endometriosis not for nothing is an insidious disease because it can affect any organ. Allocate genital endometriosis when endometriotic foci (heterotopia) detected on the genitals, and extra endometriosis, which affects other organs.
Endometrioid cyst refers to endometriosis. It is formed by the merger between a fine heterotopias disposed on the ovary, and form a cavity which is filled with blood.
Most often diagnosed endometrial cysts in women of childbearing age (25-50 years). In pre-menopausal and post-menstrual endometrial cysts are prone to resorption.
Kinds
Endometrioid cyst usually determined on both ovaries, that is a double-sided. Rarely, but there are one-sided defeat of the ovary.
Depending on the process 4 degrees incidence isolated cysts:
- 1 degree. Ovarian endometrioid heterotopias appear small, that look like a point. This degree can remain unnoticed even during the ultrasound;
- 2 degree. On one of the ovarian cyst is found not exceeding 5-6cm in diameter, abdominal adhesions are small;
- 3 degree. Cyst on the ovary more than 6 cm in diameter, in the abdomen there are significant adhesions, endometriosis affects the uterus;
- 4 degree. Diagnosed cysts larger on both ovaries, endometriosis affects the peritoneum, colon, bladder and rectouterine space.
Causes
What is the mechanism of development of endometrial cysts? On the surface, or even inside the ovarian endometrial cells are located - in its structure and functioning, they resemble endometrial. These cells line the inside of the cavity of the uterus. Accordingly, during the menstrual cycle, they are all the same changes as the endometrium.
If fertilization of the egg does not happen, it had grown by the end of the second phase of the menstrual cycle, the endometrium starts to be rejected, this process is called menstruation. The same happens with the endometrial cells of ovarian cysts. But as the blood and ottorgnuvshemusya epithelium nowhere to pour out, they accumulate and form cysts.
Predisposing factors for endometrial cysts:
- abortion;
- diagnostic curettage of the uterus;
- genetic predisposition;
- wearing an intrauterine device, especially for a long period;
- hormonal ovarian function (undesired hormonal balance);
- chronic inflammatory disease of the ovaries, uterus and tubes;
- other gynecologic pathology associated with hormonal imbalances (myoma, endometrial hyperplasia, endometrial polyps);
- endocrine diseases (pathology thyroid, adrenal, pituitary);
- overweight;
- operations on the uterus (cesarean removal leiomyomata);
- intrauterine manipulation (hysterosalpingography, hysteroscopy).
Symptoms of endometrioid ovarian cysts
Endometrial cysts are small in size does not appear for a long time. But it is worth the cyst increased in diameter, there are a variety of clinical signs.
First of all, patients worried about the pain in the abdomen and / or in the lumbar region. Pain can be aching or pulling character, they are amplified during menstruation. Increasing the intensity of pain associated with menses during stretching cysts capsules by filling it with blood. Due to this fact indirect (increased formation dimensions after menstruation) may judge presence endometriotic cysts.
Some cysts grow very quickly, it is dangerous to break them, while others, on the contrary, does not increase in size and freeze for years.
In addition, a woman observes a violation of the menstrual cycle. Menstruation becomes abundant, long and painful. Appear spotting before and after menstruation. Intermenstrual bleeding may be in the middle of the cycle.
Also, patients complain of discomfort and discomfort during sexual intercourse.
Since the spikes are formed in the abdominal cavity, then arise:
- problems with defecation (constipation);
- flatulence;
- micturition disorders.
Suffering and neuro-psychological condition of women is disturbed reproductive function.
However, very often, in addition to the inability to get pregnant, a woman did not bother.
Diagnostics
Must be differentiated endometrial cysts and cysts of other origin. First and foremost, it is important to distinguish it from a long-standing corpus luteum cyst and dermoid ovarian cyst.
In the diagnosis of the disease is important thorough history and complaints and gynecological examination. During palpation of the uterus and appendages on one, but more often with both sides of the groin palpable tugoelastichnye sensitive education with limited mobility.
A valuable tool in the diagnosis is to conduct Pelvic ultrasound. Endometrial cyst formation is visualized as a dual and sufficiently thick wall filled with liquid admixture of slurry.
Also, no harm will be to identify tumor marker CA-125. In the presence of a cyst it is normal or slightly increased, but significantly increased in ovarian cancer.
Endometrioid ovarian cyst treatment
Treatment of endometrial cysts of the ovary is a gynecologist or gynecologist-endocrinologist.
Treatment can be both conservative and operative. therapy method is chosen individually in each case and depends on:
- the woman's age;
- formations sizes;
- Her mood pregnancy;
- clinical manifestations.
Cyst of small dimensions are subject to conservative therapy. As a symptomatic treatment to relieve pain during menstruation prescribe non-steroidal anti-inflammatory drugs (aspirin, ibuprofen). Shown intake of vitamins and sedatives.
To stop the growth of cysts prescribe hormone therapy. This can be combined oral contraceptives, the duration of administration depends on the efficiency of the treatment process and prevalence. Perhaps the appointment of progestogens (premalyut, norkolut).
In order to create an artificial menopause and reduce the brush size prescribed Zoladex, danazol, buserilin and other antiestrogens. It should be noted that hormone therapy is not always effective, and some endometrial cysts are "insensitive" to hormones.
When deciding on surgery hormone therapy is prescribed as a preoperative preparation, to slow the growth of cysts or reduce their size. The operation is performed laparoscopically as possible by retaining part of the ovary. Husking produce cysts and ovarian suturing. If the cyst is too large, the ovaries are removed completely (oophorectomy). During surgery excised endometrioid heterotopias in the peritoneum and adhesions are cut.
Postoperatively, the hormonal therapy continues.
The optimal variant of rehabilitation after endometriodnyh cysts - pregnancy, which can be planned in six months when you remove large cysts or immediately, if the cysts were small.
Consequences and outlook
Endometrioid cyst can:
- burst with the content outpouring into the peritoneal cavity and the development of intra-abdominal hemorrhage (vascular damage ovary);
- fester;
- become twisted;
- in rare cases it is possible malignancy education.
Furthermore, the presence of endometrial cysts leads to infertility.
The prognosis depends on the quality and efficiency of the operation of the hormonal treatment. In many cases, after surgery, the prognosis is favorable.
