Ovarian Disorders Flashcards
Ovarian Cysts
● A sac filled with liquid or semiliquid material
that arises in an ovary
● The vast majority are benign
● Many patients with cysts are asymptomatic
Most ovarian cysts occur as a normal
part of the process of ovulation (egg
release) → these are called _____
Functional cysts
Types of Functional cysts:
● Follicular cysts (most common)
● Corpus luteum (Granulosa lutein) cysts
● Theca-lutein cysts
Follicular Cysts etiology
● Common in premenopausal women
● Result from failure in ovulation (midcycle occurrences)
○ Most likely due to secondary disturbances in release of pituitary
gonadotropins (lack of LH surge at midcycle or excessive FSH stimulation)
○ The fluid of the incomplete follicle is not completely resorbed
○ Hormonal stimulation causes these cysts to continue to grow
● Are uncommon after menopause
Signs/Symptoms of follicular cysts
● Typically asymptomatic
● Sometimes bleeding and torsion
can occur
● Can cause aching pelvic pain,
discomfort and heaviness
● Dyspareunia
● Occasional abnormal uterine
bleeding
Treatment of follicular cysts
● Most resolve spontaneously
within 60 days
● The use of OCPs is frequently
recommended to help with
establishing a normal rhythm;
however, it does not produce a
more rapid resolution compared
to waiting
Corpus luteum (granulosa lutein) cysts
● Thin walled unilocular cysts
● Develop from the corpus luteum
● Range from 3-11 cm in size
● Following normal ovulation, the
granulosa cells lining the follicle
become luteinized
How do corpus luteum cysts develop?
Abnormal changes in the follicle
of the ovary after an egg has
been released can cause the
egg’s escape opening to seal off.
Fluid accumulates inside the
follicle, and a corpus luteum
cyst develops. -Mayo Clinic
Signs/symptoms of Corpus luteum cysts
● Local pain or tenderness
● Amenorrhea
● Delayed menstruation - thus simulating the clinical
picture of an ectopic pregnancy!
● May be associated with ovarian torsion - causing severe
pain
● May rupture, causing acute pain and possibly massive blood loss
Treating corpus luteum cysts
● Laparoscopy or laparotomy = if rupture occurs (ACUTE situation)
● Otherwise, symptomatic treatment is indicated
● Usually regresses after 1-2 months in menstruating patients
● OCPs have been recommended; however, they have questionable benefit
Theca lutein cysts
Caused by luteinization and
hypertrophy of the theca interna cell
layer in response to excessive
stimulation from human chorionic
gonadotropin (hCG)
These cysts are predisposed to torsion,
hemorrhage, and rupture
Theca lutein cysts
Theca lutein cysts are seen in patients with
● Multiple gestation
● Hyperstimulation of the ovary with ovulation drugs (i.e. Clomid)
● Gestational Trophoblastic Disease (a rare condition associated with
uncontrolled proliferation of cells in the womb)
○ Hydatidiform Mole - non-viable fertilized egg implants
○ Choriocarcinoma
These cysts are Usually seen bilaterally, filled with clear, straw-colored fluid
Theca lutein cysts
Theca lutein cysts signs/symptoms
● Minimal
● Sense of pelvic heaviness or
aching
● Rupture may result in
intraperitoneal bleeding
● Continuing signs/symptoms of
pregnancy, esp hyperemesis,
breast paresthesias
Theca lutein cyst treatment
● Signs/symptoms will disappear
spontaneously following termination of the molar pregnancy, treatment of choriocarcinoma, or discontinuing of fertility therapy - may take months to occur
● Surgery is reserved for complications such as torsion or hemorrhage
Endometriomas
● A type of blood-filled cyst formed
when uterine endometrial tissue
grows on the ovaries
○ Associated with endometriosis
Also referred to as “chocolate cysts”
Endometriomas
Endometriomas treatment
Relief of symptoms (eg, pain or mass), prevent complications (eg, rupture or torsion), exclude malignancy, improve subfertility, and preserve ovarian function
Treatment Options:
● Surgical resection
● Observation with serial imaging
Teratoma
● A form of a germ cell tumor that contain elements from all three embryonic
germ layers: ectoderm, endoderm, and mesoderm
○ May contain hair, muscle bone
● Usually occur in the ovaries,
testicles, or spinal cord
● May be benign or malignant
Ovarian Torsion
The twisting of the ovary or
both the ovary and fallopian
tube
S/S of ovarian torsion
● Acute, severe
abdominal and pelvic pain
● Sometimes
nausea/vomiting
Risk Factors for ovarian torsion
● Pregnancy
● Induction of ovulation
● Ovarian enlargement
● Hx of pelvic surgery
Ovarian Torsion diagnosis
● Ultrasound (usually see
adnexal mass and reduced
blood flow on Doppler)
Management of ovarian torsion
● If reproductive age and mass is benign →
untwist, remove mass, stabilize ovary with
sutures
● If tissue is nonviable or necrotic,
salpingo-oophorectomy is required
● Recurrence rate - 19%
Polycystic Ovarian Syndrome (PCOS)
PCOS is a clinical syndrome characterized by mild obesity, irregular menses or
amenorrhea, and signs of androgen excess (eg, hirsutism, acne)
PCOS pathophysiology
● The syndrome involves anovulation or
ovulatory dysfunction and androgen
excess of unclear etiology
● One of the most common causes of
amenorrhea.
● In the US, it is the most common cause of infertility.
● Most common cause of ovulatory dysfunction in reproductive-age women
Two of the three must be present for a
diagnosis of PCOS:
- Oligo- and/or anovulation
- Signs of hyperandrogenism
a. Hirsutism (50%), infertility, weight
gain (30-75%), acne, irregular
menstrual cycle - Polycystic ovaries
PCOS S/S
● Mild obesity
● Slight hirsutism
● Irregular menses or amenorrhea
● Acne
● Temporal hair thinning
● Weight gain
● Fatigue
● Low energy
● Mood swings
● Depression/anxiety
Also called
“oyster ovaries”
PCOS
Ovaries are enlarged and “sclerocystic”
with smooth, pearl-white surfaces
without indentations
Pathophysiology of PCOS
MOA - exact cause unknown
Many small follicular cysts accumulate because none of them are capable of growing
to a size to stimulate ovulation
Insulin resistance and hyperinsulinemia play a role
Treatment goals of PCOS
● Correct hormonal abnormalities and reduce risk of estrogen excess and
androgen excess
● Relieve symptoms and improve fertility
Polycystic Ovarian Syndrome (PCOS) treatment
● OCPs - not desiring pregnancy
● Infertility treatment for those desiring pregnancy: Clomiphene citrate (Clomid)
● Insulin-sensitizing agents alone or
in combination to induce ovulation
a. Metformin
b. Rosiglitazone
Complications of PCOS
● Estrogen levels are elevated, increasing risk of endometrial hyperplasia and
eventually endometrial cancer
● Androgen levels are often elevated, increasing the risk of metabolic
syndrome and causing hirsutism.
Also known as “Primary Ovarian Insufficiency”
Premature Ovarian Failure
The ovaries stop functioning normally in women <____ years
40
○ Stop releasing eggs or release them only intermittently
○ Stop producing the hormones estrogen, progesterone, and testosterone
or produce them only intermittently
Etiology of Premature ovarian failure
● Insufficient number of follicles present at birth
● Rate of follicular atresia is accelerated (damaged ovaries - surgery, chemo/rad)
● Follicles are dysfunctional (autoimmune ovarian dysfunction)
● Certain genetic disorders are present (Turner syndrome, Fragile X)
Diagnosis of premature ovarial failure
● FSH and estradiol levels (high
and low, respectively)
● Pregnancy test (urine hCG)
● Thyroid function tests
● Sometimes genetic testing
Treatment of premature ovarian failure
● Oral contraceptives
● Estrogen/progestogen therapy
○ Hormone therapy is to be taken
until about age 51
○ Maintains bone density and
relieves symptoms and
complications of estrogen
deficiency
