Posted by Article on 2/5/2002, 11:32 am

Functional Cysts of the Ovary -------------------------------------------------------------------------------- The future and even the very existence of the human race depends on just a couple of ounces of tissue in a woman's pelvis. For here are where human eggs, hibernating since birth, finally mature and leave their nestled home to accept genetic intermingling from the male of the species. These two important structures are called the ovaries. To deal with the ovary in a single web page is impossible, so I have broken the subject up into three articles--"the good, the bad, and the ugly"--meaning that I'll talk about function, cysts, and tumors. Here I discuss the good--that is, function. There are countless numbers of eggs in each ovary at birth. Although most fade away, still a woman is left with more than she'll ever be able to ovulate in her lifetime. Ovulation is the release of an egg each month from the ovary, with a period occurring about two weeks later if conception doesn't take place. Each egg develops in a little puddle within the ovary called a follicle, and it's one function of the ovary. This is why when a cyst develops as nothing more than an exaggerated follicle, we call it a "functional" cyst, cured by doing nothing--awaiting a period during or after which it resolves with no help from anyone. The dividing line seems to be about 2 centimeters diameter, less being a follicle, more being a cyst. If a functional cyst is a little slow in going away, it can be helped along by using birth control pills which decrease ovarian function, and therefore the functioning cyst. Rarely a cyst can be so big that it can threaten to twist upon itself, strangling the ovary it originated in. Surgery, usually a laparoscope, can untwist it (assuming there's been no tissue death) and allow drainage as an out-patient procedure. The newer low-dose birth control pills are not as effective in shrinking ovarian cysts. Pills with 30 mcg of estrogen at least should be used. Another unlucky complication of an otherwise harmless functional cyst is that it can bleed into itself, the cyst itself containing the small amount of blood until absorbed or leaked into the abdomen. Called a corpus hemorrhagicum (hemorrhagic cyst), the result of leakage is usually a vague burning sensation across the pelvis that replaces a more discrete pin-point pain hours earlier. Almost always the blood loss is negligible, the treatment being only observation. In fact, almost every woman has experienced this very thing, whether she visited her gynecologist or not. After such an event, a woman's next period may not be on time, for the normal cycle has been altered by the cyst. The biggest problem with harmless functional cysts is that it is often impossible to tell them apart from the bad and the ugly (see subsequent links)--that is, benign tumors and malignancies. The mainstay of evaluation and diagnosis lies with the temporary use of the birth control pill. The pill will melt away a functional cyst, but anything else will remain unaltered by this treatment, making the pill a useful diagnostic tool. After the pill a persistent cyst requires ultrasound and perhaps even laparoscope and other surgery, because no gynecologist wants to take a chance on ovarian disease. It may be deadly to do so. Luckily, most evaluations of the ovary and cysts result in the "functional" diagnoses that can be simply followed with follow-up ultrasound. ©1995, 2000 Gerard M. DiLeo, M.D., F.A.C.O.G.;

Link: Article Online