Endometriosis is not for nothing considered an insidious disease, because it can infect any organ. Genital endometriosis is distinguished when endometriotic foci (heterotopies) are found on the genitals, and extragenital endometriosis, in which other organs are affected.
Endometrioid cyst refers to genital endometriosis. It is formed as a result of the fusion between small heterotopies located on the ovary and the formation of a cavity that is filled with blood.
Most often, endometrial cysts are diagnosed in women of childbearing age (25-50 years). In the premenopausal period and after the end of menstruation, endometrial cysts are prone to resorption.
An endometrioid cyst is usually defined on both ovaries, that is, it is bilateral. Rarely, but unilateral damage to the ovary occurs.
Depending on the extent of the process, there are 4 degrees of cyst:
- 1 degree. Small endometrioid heterotopies appear on the ovaries that look like dots. This degree may go unnoticed even during the ultrasound;
- 2 degree. One of the ovaries has a cyst that does not exceed 5-6 cm in diameter, there are small adhesions in the abdominal cavity;
- 3 degree. The cyst on the ovary exceeds 6 cm in diameter, significant adhesions are observed in the abdominal cavity, endometriosis affects the uterus;
- 4 degree. Large cysts are diagnosed on both ovaries, endometriosis affects the peritoneum, large intestine, bladder and rectal uterine space.
What is the mechanism of development of endometrioid cysts? Endometrioid cells are located on the surface or even inside the ovaries – in their structure and functioning they resemble endometrial cells. These cells line the uterus from the inside. Accordingly, during the menstrual cycle, they undergo the same changes as the endometrium.
If fertilization of the egg has not taken place, the endometrium that has grown by the end of the second phase of the menstrual cycle begins to be rejected, this process is called menstruation. The same happens with the endometrioid cells of ovarian cysts. But since there is no place for the blood and the epithelium to be torn away, they accumulate and form cysts.
Predisposing factors for endometrioid cysts:
- diagnostic curettage of the uterus;
- genetic predisposition;
- wearing intrauterine device, especially long-term;
- violation of hormonal ovarian function (disruptions in the hormonal balance);
- chronic inflammatory diseases of the ovaries, uterus and tubes;
- other gynecological pathology associated with hormonal imbalance ( fibroids , endometrial hyperplasia , endometrial polyps );
- endocrine diseases (pathology of the thyroid, adrenal glands, pituitary);
- uterus surgery (cesarean section, removal of myomatous nodes);
- intrauterine manipulations ( hysterosalpingography , hysteroscopy ).
Endometrioid cysts of small size do not appear for a long time. But as soon as the cyst increases in diameter, various clinical signs appear.
First of all, patients are worried about pain in the lower abdomen and / or in the lumbar region. The pains can be of a whining or pulling nature, they increase during menstruation. The increase in the intensity of pain during menstruation is associated with stretching of the cyst capsule as a result of filling it with blood. Due to this indirect fact (an increase in the size of the formation after menstruation), it is possible to judge the presence of an endometrial cyst.
Some cysts grow very quickly, which is dangerous by their rupture, while others, on the contrary, do not increase in size and freeze for years.
In addition, the woman notes a violation of the menstrual cycle. Menstruation becomes profuse, prolonged and painful . There are bloody discharge on the eve and after menstruation. Possible intermenstrual bleeding in the middle of the cycle.
Also, patients complain of discomfort and discomfort during sexual intercourse.
Since adhesions form in the abdominal cavity, there are:
- problems with defecation ( constipation );
- urinary disorders.
The woman’s neuro-psychological condition also suffers, and the reproductive function is disturbed.
However, very often, apart from the impossibility of becoming pregnant, a woman does not bother with anything.
It is necessary to differentiate endometrioid cyst and cysts of other origin. First of all, it is important to distinguish it from the old cyst of the corpus luteum and dermoid ovarian cyst.
In the diagnosis of the disease, it is important to carefully collect anamnesis and complaints and conduct a gynecological examination. During palpation of the uterus and appendages on one, but more often on both sides in the inguinal region are felt elastic, sensitive formations with limited mobility.
A valuable assistant in the diagnosis is an ultrasound of the pelvic organs . An endometrioid cyst is visualized as a formation with a double and sufficiently thick wall, filled with fluid mixed with a suspension.
Also, the definition of the CA-125 oncomarker will not be superfluous . In the presence of a cyst, it is normal or slightly elevated, but it significantly increases with ovarian cancer.
Treatment of endometrioid ovarian cysts is conducted by a gynecologist or gynecologist-endocrinologist.
Treatment can be both conservative and operative. The method of treatment is selected individually in each case and depends on:
- the age of the woman;
- the size of the formations;
- her attitude toward pregnancy;
- clinical manifestations.
Small cysts are subject to conservative therapy. As a symptomatic treatment, non-steroidal anti-inflammatory drugs (aspirin, ibuprofen) are prescribed to relieve pain during menstruation. Reception of vitamins and sedatives is shown.
To stop the growth of cysts prescribed hormone therapy. This may be combined oral contraceptives, the duration of their reception depends on the effectiveness of treatment and the extent of the process. Perhaps the appointment of progestogens (premalyut, norkolut).
In order to create artificial menopause and reduce the size of cysts, zoladex, danazol, buserilin, and other antiestrogens are prescribed. It should be noted that hormone therapy is not always effective, and some endometrial cysts remain “insensitive” to hormones.
When deciding on surgery, hormone therapy is prescribed as a preoperative preparation in order to slow the growth of cysts or reduce their size. The operation is performed as far as possible by laparoscopic means with preservation of part of the ovary. Hustling cysts and closure of the ovaries. If the cysts are too large, then the ovaries are completely removed (ovariectomy). During surgery, endometrioid heterotopies on the peritoneum are excised and adhesions are dissected.
In the postoperative period, hormone therapy continues.
The best option for rehabilitation after an endometrial cyst is a pregnancy that can be planned six months later when large cysts are removed or immediately if the cysts are small.
An endometrial cyst can:
- burst with the outpouring of the contents into the abdominal cavity and the development of intra-abdominal bleeding (damage to the ovarian vessels);
- in rare cases, malignancy of the formation is possible.
In addition, the presence of an endometrioid cyst leads to infertility.
The prognosis depends on the quality of the surgery and the effectiveness of hormonal treatment. In many cases, after surgery, the prognosis is favorable.