GYN CHRONICLES fluid that will create a cyst . Just prior to ovulation the cyst should be between 18-24mm . The cyst formed due to this is known as a follicular cyst and is quite normal .
Following ovulation , we get formation of the corpus luteum - roughly translated means yellow body , which will also take the appearance of a cyst but will be slightly smaller than the follicular cyst . If there is no pregnancy the corpus luteum is going to regress i . e . shrink and disappear . That is why during menstruation we do not expect an ovarian cyst .
However , should pregnancy occur , the hormone of pregnancy beta HCG , will rescue the corpus luteum and the cyst will now be referred to as the corpus luteum of pregnancy .
In a nutshell what am I trying to communicate - not all cysts are bad and it is actually normal to have an ovarian cyst and I would actually be concerned for a woman of reproductive age who does not have a cyst on ultrasound performed between the 8th - 20th day of her cycle . This may signify that she is not ovulating . Follicular cysts and Corpus Lutei are therefore what we clinicians call physiological cysts i . e . their presence is part of the normal functions of the body .
In some instances , the cysts persist and for the fertility specialist seeing a cyst during menstruation does not bode well for that cycle , unless time is a factor most would opt to stimulate in the subsequent cycle without a cyst .
My next client is Brenda , a 30 year old lawyer who has just gotten married . She came in with her spouse Brian and the two of them are concerned that she is as yet to get pregnant . If I could rub my hands together in glee that is what I would be doing as this is my kind of patient , a fertility consultation .
The two have been married for 6 months and she stopped contraception immediately after the honey moon as they had been together for some time and were ready to start a family . Normally , I would chase them away and tell them to come again in six months but remember history , history , history .
“ A cyst is a cavity or sac that has fluid in it . Cysts can form in any part of your body , that has epithelium . A cyst in the ovary is therefore called an ovarian cyst . This is one of the most common gynecological diagnosis .”
From her history it turned out she had irregular cycles and could stay up-to 3 months when she was not using the contraceptive pill . She also noted she had to go frequently to the beauty pallor for waxing as she was quite hairy and she developed hair on her chin . Classical a patient with potential to have Polycystic Ovarian Syndrome ( PCOS ).
She further noted since coming off the pill her periods were delaying for about 50 days . In view of my predetermined diagnosis I requested Brenda to do an Ultrasound and some hormonal tests .
The scan came back as Polycystic Ovaries , which classically are multiple small cysts arranged on the periphery of the ovary , what we call pearl necklace appearance . She concurrently , had slightly elevated prolactin levels .
In view of the above we started her on medication to control both the PCOS and prolactin levels and added some ovulation induction drugs and she is fortunate to have a beautiful princess for a daughter . In this instance though the cysts were small they were pathological i . e . causing disease .
My last client is Mary , a 50 year old lady who came in with complaints of swelling in the abdomen . She had noticed the swelling about a year ago and it had gradually been getting bigger . What was concerning was that this swelling was associated with weight loss , fatigue and alternating bowel habits - she would get bouts of constipation followed by diarrhea and vomiting . On physical exam we found she had a huge mass and Ultrasound confirmed an ovarian cyst , which looked cancerous .
The history was indicative of a probable ovarian malignancy , so we did the obvious thing and that was tumor markers and sent her for an MRI for presurgical staging .
Staging of Cancer of the ovary is normally done intra-operatively . My oncology colleagues can correct me if this has changed . With the elevated tumor markers I referred the patient to one of my oncology colleagues and the histology confirmed the malignant process . She is still undergoing followup and chemo-therapy with the gynaecological oncologist .
These 3 patients have illustrated that cysts can me a normal process . Such cysts are usually less than 5 cm in largest diameter and unless from the history something makes you worry nothing needs to be done immediately . The patient can be followed up and if the cyst shrinks or disappears you have nothing to worry about .
Any cyst greater than or equal to 5 cm in size needs to be investigated to rule out serious disease and these can be non-cancerous such as teratomas and endometriaomas . Unfortunately some cysts are malignant , and these need to be handled expertly and expeditiously .
The bottom line is you need a clinician to figure out what the problem is and for any cyst involving your reproductive organs the best clinician would be a gynaecologist .
I hope I have demystified this thing called cysts and wish you all a blessed Easter !! ■
MAL 47 / 22 ISSUE 19