The diameter of the cyst is more than 7-8 centimeters.
• Large (giant) cysts – 15 centimeters, which are removed in order to prevent twisting of the stalk or rupture of the capsule.
• Emergency cases, complications – rupture of the cyst capsule, ovarian apoplexy, clinical picture of “acute abdomen”.

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

How to treat ovarian follicular cyst?

The question of how to treat a follicular ovarian cyst should be answered by the attending gynecologist, since each organism is individual, and accordingly, the condition of the cyst and its features may have specific properties.

However, standard treatment options for follicular cysts may include:

• Dynamic monitoring of the cyst development, its growth or persistence. Ultrasound and gynecological examination are indicated, i.e. expectant tactics for 3 months, or until the cyst resolves on its own.
• Normalization of hormonal balance with the help of oral contraceptives and other drugs adequate to the patient’s condition and age.
• Prescribing homeopathic and vitamin preparations that strengthen the immune system and the general health of the woman.
• Normalization of body weight in case of excess weight.
• Treatment of concomitant inflammatory diseases and disorders, this is especially important in relation to the endocrine system and digestive tract organs.
• Prescribing physiotherapeutic procedures, possibly herbal preparations. These methods do not affect the size and structure of the cyst, but have a general strengthening effect and create the possibility for self-resorption of the cystic formation.

Surgical treatment is indicated in cases where the cyst significantly increases in diameter, disrupts the functioning of nearby organs, and there is a risk of rupture of the cyst capsule, torsion of the pedicle, tissue necrosis, apoplexy of the ovary itself. Cysts exceeding 5-6 centimeters in diameter are operated, as well as inflamed formations prone to suppuration. The operation is performed using a gentle method - laparoscopy, in exceptional, complicated situations, laparotomy is indicated.

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

Duphaston for ovarian follicular cyst

Most often, the causes of follicular functional cyst formation are changes in the hormonal system and inflammatory processes in the appendages, uterus, both separately and in combination with each other. A primary follicular cyst, which formed as a single case as a result of hormonal imbalance, can resolve on its own. However, hyperestrogenism against the background of insufficient progesterone production creates conditions for intensive cyst growth or its recurrence. In addition, with such an imbalance, there is a risk of torsion of the cyst stalk, rupture of its capsule, disruption of the normal menstrual cycle, hyperplasia, proliferation of the uterine mucosa, endometriosis. Long-term, exceeding 2-3 months, predominance of estrogens is a reason for prescribing specific drugs that balance the hormonal balance - gestagens.

Duphaston is a drug that is an effective 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 for follicular ovarian cysts is considered one of the most effective means, which, without suppressing the ovulation process, is able to transfer the first phase of the cycle to the secretory, second. This action leads to the normalization of the synthesis of LH (luteinizing hormones), the collapse of the cyst membrane, to a decrease in its size. It is these properties of Duphaston that contribute to the resorption of the follicular cyst (other functional formations).

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

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

The method of using Duphaston, dosage and regimen is the prerogative of the doctor, contraindications to the prescription of this drug are the following conditions and pathologies:

• Suspected oncological process of various localizations, malignant neoplasms.
• Rarely - individual intolerance to the main active ingredient - dydrogesterone.
• Pathological condition of the liver, hepatitis, cirrhosis.
• Poor blood clotting, hemophilia.

It should be noted that Duphaston cannot be considered a panacea in the treatment of follicular and other types of cysts. If after 2-3 months of treatment with the drug the cyst continues to increase, no positive dynamics are observed, another treatment option is possible, including surgery.

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