Cyst on the ovary: treatment and symptoms. Endometrioid ovarian cyst Management of the postoperative period

Every healthy woman, if she is not carrying a baby, menstruates every month. Blood is a manifestation of the rejection of the “old” endometrium (the inner layer of the uterine mucosa). Apart from the inner surface of the uterus, such a layer should normally not exist anywhere. However, in some cases, endometrial cells move outside the muscular organ, causing various diseases of the female reproductive system. One of these pathological conditions The so-called endometrioid ovarian cyst is considered to be a cavity formation on the surface of the gland, which consists of menstrual blood enclosed in a capsule from the endometrium.

Causes of endometriotic cysts

Despite many discoveries in the field of medicine, scientists still do not know for certain the etiology of the disease.

However, there are several established reasons why endometrial cells are “out of place”:

1. Retrograde menstruation is a pathological process in which menstrual blood does not exit, as expected, through the cervix, but moves in the opposite direction - through fallopian tubes right in abdominal cavity. It is not known exactly what exactly causes blood to flow in the wrong direction, but the disease is more often observed in lovers of vigorous yoga classes. Especially, according to doctors, it is dangerous to frequently perform those poses when the hips and legs are above the body. To avoid problems, doctors do not recommend engaging in this sport (or any heavy physical activity) on the eve of menstruation, during it, and at least 3-5 days after.
2. The cervical canal is too narrow. On average, the width of the cervical canal should be about 2-3 mm. If for some reason the cervix is ​​partially or completely closed, this can lead to many problems: pain during sexual intercourse, infertility, scanty painful menstruation or even its absence. At the same time, despite the failure of the canal, the cyclical processes in the uterus continue as usual. Menstrual blood cannot flow out, and therefore accumulates in the cavity and exits in another way, ending up on neighboring organs.
3. Injury to the uterine layers as a result of surgical manipulations.
4. Metaplasia is the transformation of one tissue into another. The reasons for the transformation can be: poor ecology, inflammation, endocrine disorders, infections.
5. Hereditary predisposition and gene mutations. Only recently have scientists been able to identify genetic markers responsible for a tendency to pathology.
6. Hormonal imbalances. Almost all patients with endometrioid cysts had high level luteinizing and follicle-stimulating hormones, which in turn entails a decrease in progesterone levels and an increase in prolactin.
7. Inflammatory diseases of the pelvic organs.
8. Long-term use of the uterine device. Each spiral has its own service life, which averages 3-5 years. After this period has expired, the contraceptive must be removed. Delaying a visit to the doctor is fraught with: inflammatory process, ingrowth of a foreign body.
9. Deviations in the functioning of the endocrine system (thyroid gland, adrenal glands).
10. Severe emotional shock.
11. Obesity.

According to the international classification of diseases, the ICD-10 code for this pathology is No. 83.2 (Other and unspecified).

Stages of development and symptoms of endometriotic cyst

The clinical picture of the pathology directly depends on how far the pathological process has progressed. In total, there are 4 stages of the disease:

• Stage 1 – the cyst has not yet formed, however, isolated foci of endometriosis are already present in the ovary. This stage is always asymptomatic and does not in any way affect the woman’s quality of life and her reproductive function;
• Stage 2 – a small (3-4 cm) cyst forms on one of the ovaries. Endometrioid cysts of the right and left ovaries are equally common;
• Stage 3 – the pathology extends to the second ovary. Cysts reach sizes of 5-7 cm. Adhesions often develop in the area of ​​the uterine appendages and intestines.
• Stage 4 - on both ovaries there are cysts exceeding 7 cm in diameter. Endometriotic damage goes further, affecting the direct and sigmoid colon, bladder.

At stages 2-4 of the disease, clinical signs also appear, which can be expressed in:

1. Heavy menstruation. Moreover, often spotting appear in the middle of the cycle.
2. Aching pain in the lower abdomen, sometimes radiating to the groin. It can hurt both on the left and on the right (depending on the side of the lesion, but if there are cysts on both ovaries, the pain is not localized).
3. Increased urge to urinate.
4. Weakness, loss of appetite, nausea, increased body temperature.

It is worth remembering that pathology cannot form overnight. There is no single scheme: for some, it may freeze for several years, or increase extremely slowly.

Hello. I have an endometrioid cyst on my right ovary measuring 5 cm. I want to treat it, but now I’m on vacation, I want to go to Egypt. Tell me, a holiday at sea won't hurt? (Elena, 26 years old)

Hello, Elena. Each of us needs to rest. However, your cyst is already quite large, and before your trip you just need to consult a doctor, he will tell you further tactics. As for relaxation, sunbathing is not recommended for any ovarian tumor; this can provoke its active growth. You will have to hide in the shadows all the time and cover your body with clothes.

Diagnostics

To make a diagnosis of an “Endometrioid cyst,” an examination in a gynecological chair will not be enough; the doctor simply may not “see” the neoplasm, especially if it is small.

The most informative methods of instrumental examinations:

• diagnostic laparoscopy. The method is rightfully considered the best for diagnostics. Thanks to the latest equipment, the physician can not only examine in detail the structural composition of the cystic formation, but also take a biopsy for further histological examination;
• Ultrasound + Doppler is used to clarify the size of the cyst, as well as to determine the lack of blood flow in its walls;
• MRI allows for differential diagnosis of an endometriotic cyst from a dermoid cyst.

Laboratory examinations are needed to exclude an oncological process, as well as possible inflammation. For any detected cyst, it is better to take the following blood tests:

• tumor marker CA-125;
• general and biochemical.

The above examinations are only the main, but most important part. Based on the individual manifestations of the disease and the patient’s complaints, the doctor may prescribe additional diagnostics.

Treatment of the disease

If the pathological process is still in the early stages, the gynecologist may try to cure the patient with medications. With drug treatment without surgery, a small cyst can resolve. Also, in isolated cases, cysts sometimes resolve on their own during pregnancy due to physiological changes in hormonal levels. However, it is worth remembering that medication alone cannot completely get rid of the diagnosis; treatment can only prevent the spread of the lesion, normalize hormone levels and smooth out symptoms.

Today, the following medications are used to promote tumor regression:

• antibiotics;
• androgens;
• vitamins;
• progestins;
• sodium thiosulfate;
• antispasmodics;
• COCs;
• gonadotropin releasing hormone agonists.

In more difficult cases when the pathology has progressed beyond stage 2 and/or drug treatment for 2-3 months it didn’t work positive results, without surgical intervention can't get by. The scope of the operation is always assessed by the surgeon, taking into account many factors: the patient’s age, her reproductive plans, the severity of the disease, and the presence of concomitant pathologies.

As a rule, for women who want to become pregnant in the future, best solution– performing laparoscopy. The low-traumatic operation is performed using special equipment through 3 small incisions (2-3 cm). Thanks to lighting fixtures, the doctor sees everything that is happening on a large monitor. This method is good for not very large cysts (up to 6 cm), and is popular all over the world due to the short rehabilitation period and lower risk of complications.

The classic method, laparotomy, is used if the disease has progressed too far or there is a risk of malignant degeneration of the cyst. If a woman has no reproductive plans, the affected organ is completely removed.

The surgical method allows the patient to be relieved of the harmful consequences of the disease, but it is not able to eliminate its cause, so postoperative therapy is prescribed to everyone and includes taking hormonal medications. Properly selected medications prevent the growth of a pathological focus and reduce the risk of developing inflammatory process and greatly reduce the risk of relapse. Treatment after removal of the ovary is also mandatory.

Endometrioid cyst and pregnancy

Most often, the disease, unfortunately, leads to infertility. However, not in all cases, and the onset of a natural pregnancy is not at all excluded, although the chances of it are extremely low.

Sometimes when a woman is already pregnant. Doctors should closely monitor such a patient and conduct ultrasound examinations every 2-3 weeks. In 90% of cases, after conception, the endometrioid cyst decreases slightly or stops growing. But it can also increase in size at catastrophic speed. There is a risk of rupture of the cyst by the pregnant uterus. There is only one way out of this situation - surgical intervention (but not earlier than 16-17 weeks). Remember that planning a pregnancy is a responsible step, and before trying to conceive a baby, it is better to consult a gynecologist for an examination.

With infertility due to endometriosis spreading to the ovaries, many women wonder whether it is possible to seek help from in vitro fertilization(ECO). It is known that cyst growth is favored by increased level estrogen, and during pregnancy its level decreases significantly. Therefore, carrying a baby will have a beneficial effect on the health of the expectant mother. However, before the procedure, the ovarian cyst must be surgically removed. Then the patient must recover from the operation, and only after a few months can ovulation stimulation be carried out under the strict supervision of experienced doctors.

Hello, doctor. I was diagnosed with endometrial hyperplasia and endometrioid cysts of both ovaries (3 cm on one, 4 on the other). My husband and I want a child. Please tell me, can I get pregnant? (Yana, 33 years old)

Hello, Yana. Of course, you can get pregnant, although the chances of this are very low. But I strongly do not recommend that you live an open sex life until you have treated your pathology with a doctor. In millimeters, your cysts are small, which means that you can try therapy without surgery. If you still manage to conceive a child with your diagnosis, this will entail the following risks: miscarriage, abnormal development of the fetus with the formation of defects, the formation of malignant tumors. Don't take the risk, go to the hospital.

Possible complications

If you fail to apply in a timely manner medical care, when nothing prevents the growth of the cyst and it reaches large sizes (over 4-5 cm), the risk of very unpleasant consequences increases many times, such as:

1. Development of adhesions, inflammatory reaction and suppuration.
2. Scarring of tissue on the ovaries, which has a bad effect on the functioning of the gland.
3. Disruption of the egg maturation process due to compression of the ovarian tissue.
4. Rupture of the cyst cavity with spillage of its contents into the abdominal cavity, causing peritonitis. The presence of free fluid in the abdominal cavity can be confirmed by puncture or ultrasound. A rupture can be caused by: increased physical activity, blow to the stomach, active sexual intercourse, sudden bending. At the moment when the cyst bursts, the woman feels a sharp dagger pain, her pulse quickens, her blood pressure decreases, her temperature rises, she looks pale, and cases of fainting are common. With this complication, it is necessary to urgently carry out surgical intervention, otherwise peritonitis can be fatal.
5. . Pathology can also be provoked by sudden movements, but torsion can also occur in a state of complete rest. Due to excessive compression of the tissues, blood stops flowing to them, and necrosis (tissue death) develops. To prevent the development of peritonitis and sepsis, the woman must be immediately taken to the clinic.
6. Disruption internal organs(intestines, bladder), due to their compression by the neoplasm.
7. Malignization. With an untreated stage 4 cyst, its malignant degeneration is possible.

Many of the above complications can only be treated with surgery. To avoid ending up on the operating table, if you are in good health, visit a gynecologist at least once a year, or better yet, once every 6 months.

Treatment of endometriotic cysts with folk remedies

Homeopathic treatment helps alleviate or even cure many diseases. However, it is worth remembering that an endometrioid cyst is dangerous for the development of serious complications, and therefore one should approach grandmother’s methods with extreme caution. Before doing anything, consult your doctor.

According to homeopaths, the most effective methods are considered:

1. Viburnum juice diluted with liquid honey.
2. Liquid honey combined with finely chopped green nuts.
3. Alcohol tincture with Kirkazon fruits.
4. Fresh burdock juice.
5. Brewed calendula leaves.
6. Hog queen and red brush.
7. Tinctures of celandine, dandelion, acacia flowers.

In addition to honey and useful herbs, the following will help improve blood circulation in the affected organ:

1. Acupuncture.
2. Moxibustion therapy (heat treatment).
3. Acupressure.

If you are a follower folk remedies, the best option There will be the use of herbs and physiotherapy along with drug treatment. Treatment without surgery is possible only when the stage of the disease has not reached stage 3-4, and the cyst is still quite small.

Hello! A couple of days ago, during an ultrasound, the doctor discovered an endometrioid cyst of my left ovary measuring 2 cm. What should I do? Should I delete it or not? (Larissa, 22 years old)

Hello, Larisa. Such a cyst can be treated without surgery; its size is too small for surgery. However, there is no need to launch yourself. Contact your gynecologist as soon as possible to select further tactics.

You can ask your question to our author:

2010-06-25 15:32:11

Elena asks:

Good afternoon I am 27 years old. A month ago I was admitted to the hospital with bleeding and underwent surgical curettage. Did an ultrasound, the conclusion was endometrial hyperplasia and uterine fibroids small sizes. Histology results: endometrioid endometrial hyperplasia, focal endometritis. I also took a tank test from the vagina and uterine cavity, but there are no results yet. This hospital recommends treatment with the hormonal drug Yarik or Nova-Ring. At the same time, they did not take a hormone test from me.
A year ago I gave birth. Pregnancy and childbirth passed without complications. The child was born weighing 4 kg. The first period came after a year and 1 month and immediately bleeding.
I also had 2 juvenile hemorrhages at age 14. At the age of 17, I had surgery to remove a parovarian ovarian cyst, and I also had polycystic disease of the left ovary. After this, I injected progesterone intramuscularly for some time before my period. Then the menstrual cycle more or less regulated. There were no particular problems. Got pregnant without problems.
Please tell me how I should be treated and which of these drugs is preferable?

Answers Lishchuk Vladimir Danilovich:

Dear Elena! I can only advise that you need to take one of the contraceptive drugs with therapeutic purpose. Which one specifically? This can only be decided by the doctor who is observing you. There are many options.

2010-06-23 17:53:27

You can't ask:

My mother’s ovarian cyst burst and there was no bleeding. There was just some kind of brown color that I don’t even know. She went to the gynecologist for an ultrasound. Is it dangerous if it bursts, the cyst and fibroids will not become cancer later??? Tell me please???

Answers Lishchuk Vladimir Danilovich:

Your mother most likely had a so-called functional cyst. These formations belong to pseudotumor formations. There is no danger of developing cancer, but you need to be under the supervision of a gynecologist because this is a sign of impaired ovarian function.

2010-06-21 11:20:11

Olga asks:

4th day after laparoscopy of bilateral ovarian cysts (5 cm and 8 cm) diagnosis of endometriosis, I have not given birth or become pregnant for 39 years, they offer hormone injections for 3 months (menopause) - I am afraid of the consequences - obesity, hair loss and bone collapse, very I'm afraid I can't make a decision if I even have a chance of getting pregnant

Answers Kushniruk Natalya Sergeevna:

Dear Olga,
it all depends on your plans: to engage in infertility treatment or not? Try injecting 3.75 mg instead of a dosage of 11.25 mg of GnRH agonist with a review of the ultrasound 27 days after the injection. It is very difficult to assess your chances of pregnancy without seeing your uterus, ovaries, hormone levels, and sperm count.
Everything needs to be decided directly at the reception.
The only thing that can be said for sure is that there is no time to waste. As soon as you are discharged, make an appointment at the reproductive medicine clinic.
Sincerely, Natalya Sergeevna Kushniruk.

2010-06-19 20:05:54

Alexa asks:

Hello! I ask you to suggest methods of treatment. You know more than our city doctors and I have been convinced of this more than once. My mother is 51 years old and has had a large ovarian cyst of 200 ml for 3 years already. The doctors wanted to cut, but her heart could not stand it .Cancer cells (CA-125) were higher than normal. A herbalist helped. I drank natural drops, herbal tinctures, etc. Now the cyst has decreased to 100 ml in 1.5 years. But fluid has appeared in the abdominal cavity (where the ovaries are). It was seen using an ultrasound, 7-10 ml in volume. It is difficult to get to a herbalist, but good specialist We can’t find a doctor. In a couple of days we’ll get tested again for CA-125. Tell me, what kind of liquid could this be??? Thanks for any help.

Answers Kaliman Viktor Pavlovich:

Good afternoon
CA-125 is one of the tumor markers. It must be taken according to indications and as prescribed by a doctor.
The fluid that is located in the pouch of Douglas can be of various etiologies. Therefore, you need to consult a doctor.

2010-06-15 15:35:10

Klopot Kristina asks:

Hello, I had a follicular ovarian cyst, I cured it, but I haven’t been able to get pregnant for 2 years now, what do I need to take, what medicine should I take, thank you

Answers Medical consultant of the website portal:

Good afternoon, Christina. First you need to find out why pregnancy does not occur. To do this, you need to consult a fertility specialist. You and your husband must undergo the examination. Only then can any treatment be discussed.

2010-06-13 08:07:31

Natalie asks:

Tell me, please, how can an endometrioid ovarian cyst (size 19x24mm) be cured? Is the treatment option appropriate? hormonal contraceptive Janine?

2010-06-12 22:00:57

Inna asks:

Good afternoon. On April 9, I had a laparoscopy (ovarian cysts were removed). After that, my period was on April 15th. I didn’t have my period in May, I thought I was pregnant, I went to the hospital, but the doctor said no. Still no period. What's the matter? I'm already worried.

2010-06-01 08:06:05

Elena asks:

A month and 10 days ago I had an operation to remove the uterus and left ovary due to uterine fibroids and ovarian cysts. I feel normal. Great fear of having sex. Please explain what I need to be afraid of and what I shouldn’t? When can I start? sex life after surgery without harm to health?

2010-05-31 16:41:32

Olga asks:

Hello! I have a left ovarian cyst that has not resolved for 5 months after its treatment. That month the cyst was 5 cm in size, this month it is already 62*60 mm and has changed due to fluid formation. I am 24 years old, I have not given birth yet, my husband and I really want a child, please tell me whether it is possible to get pregnant with an ovarian cyst and what the consequences may be, thank you very much in advance.

Answers Vengarenko Victoria Anatolevna:

Olga, of course, you must first remove or cure the cyst, and then plan a pregnancy, otherwise there may be torsion or rupture of the cyst (ovarian apoplexy)

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Update: December 2018

An endometrioid ovarian cyst is one of the manifestations of endometriosis. Imagine that blood, parts of the inner lining of the uterus (endometrium) and clots that are normally released during menstruation begin to penetrate the wall of the uterus and then spread to the fallopian tubes and ovaries.

In addition to its abnormal location, this tissue (it is called endometrioid) continues to partially function. During menstrual cycle the same changes occur in it as in the normal uterus. The tissue also swells, grows and bleeds.

When endometrioid tissue reaches the ovaries, it penetrates its membrane and forms a capsule. As already mentioned, this tissue continues to function and blood accumulates in the capsule. The shell of the cyst is dense, and the contents are thick and resemble dark chocolate (the color of coagulated blood). Sometimes such cysts are called “chocolate” cysts.

The size of cysts can vary significantly.

What does this depend on? It has not yet been established, as well as the nature of endometriosis in general. Of course, the longer a cyst exists without treatment, the more its size will increase. But in some women the progression will be slow, while in others the growth of the cyst is very rapid and is combined with other symptoms of endometriosis (pain during intercourse and during menstruation, infertility and heavy menstrual bleeding).

Why are endometriotic ovarian cysts dangerous?

Among all pelvic formations (cysts, tumors), 10-14% are endometrioid ovarian cysts. The danger of these cysts in the development of infertility, frequent relapses cysts after treatment, the development of massive adhesions in the pelvis and the formation of persistent pelvic pain. There is also a danger of cyst rupture due to their large size or sudden physical stress and injury.

Why do endometrioid ovarian cysts form?

The cause of endometriosis has not yet been identified. Obstetricians-gynecologists and endocrinologists, histologists, cytologists and pathologists are working on this. There is even a special association where the slogan is the phrase “When endometriosis is a sore point.”

What we managed to find out is the hormonal predisposition of some women to endometriosis and some other factors:

• a disorder with an excess of estrogens and a lack of progestins. Behind these terms lies the fact that the first phase of menstruation (up to the 15th day of the cycle) occurs with an excess of hormones, and the second phase (from the 15th day until menstruation) - with a deficiency.
• surgical termination of pregnancy, that is, medical abortion. During an abortion, a sharp metal curette is used to scrape the inner wall of the uterus. During curettage, the layers of the uterine wall are damaged and cell migration may occur.
• heredity. If the mother or other close relatives suffered from manifestations of endometriosis, then this can be passed on genetically.
• chronic inflammatory diseases pelvic organs (PID). If there is presence in the tubes and/or ovaries chronic inflammation, then the tissues become more vulnerable and loose. Such tissue is always less resistant to damage, including the introduction of foreign cells.
• other dishormonal and metabolic diseases. As a rule, all hormonal systems are interconnected. Therefore, patients with diseases thyroid gland(especially with hypothyroidism, when thyroid function is reduced), cycle disorders and diabetes mellitus of any type are at risk.

Types of endometrioid cysts

In some sources, endometrioid cysts are divided according to the stages of the disease:

• Stage I – damage to one ovary, the size of the cysts is insignificant (up to 3 cm);
• Stage II – damage to one ovary, cyst sizes up to 5 – 6 cm;
• Stage III – damage to one or more often both ovaries, cyst sizes up to 5–6 cm, active formation of adhesions in the pelvis and initial signs damage to other organs (intestines, bladder, etc.);
• Stage IV – damage to both ovaries, the size of the cysts is large, more than 6 cm. Such cysts are already called cystomas. A cystoma is a large cyst, which at the initial stage of diagnosis is always suspicious of oncology.

But more often, a purely clinical classification of endometrioid cysts is used, which indicates which ovary is affected, the size of the cyst and complications. This helps not to be distracted from the main thing and formulate only the most important things in the diagnosis.

An example of a diagnosis:

1. Common endometriosis. Endometrioid cyst of the left ovary. Cyst rupture. Internal bleeding. Hemorrhagic shock of the first degree.
2. Common endometriosis. Large endometrioid cyst of the right ovary (5 cm). Secondary infertility.

As we can see, the presence of a cyst entails various consequences. Below we will talk about this in more detail.

Diagnostics

Clinical picture, that is, symptoms

The patient’s complaints, absence of pregnancies and analysis of the menstrual calendar allow us to suspect endometriosis and cysts as its manifestation.

Ultrasound examination (ultrasound)

Ultrasound is an accessible, safe and painless method for diagnosing a wide variety of diseases. In addition, this method allows you to get results immediately. Ultrasound reveals cysts of even very small sizes; the accuracy of detection depends on the level of resolution of the ultrasound machine, as well as on the experience of the doctor. Often we see descriptions of formations from 5-8 mm.

Ultrasound statistics indicate:

• unilateral cysts are detected in approximately 80% of patients;
• bilateral cysts in approximately 20%
• one cyst in the affected ovary occurs in the majority, this is approximately 80%
• two cysts in one ovary - 16%;
• three cysts in 2.5%;
• four cysts are very rare, up to approximately 0.5%.

Ultrasound features of endometrioid cysts:

• thick capsule (outer lining or wall of the cyst)

The wall of endometrioid cysts not only limits its contents, but also functions. The inner layer of the cyst shell continues to “menstruate”, the contents accumulate, so the cyst grows.

• relatively small diameter of cysts, mostly cysts measuring up to 7-8 cm are found
• thick, “opaque” content for ultrasound. Ultrasound doctors call this “increased echogenicity.”

Due to the fact that the internal contents of cysts are very thick and dense, small cysts are sometimes mistaken for tumors.

• On ultrasound, the cyst wall sometimes has a double contour
• cysts are most often located on the side of the uterus or behind the uterus.
• endometrioid cysts are most often detected during childbearing age, when the menstrual cycle has already established.
• cysts grow outward from the ovary

This means that the cyst does not “inflate” the ovary, but grows away from it. Therefore, with large cysts, the ovarian tissue seems to “spread out” and stretch over the surface of the cyst.

• often an adhesive process forms around the cyst

Magnetic resonance imaging (MRI) and computed tomography (CT)

These are additional research methods that can clarify the structure of the cyst, its adhesion to neighboring organs and other subtleties that may be needed to decide on further treatment tactics.

These methods are very expensive, and computed tomography also carries a significant radiation load. CT is a method from the X-ray group, so it cannot be used during pregnancy.

Laparoscopy

Laparoscopy is an examination of the abdominal cavity from the inside using instruments (laparoscope and manipulators).

This is an operation that is performed under anesthesia. Spinal anesthesia or general anesthesia is used depending on the clinical situation. Holes are made in the anterior wall of the abdomen through which the devices are inserted. Air is pumped into the abdomen, the organs are slightly moved apart and the area of ​​interest in the abdominal cavity can be examined.

Ideally, diagnostic laparoscopy turns into therapeutic laparoscopy, which we will discuss below.

Depending on the symptoms and stage of the process, diagnosis can be carried out and completed at the ultrasound level or continue further.

If there are manifestations (pain, heavy irregular menstruation, etc.), according to ultrasound we see small endometrioid cysts and endometriosis of the uterus, then it is logical to carry out drug treatment, evaluate the effect and carry out ultrasound monitoring.

If the patient does not become pregnant. severe abdominal pain before and during menstruation, then you may need more high-tech methods from points 3 and 4.

Symptoms

Pain syndrome

Pain occurs before and during menstruation, sometimes reaching an intensity that women describe as “unbearable” and “exhausting.”

The pain is most often nagging and aching in nature; pain in the lower abdomen and lower back is more common.

Less often, women notice the same pain in the middle of the cycle, approximately on days 14-16 of the menstrual cycle, that is, during the period of ovulation (the release of an egg from the ovary).

There may also be pain during sexual intercourse; they are usually localized on the side where the cyst has formed.

Menstrual irregularities

If the cyst deforms the ovary, is large and displaces normal ovarian tissue, then ovulation may not occur in this ovary. Then the cycle is broken.

Menstruation may be delayed and then come very heavily.

Infertility

The cysts themselves disrupt the maturation of eggs. In this case, it is necessary to take into account the causes of the development of endometriosis. One of the reasons is an excess of estrogens, female sex hormones, which predominate in the first phase of the cycle. If there is a lot of estrogens, and few gestagens (hormones of the second phase of the cycle), then the entire process of conception and implantation of the embryo in the uterus is disrupted.

Infertility in the case of cysts can be primary or secondary. Primary infertility- this is the state when there have never been pregnancies. Secondary - if there were pregnancies with any outcome (normal birth, premature birth, miscarriage or frozen pregnancy), and then the desired pregnancy does not occur for more than 1 year without contraception.

Nonspecific treatment

Non-specific treatment means that the treatment will not remove endometriosis and cysts from the body, but will help relieve symptoms (pain, heavy bleeding). NSAIDs (non-steroidal anti-inflammatory drugs):

• diclofenac,
• indomethacin,
• celecoxib,
• rofecoxib.

These drugs are used situationally, usually in the period before and during menstruation, if necessary in the middle of the cycle. You should be aware that uncontrolled use of these drugs is by no means harmless and can lead to serious liver damage.

Hormonal treatment

COCs (combined oral contraceptives)

COCs are used in women with endometriosis to reduce symptoms (pain, heavy bleeding) and recovery after surgery.

But contraceptives do not solve the problem of having cysts. It is impossible to “treat” exclusively with COCs, but they can be used in combination with other methods.

Today, the optimal regimen for taking COCs is a continuous regimen after surgical treatment. Thus, the possibility of recurrence of endometrioid cysts is maximally suppressed.

Of the variety of combined estrogen-gestagen contraceptives for patients with endometriosis, those that contain the dienogest component are preferable: Janine (or its analogues Siluet and Bonade) or Qlaira (on at the moment has no analogues).

Progestogens

These are drugs that are analogues of female hormones that predominate in the second phase of the menstrual cycle.

Typically, women with endometrioid cysts have excess estrogen. Progestogens “balance” this imbalance, and thus help suppress the growth of lesions and cysts.

There are progestogen preparations in tablets and injections, each type has its own disadvantages and advantages.

Drugs in tablets are easier to dose and stop if an allergy develops, but you have to take them every day, remember about it and control the intake at the same time.

Injections are easier to use; they are done once every few days or even once a month. But at the same time, if the drug is not suitable, then its effect cannot be taken and “cancelled”, because it has already been introduced and its formula is such that it will be absorbed slowly and gradually. One thing that can be said in favor of intramuscular drugs is that allergic reactions on them - this is still a rarity.

The following tablet drugs are used: dydrogesterone (Duphaston), norethisterone acetate (Norkolut), dienogest (Visanne), and much less commonly megestrol (Megais).

The following intramuscular drugs are used: medroxyprogesterone acetate (Depo-Provera or Medroxyprogesterone-Lance).

Duphaston is used from 1 to 3 tablets per day, dosage regimens and duration vary depending on the severity of the symptoms of the disease and other concomitant diseases.

Norkolut is used 1 tablet (5 mg) from days 5 to 25 of the cycle for up to 6 months, then a second appointment with a gynecologist to determine management tactics. It is categorically not recommended to prescribe the drug yourself, as you may not take into account many side effects and risk of thrombosis.

Megaice is used extremely rarely, but still appears in clinical recommendations. Dosages and duration of administration are regulated exclusively by an obstetrician-gynecologist.

Visanne is currently the drug of choice or the first line of therapy. This hormonal drug a group of gestagens, which regulates a woman’s hormonal levels in such a way that it eliminates and balances excess estrogen. Namely, excess (absolute or relative) serves good reason development and further spread of endometriosis. And, as a consequence, the development of endometrioid ovarian cysts and adhesions in the pelvis.

Dienogest 2 mg (Visanne) is used continuously from any day of the cycle, 1 tablet per day. The duration of treatment is determined by the attending physician. As a rule, the initial intake cycle is 3 or 6 months. After the treatment period, ultrasound monitoring is indicated to evaluate the achieved effect. We want to see a decrease or disappearance of ovarian cysts and a decrease in the size of the uterus. Pure clinical supervision is also necessary. The patient's complaints must be assessed over time. You always need to know whether the pain (if any), heavy menstrual bleeding has disappeared and how much the amount of blood loss has decreased.

While taking the drug, menstruation changes its character; it may disappear completely in the second or third month of use, or may appear as scanty spotting without obvious cyclicity. This is not entirely convenient, but when the patient is accustomed to monthly five- to seven-day (sometimes more) heavy bleeding, when the pad is changed once an hour or more often, work activity is disrupted and well-being suffers, this is usually tolerated.

Also, while taking the drug, you need to be prepared for some unpleasant sensations. Symptoms of estrogen deficiency may appear, such as hot flashes to the face and body, episodes of sweating and rapid heartbeat, and dry mucous membranes. All these manifestations are temporary and will disappear after stopping use.

Depo-Provera (Medroxyprogesterone-Lance) is administered intramuscularly, your doctor will prescribe how and how many times a month to administer the drug. These drugs have significant side effect- breakthrough bleeding that does not coincide with the cycle, they are almost impossible to predict and cannot always be stopped quickly.

There is also an intrauterine therapeutic system with the hormone levonorgestrel. IN ordinary life patients often call it a “spiral”.

But there is a fundamental difference between a regular copper IUD, which is intended only for contraception, and the intrauterine system.

The intrauterine therapeutic system (Mirena) releases a small dose of a hormone every day that acts on the inner wall of the uterus and suppresses the growth of endometriotic lesions and cysts.

As a rule, Mirena is installed after surgical treatment of cysts if the patient does not plan a pregnancy. Mirena has a significant drawback - its price, in different pharmacies it ranges from 10 to 15 thousand rubles. Not everyone can pay this amount at a time, but when calculated, the benefits are obvious, since Mirena is set for a minimum of 5 years.

Antigonadotropins

Danazol and gestrinone, which belong to this group of drugs, are currently rarely used due to the mass of side effects.

Gonadotropin-releasing hormone agonists

These are drugs that suppress the synthesis of your own hormones. They are quite difficult to tolerate, causing dry mucous membranes, hot flashes and other symptoms. which are similar to menopause. Drugs of this group (diferelin, buserelin) are not prescribed to adolescents and nulliparous women.

But in IVF schemes for women with endometriosis and after removal of endometrioid cysts, these drugs, in a short course and in combination with others medicines, simply irreplaceable.

Should I delete or not? Surgical treatment

Question about surgical treatment endometrioid cysts are resolved taking into account clinical manifestations and a woman's reproductive plans. The same cysts in those who have given birth and in those who are planning a pregnancy are treated differently. Indications for surgical treatment of endometrioid cysts:

Endometrioid cysts and chronic pelvic pain

Chronic pelvic pain is always present. and in the middle of the cycle, before and during menstruation it intensifies. Sometimes painful sensations so pronounced. that the woman is unable to work. takes a large amount of painkillers, which in turn can increase bleeding and adversely affect the liver.

Infertility

In cases where cysts interfere with pregnancy, surgical treatment is indicated. If technical capabilities are available, laparoscopic surgery is recommended.

The extent of the operation is selected individually depending on the size of the cysts and the preservation of ovarian tissue.

In order for a woman to become pregnant in the future, we must preserve the maximum amount of ovarian tissue.

It is recommended to use different types modern technologies(laser knives, ultrasound), abdominal lavage. If possible, suturing the ovary with threads should be avoided; this interferes with blood flow and may impair the function of the remaining part of the ovary.

Compression of neighboring organs

Cysts can reach impressive sizes (8-12 cm or more). Of course, such “additions” in the abdominal cavity cannot but affect the functioning of other organs. Next to the uterus and ovaries are the bladder, rectum, and loops of the small intestine.

Depending on the direction in which the cyst grows (forward and backward), the functioning of one or another organ suffers. If the cyst/cysts grow backwards, they can put pressure on the rectum.

In this case, the process of defecation is disrupted, that is, difficulties when going to the toilet “in a big way.” You have to strain, make more effort, the toilet becomes less frequent, and the feces become harder due to stagnation. Due to constant straining, a crack may form anus or inflammation of hemorrhoids (hemorrhoids).

People rarely associate problems with the toilet with gynecology, unless there are other complaints (menstrual irregularities or pain in the lower abdomen during menstruation). Therefore, patients often take laxatives for years, and then come to the gynecologist with cysts of impressive size.

If the cyst/cyst is located in the front, it can put pressure on the bladder. If the cyst is large, then the compression of the bladder is significant, its possible volume decreases. That is, for example, the average woman’s maximum bladder volume reaches 750 ml. And if a cyst presses on the bladder, then its volume decreases, you can “endure” much less and you have to run to the toilet much more often.

Less often, patients are concerned about such a problem as stress incontinence urine. Due to the small volume of the bladder, the tension in it becomes greater and with sudden movement (standing up, bending over), coughing, sneezing, small portions of urine are lost.

This greatly affects the quality of life; the patient has to constantly wear highly absorbent pads, time her movements around the city, and drink less fluid than she wants.

Also (less commonly), cysts can compress the loops of the small intestine, which descend into the small pelvis and cause pain and stool disturbances.

As we see, problems of adjacent organs sometimes come to the fore and significantly disrupt normal activity. Therefore, surgical treatment is indicated here.

Methods of surgical treatment

Laparoscopy

It is the “gold standard” in the surgical treatment of many gynecological and surgical diseases. Endometrioid ovarian cysts are among them.

The operation is performed under anesthesia. There will be general anesthesia or spinal anesthesia (an injection into the spine with pain relief in the lower part of the body while maintaining consciousness) - this is decided by the anesthesiologist before the operation.

For any type of anesthesia, the further surgical technique is carried out according to a specific algorithm. Incisions (punctures) of about 1 cm are made on the skin of the abdomen, usually three of them. Through these punctures, instruments are inserted into the abdominal cavity, with the help of which the operating doctor can examine the abdominal cavity and perform various actions.

Injected into the abdominal cavity small quantity air, this is necessary so that all organs straighten out and the area we are operating on is better visible. Also, after straightening the intestinal loops, it is better possible to examine the abdominal cavity and identify other foci of endometriosis.

It is rare for endometrioid cysts to exist on their own. More often, along with cysts, there are other manifestations, in this case we're talking about about foci of endometriosis on the peritoneum.

If we find them during surgery, then we must ablate (cauterize) these lesions. This helps prevent the re-development of cysts.

Laparotomy access

Laparotomy is an operation with an incision in the abdominal wall. For endometrioid cysts, it is performed much less frequently. Open laparotomy may be chosen in women, taking into account individual characteristics. For example, if there have already been operations on the abdomen (not necessarily gynecological) and there is a risk of adhesions, then it is simply technically impossible to go through all the departments with a laparoscope. Either there was an unsuccessful laparoscopic operation, or if the doctor suspects a malignant degeneration of the cyst.

Related manipulations

During any of these operations, the following operational actions can be additionally carried out:

• ablation (cauterization) of endometriotic lesions on the peritoneum and intestines (more on this above)
• ablation of the uterosacral nerve (to reduce or completely eliminate pelvic pain)
• presacral neurectomy (removal of some nerves to relieve pelvic pain).

How to recover after surgery

The recovery period after surgery depends on the extent of surgery. After laparoscopic surgery, the sutures are removed on days 7-9, abdominal pain and suture healing go away quite quickly. By the time of discharge (the same 7-9 days), the patient usually feels quite well. After open surgery, pain may persist longer, up to two to three weeks in decreasing order.

In order to recover after surgery and prepare for pregnancy, it is recommended to take a COC with dienogest or Visanne (see section on conservative treatment).

Traditional methods of treating endometrioid cysts

Unfortunately, neither herbs nor any “natural” remedies will help get rid of cysts and pain/heavy irregular periods. Therefore, you should not waste time on courses of questionable treatment. Sometimes a patient comes to the doctor with the process so advanced that there is very little hope of talking about pregnancy or regulation of the cycle.

What not to do if you have an endometrioid ovarian cyst

There are no specific restrictions for patients with endometrioid cysts. Only intense physical activity and frequent thermal procedures (bath, sauna, hot baths) are not recommended, as they can cause cyst rupture and/or bleeding.

Conclusion

In our article today, we tried to tell you in the most complete and accessible way about what endometrioid ovarian cysts are, what they threaten and how to treat them. We encourage you to promptly contact a gynecologist you trust and follow his recommendations. Take care of yourself and be healthy!