An ovarian follicle is a set of approximately spheroid cell aggregation found in the ovaries.
Women begin puberty with around 400,000 follicles, each with the potential to release an ovum at ovulation for fertilization. These eggs develop once each menstrual cycle.
The ovarian follicular cyst, Graaf’s follicular cyst or follicular cyst is a type of simple functional cyst, and is the most common type of ovarian cyst. Ovarian cysts are sacs of fluid that can grow in the ovaries.
There are two types of small ovarian cysts that can be considered “normal”. During the first half of the menstrual month (“follicular phase”) estrogen stimulates the growth of a dominant follicle.
This follicle is filled with fluid that spills when the ready ovum (“oocyte”) is expelled (“ovulation”). After the egg is released, its previous follicle closes and becomes the “corpus luteum” that produces progesterone for the next two weeks (“luteal phase”).
If larger than normal amounts accumulate in any of these phases, ovarian cysts may develop that will cause pain or changes in menstrual bleeding. A normal ovary measures approximately 2 x 3 cm (almond size).
A follicular ovarian cyst, if the ovum is not expelled and the amount of fluid continues to increase, can reach sizes up to 10 cm.
Fortunately, most follicular cysts are smaller and will resolve in one to three months. If the size is large (for example, more than 8 cm), the heavy cyst may cause the ovary to turn on itself like a heavy flower on a too fragile stem.
This torsion (“ovarian torsion”) causes intense pain as it cuts off the blood supply to the ovary. While follicular cysts are the most common type of ovarian cysts, torsion is uncommon.
They are very common; Most women will get them at least once at some point in their lives. For the most part, ovarian cysts are not life threatening or even annoying. Some women experience more advanced cases that require medical treatment.
The ovarian follicle matures during the proliferative phase of the menstrual cycle, then the luteinizing hormone increase causes the release of mature oocytes in the middle of the cycle, then the follicle is transformed into a corpus luteum.
If there is no fertilization, the corpus luteum typically atrophies, eventually forming an albicans body.
If there is no increase in LH or there is no ovulation, the follicle grows and becomes a cyst, which usually disappears in 2 – 3 menstrual cycles, but may persist.
- Generally asymptomatic or form an adnexal mass.
- The Pedicle can twist and cause a hemorrhagic infarct.
- Associated with precocious puberty in children.
It can be multiple when it is a component of the McCune-Albright syndrome (polyostotic fibrous dysplasia, pigmentation of cutaneous melanin and hyperactivity of the endocrine organ).
Pathophysiology of a follicular cyst
This type can be formed when ovulation does not occur, and a follicle does not break or release its ovum, but grows until it becomes a cyst, or when a mature follicle involutes (collapses on itself).
It is thin-walled, lined by one or more layers of granulosa cells and filled with clear liquid.
Signs and symptoms
Many times ovarian cysts do not cause symptoms. When symptoms occur, they may include the following:
- Pain during intercourse or menstruation.
- Abdominal swelling
- Unusual bleeding
- Weight gain.
- Inability to empty the bladder completely.
- Breasts pain.
- Pain in the pelvic region, lower back or thighs.
The following symptoms require immediate medical attention:
- Severe abdominal pain that appears suddenly (may be a sign of rupture of an ovarian cyst).
- Fast breathing.
Its rupture can create a sharp and severe pain on the side of the ovary in which the cyst appears. This acute pain (sometimes called mittelschmerz) occurs in the middle of the menstrual cycle, during ovulation. About a quarter of women with this type of cyst experience pain.
Many women with ovarian cysts do not experience any symptoms. Symptoms usually occur when something goes wrong.
For example, a cyst may grow, begin to bleed, open, turn the fallopian tube, or interfere with the blood supply to the ovary, according to the National Library of Medicine. Some symptoms also occur when a cyst is struck during sexual intercourse.
Possible symptoms may include a feeling of pelvic fullness because a cyst is pressing on the bladder, pelvic sensitivity or pain in the right or left side of the lower abdomen that can radiate to the back and legs, pain when defecating, tenderness in the the breasts etc.
Women who experience ovarian cysts may also have problems eating. Feeling full quickly when eating, losing your appetite and losing weight without trying most days for at least two weeks can be a sign of a cyst, according to the National Library of Medicine.
It is important to know the symptoms of ovarian cysts because some symptoms indicate that immediate medical attention is needed. If you experience sudden and severe abdominal or pelvic pain, nausea or vomiting or fever, seek immediate medical attention, as this may be a sign of a more serious problem.
According to the National Library of Medicine of the United States, women who are between puberty and menopause are more likely to develop ovarian cysts. There are several types of cysts that can form in the ovaries during this time of life.
The most common is a functional cyst. The ovaries grow structures called follicles, where immature ovules develop.
If the follicle does not open and release the egg, it fills with fluid and causes a cyst. This is a type of functional cyst called follicular cyst. If the cysts form after the ovum is released, it is called the corpus luteum cyst.
Polycystic ovarian syndrome (PCOS) is when the body does not produce enough hormones for the follicle to release the egg, which causes follicular cysts. Polycystic ovary syndrome interrupts the normal production of hormones, which can cause various problems.
Other cysts develop from tissues and cells. Some are created with ovarian tissue filled with an aqueous liquid or mucous material. These types of cysts are called cystadenomas.
Dermoid cysts are ovarian cysts that may contain hair, skin or teeth. These unusual additions are caused by cells that produce human eggs, according to the Mayo Clinic.
Endometriomas are cysts caused by uterine endometrial cells that grow outside the uterus and attach to the ovary to form a growth.
Sometimes cysts can be caused by external factors. For example, fertility medications can cause multiple and large cysts in the ovaries. This condition is called ovarian hyperstimulation syndrome.
When a cyst becomes cancerous it is called ovarian cancer. One in 75 women will develop ovarian cancer, and about 14,240 women will die of ovarian cancer in 2016, according to the American Cancer Society.
What are the different types of ovarian cyst?
The most common type of ovarian cyst is called functional cyst. Functional cysts are usually not dangerous and often do not cause symptoms. If an ovarian cyst is not functional, it is considered a “complex ovarian cyst”.
Functional ovarian cysts:
There are two types of functional ovarian cysts: follicular cysts and corpus luteum cysts.
Follicular cysts contain a follicle that did not break and was filled with more fluid. Cysts of the corpus luteum occur when the follicle breaks to release the ovum, but then seals and swells with fluid.
Cysts of the corpus luteum can be painful and cause bleeding. When bleeding occurs in a functional cyst, it is known as a hemorrhagic cyst.
Complex ovarian cysts:
Other types of ovarian cysts may be associated with endometriosis, polycystic ovarian syndrome, and other conditions. Polycystic ovaries are produced when the ovaries are abnormally large and contain many small cysts at the outer edges.
The non-cancerous growths that develop from the tissue of the outer lining of the ovaries are known as cystadenomas. A cyst can also develop when the tissue of the uterine lining grows outside the uterus and adheres to the ovaries; This is known as endometrioma.
Ovarian cysts during pregnancy:
Ovarian cysts during pregnancy are usually functional ovarian cysts discovered in the first trimester.
A large luteinized follicular cyst may rupture or twist during pregnancy. However, in the absence of these complications, a simple ovarian cyst can often be treated conservatively, provided that the ultrasound evaluation of the cyst is benign.
Rapid growth of a simple follicular cyst is rare, but it can sometimes complicate pregnancy. Ovarian cysts during pregnancy tend to resolve on their own before delivery.
The following are potential risk factors for developing ovarian cysts:
- History of previous ovarian cysts.
- Irregular menstrual cycles.
- Polycystic ovary syndrome.
- Early menstruation (11 years or less).
- Hyperthyroidism .
- Tamoxifen therapy for breast cancer.
Follicular cyst diagnosis
Ultrasound is the main tool used to document the follicular cyst. A pelvic exam will also help in diagnosis if the cyst is large enough to be seen.
Ovarian cysts can be diagnosed in different ways. Once the doctor suspects an ovarian cyst, additional tests will be performed to confirm the diagnosis.
Pelvic and transvaginal ultrasound:
Ovarian cysts are often detected during a pelvic exam. A pelvic ultrasound may allow the doctor to see the cyst with sound waves and help determine if it is composed of fluid, solid tissue or a mixture of the two.
A transvaginal ultrasound is a doctor who inserts a tube into the vagina to examine the uterus and ovaries. The exam allows the doctor to see the cyst in more detail.
During laparoscopic surgery, a doctor will make small incisions and pass a thin endoscope (laparoscope) through the abdomen. The laparoscope will allow the doctor to identify the cyst and possibly remove or biopsy the cyst.
CA-125 serum assay:
A blood test for cancer antigen 125 (CA-125) may help suggest if a cyst is due to ovarian cancer, but other conditions, including endometriosis and uterine fibroids, can also increase CA-125 levels, So this test is not specific to ovarian cancer.
In some cases of ovarian cancer, the levels of CA-125 are not high enough to be detected by the blood test.
The doctor can order a pregnancy test and evaluate hormone levels. Blood tests may also be done to detect other hormones that can cause polycystic ovarian syndrome.
A fluid sample can be taken from the pelvis to rule out bleeding in the abdominal cavity. Culdocentesis is performed by inserting a needle through the vaginal wall behind the cervix.
A doctor monitors them to make sure they disappear, and analyzes the treatment options if they do not.
Most cysts disappear on their own without the need for treatment in eight to 12 weeks, according to the National Library of Medicine. However, cysts that grow more than 5 centimeters are at greater risk of torsion (to rotate around the fallopian tube).
Torsion is a gynecological emergency. Women with ovarian torsion have a sudden onset of abdominal pain, often associated with nausea and possibly vomiting and low fever.
Early monitoring is key to finding ovarian cysts before they become a problem. All women should visit their gynecologist regularly.
Routine pelvic exams can detect ovarian cysts or any other change in your ovaries as soon as possible. It is important to pay attention to your body and report any changes in your monthly cycle to your doctor.
Doctors often check cysts using ultrasound, but other imaging devices can also be used, such as CT scans or MRI scans.
Blood tests may also be done to look for changes in hormone levels, signs of pregnancy and possible cancer. Once a cyst is confirmed, larger, cancerous or persistent cysts can be removed surgically.
If the woman is close to menopause, the cysts can also be eliminated.
Some women are more likely to develop cysts. In these cases, a medical professional will often prescribe a contraceptive method that contains estrogen to help reduce the risk of developing certain types of functional cysts that occur after ovulation.
Women are often worried that the cysts may affect their fertility. In general, fertility is not affected by functional cysts.
However, if the cysts become too large and need to be surgically removed, there is always a risk that the ovarian tissue will be compromised or the ovary will be removed in its entirety.
While the other ovary is intact and functioning properly, a woman can usually have children.
Follicular cyst treatment
Many functional ovarian cysts do not require any treatment, and often resolve on their own. Ovarian cysts, especially fluid-filled cysts, in women of childbearing age are often managed with watchful waiting.
This involves undergoing a repeat exam 1 to 3 months after the cyst is discovered. If the cyst has disappeared or if there is no change, no treatment may be necessary.
Analgesics such as ibuprofen can be used to help reduce pelvic pain. These anti-inflammatory medications do not help dissolve the ovarian cyst, they only offer relief to the symptoms.
If a woman has frequent functional ovarian cysts, the doctor can prescribe hormonal contraceptives to prevent ovulation and decrease the risk of forming new cysts.
Broken ovarian cysts:
Analgesics can help reduce the uncomfortable symptoms of a ruptured ovarian cyst.
Generally, surgery is not required, but a broken dermoid ovarian cyst (a type of benign tumor that contains many types of body tissue) may require surgery because the contents of the cyst are very irritating to the internal organs.
Surgery may also be necessary for the rupture of ovarian cysts if there is internal bleeding or the possibility of cancer.
Ovarian cyst surgery:
If an ovarian cyst continues to grow, does not resolve itself, seems suspicious on ultrasound or causes symptoms, the doctor may recommend surgical removal.
Surgery can be recommended more often for postmenopausal women with worrying cysts, since the risk of ovarian cancer increases with age. An ovarian cyst can be removed surgically by laparoscopy or laparotomy .
Laparoscopy involves the removal of the cyst by making several small incisions in the abdomen. Then, the doctor will use a camera and specialized instruments to remove the cyst.
If the cyst is large or the doctor suspects cancer, the surgeon will perform a laparotomy, which involves a large abdominal incision. In some cases of ovarian cysts, an ovary or other tissues should be removed.
A premenopausal woman who has an ovary removed will not become infertile or go through menopause due to the procedure.
What is the prognosis of the ovarian cyst?
The prognosis for women, especially premenopausal women , who have functional ovarian cysts is very good. Most of these cysts resolve in a few months on their own without treatment.
The prognosis for women who have other types of ovarian cysts depends on a variety of factors. The age of the woman, the state of health and the underlying cause of the cyst are factors that influence the prognosis.
Hormone stimulation of the ovary determines the development of a functional ovarian cyst. A woman who is still menstruating and producing estrogen is more likely to develop a cyst.
Postmenopausal women have a lower risk of developing ovarian cysts because they are no longer ovulating or producing large amounts of hormones.
Younger women who are developing higher amounts of hormones are more likely to develop ovarian cysts than postmenopausal women.
Size of the cyst:
The size of a cyst corresponds directly to the speed at which it contracts. Most functional cysts are 2 inches in diameter or less and do not require surgery to remove them. However, cysts that are more than 4 centimeters in diameter usually require surgery.
Can follicular ovarian cysts be prevented?
Although ovarian cysts can not be prevented, regular pelvic exams can help diagnose any changes in the ovaries.
If a woman is premenopausal and has recurring functional ovarian cysts, birth control pills or other hormone therapy can help prevent the formation of new cysts.
Most ovarian cysts resolve on their own without treatment and are not dangerous.