Ovarian Cysts and Fibrous PDF

OVARIAN CYSTS AND FIBROUS GROUP 3 MEMBERS 1.ASIKOYE FREDRICK 22-2639 2. ZERAH KOROS 22-2772 3. DIANA CHERONO 23_3876 4. NICKSON TAPARIO 22-3309 5. ENOCK KANDIE 22-2628 6. JOAN MUTAI 22-2251  OVARIAN CYSTS 1. Definition Ovarian cysts are fluid-filled sacs or pockets within or on the surfac...

OVARIAN CYSTS AND FIBROUS GROUP 3 MEMBERS 1.ASIKOYE FREDRICK 22-2639 2. ZERAH KOROS 22-2772 3. DIANA CHERONO 23_3876 4. NICKSON TAPARIO 22-3309 5. ENOCK KANDIE 22-2628 6. JOAN MUTAI 22-2251  OVARIAN CYSTS 1. Definition Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. They are common and often form during the ovulation process.  Most ovarian cysts are benign and resolve on their own without treatment 2. Etiology and Causes Functional Cysts Functionalcysts are the most common type and are related to the menstrual cycle: Follicular Cysts: These occur when the follicle (the sac that holds the egg) doesn’t rupture to release the egg and continues to grow. Corpus Luteum Cysts: After the follicle releases the egg, it transforms into the corpus luteum, which produces hormones. If the opening of the follicle seals off, fluid can accumulate inside, forming a cyst Other Types of Cysts Dermoid Cysts: These are formed from embryonic cells and can contain various types of tissues such as hair, skin, or teeth. Cystadenomas: These develop on the surface of an ovary and can be filled with a watery or mucous material. Endometriomas: These are caused by endometriosis, where endometrial tissue grows outside the uterus and attaches to the ovary. Polycststic ovarian syndrom  PCOS can cause hormonal imbalances, irregular periods, excess androgen levels and cysts in the ovaries. Irregular periods, usually with a lack of ovulation, can make it difficult to become pregnant. PCOS is a leading cause of infertility. CONT… Additional Causes Hormonal Imbalances: Changes in hormones can lead to the formation of cysts. Medications: Certain ovulation-inducing drugs can increase the risk of developing ovarian cysts. Pregnancy: Sometimes, a cyst forms early in pregnancy to support the pregnancy until the placenta develops. Pelvic Infections: Severe infections that spread to the ovaries and fallopian tubes can cause cysts 3. Pathophysiology Functional cysts are related to the normal menstrual cycle. When the follicle or corpus luteum fails to function properly, it can lead to cyst formation. Non-functional cysts, such as dermoid cysts, cystadenomas, and endometriomas, arise from different pathological processes, including abnormal cell growth and endometrial tissue implantation. 4. Clinical Features Often asymptomatic and discovered incidentally during pelvic exams. Symptoms, when present, may include pelvic pain, bloating, fullness, or pressure in the abdomen.  Severesymptoms can occur if a cyst ruptures or causes ovarian torsion, leading to sudden, sharp pain 5. Diagnosis Pelvic Examination: Initial detection during routine exams. Ultrasound: Primary imaging tool to confirm the presence, size, and type of cyst. Other Imaging: MRI or CT scans may be used for further evaluation. Blood Tests: CA-125 test to assess for potential malignancy, especially in postmenopausal women. 6. Investigations Transvaginal Ultrasound: Provides detailed images of the ovaries. Laparoscopy: Minimally invasive surgery to view and possibly remove cysts. Tumor Marker Tests: To differentiate between benign and malignant cysts.  7. Treatment and Prevention Treatment:  1. Oral Contraceptives (Birth Control Pills) Purpose: Prevent ovulation, which can help reduce the formation of new functional cysts. Examples: Combination Pills (containing estrogen and progestin): e.g., Ethinyl estradiol and levonorgestrel. Progestin-only Pills: e.g., Norethindrone. Mechanism: By preventing ovulation, birth control pills reduce the hormonal fluctuations that can lead to cyst formation. Cont…  2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) Purpose: To relieve pain associated with ovarian cysts. Examples: Ibuprofen Naproxen Mechanism: NSAIDs reduce inflammation and help manage pain but do not treat the cyst itself Cont…  3. Gonadotropin-Releasing Hormone (GnRH) Agonists Purpose: In some cases, these are used for hormone-sensitive cysts (e.g., endometriomas) to reduce estrogen levels. Examples: Leuprolide (Lupron) Goserelin (Zoladex) Mechanism: These drugs suppress ovarian function and lower estrogen levels, which can help shrink certain types of ovarian cysts. Cont…  4. Progestin Therapy Purpose: Sometimes prescribed for women who cannot or do not want to take combination oral contraceptives. Examples: Medroxyprogesterone acetate (Depo-Provera) Norethindrone Mechanism: Helps to regulate menstrual cycles and prevent the formation of new cysts Cont…  5. Metformin Purpose: Sometimes prescribed for women with polycystic ovary syndrome (PCOS) who develop ovarian cysts. Mechanism: Metformin improves insulin sensitivity and may help in the regulation of ovarian function, reducing the development of cysts in women with PCOS. Cont…  6. Hormonal Therapy for Endometriosis-related Cysts (Endometriomas) Purpose: For cysts associated with endometriosis, hormonal therapy can help manage symptoms and cyst size. Examples: Danazol Dienogest (used in some countries for endometriosis management) Mechanism: These drugs suppress ovarian function, reducing estrogen levels and the growth of endometriomas. Cont… Watchful Waiting: Many cysts resolve on their own; follow-up ultrasounds may be recommended. Surgery: Indicated for large, persistent, or symptomatic cysts. Options include cystectomy (removal of the cyst) or oophorectomy (removal of the ovary) if necessary Prevention Regular pelvic exams to monitor ovarian health. Use of hormonal contraceptives to reduce the risk of developing new cysts. 8. Complications 1.Ovarian Torsion Twisting of the ovary due to a large cyst, cutting off blood supply (medical emergency). 2.Cyst Rupture A cyst bursting, leading to internal bleeding or severe pain 3.Infection Rare but possible if a cyst becomes infected, leading to pelvic infections or abscess formation. 4.Pressure on Nearby Organs Large cysts pressing on the bladder or intestines, causing issues like frequent urination or bowel changes. 5.Infertility Certain cyst types (like those from endometriosis or PCOS) can interfere with ovulation, affecting fertility. 6.Cancer While rare, some ovarian cysts can be malignant, especially in postmenopausal women. 7.Hemorrhagic Cysts Cysts that contain blood and may cause internal bleeding if they rupture. 2.FIBROUS FIBROIDS. Fibroids are a type of nan cancerous tumour that forms in the muscular wall of the uterus. Fibroid causes. It’s not clear what causes uterine fibroids, but female sex hormone levels and genetics may play a role. And they’re increasingly common after age 30 through menopause.  Factors contributing to the formation of fibroids. 1. Hormonal Influences  Oestrogen and Progesterone: Fibroids are oestrogen-dependent tumours, meaning their growth is often stimulated by oestrogen. They typically enlarge during reproductive years and may shrink after menopause when oestrogen levels decline.  Growth Factors: Fibroids also respond to various growth factors, including insulin-like growth factors (IGFs) and transforming growth factor-beta (TGF-β), which can promote their growth.. cont… 2. Genetic Factors.  Family History: There is a genetic predisposition, as fibroids often run in families. 3. Cellular Changes  Smooth Muscle Cells: Fibroids arise from the smooth muscle cells of the uterus, which undergo hyperplasia (increased cell number) and hypertrophy (increased cell size).  Extracellular Matrix: An abnormal accumulation of extracellular matrix components, including collagen, occurs in fibroids, contributing to their stiffness and size Cont… 4. Microenvironmental Factors  Vascular Supply: Fibroids have a rich blood supply, which can enhance their growth. They often outgrow their blood supply, leading to areas of necrosis or degeneration.  Inflammation: Local inflammation and immune responses may play a role in fibroid development and growth. CONT… 5. Environmental Factors  Lifestyle Factors: Obesity, diet, and exposure to certain environmental toxins can influence the risk of developing fibroids, likely through hormonal mechanisms Clinical features  Heavy Menstrual Bleeding (Menorrhagia): Many women experience excessive bleeding during periods, which can lead to anaemia.  Prolonged Menstrual Periods: Periods may last longer than usual.  Sharp or Dull pelvic pain: Pain may occur due to fibroid size or degeneration (e.g., when a fibroid outgrows its blood supply). Cont…  Increased urination: Larger fibroids can exert pressure on the bladder, leading to frequent urination. In some cases, fibroids may obstruct the urinary tract.  Infertility: Fibroids can interfere with implantation or fetal growth, leading to reproductive challenges.  Complications in Pregnancy: They can increase the risk of complications such as miscarriage, preterm labor, and abnormal fetal position.  Abdominal Distension: Large fibroids may cause noticeable swelling or enlargement of the abdomen. Diagnosis tests. Diagnosing uterine fibroids typically involves a combination of clinical evaluation and imaging studies. Here are the most common diagnostic tests used: 1. Pelvic Examination  A healthcare provider may perform a pelvic exam to check for an enlarged uterus or abnormal masses. Cont… 2. Ultrasound  Transabdominal Ultrasound: A common initial imaging test that uses sound waves to create images of the uterus, allowing for the identification of fibroids.  Transvaginal Ultrasound: Provides clearer images of the uterus and is often more effective in detecting smaller fibroids. CONT…. 3. Magnetic Resonance Imaging (MRI)  MRI offers a detailed view of the uterus and surrounding structures, helping to characterize the size, location, and number of fibroids. It’s particularly useful for planning treatment. 4. Laparoscopy  In some cases, a surgical procedure may be performed to directly visualize the uterus and fibroids, especially if there are concerns about other conditions. CONT… 5. CT scan.  While less commonly used for diagnosing fibroids, a CT scan can help assess the size and location of larger fibroids or rule out other conditions. 6. Endometrial Biopsy  If there are concerns about abnormal bleeding, an endometrial biopsy may be performed to evaluate the uterine lining for other abnormalities, though it’s not a primary test for fibroids MEDICAL TREATMENT Hormonal treatments;  Gonadotropin-releasing hormone (GnRH) agonists. Temporarily reduce estrogen and progesterone levels, shrinking fibroids.  Progestin-releasing intrauterine device (IUD). Controls heavy bleeding but doesn’t shrink fibroids. CONT…  Oral contraceptives or hormone therapies. Regulate menstruation and reduce bleeding.  Tranexamic acid. Non-hormonal medication used during periods to reduce blood loss.  Nonsteroidal anti-inflammatory drugs (NSAIDs). Relieve pain but don’t shrink fibroids 2. SURGICAL TREATMENT  Myomectomy: Surgical removal of fibroids, preserving the uterus. Recommended for women who wish to retain fertility.  Hysterectomy: Complete removal of the uterus. This is the only permanent solution but ends the ability to bear children.  Uterine artery embolization (UAE): Cuts off blood supply to the fibroids, causing them to shrink.  MRI-guided focused ultrasound surgery (FUS): A non- invasive procedure that uses high-frequency sound waves to destroy fibroids PREVENTION There are no guaranteed methods to prevent fibroids, but maintaining a healthy lifestyle may help reduce the risk. This includes:  Maintaining a healthy weight. Obesity is linked to higher oestrogen levels, which may contribute to fibroid development.  Regular exercise. Some studies suggest that physical activity may reduce the risk of developing fibroids.  Healthy diet. Eating a diet rich in fruits, vegetables, and whole grains, while avoiding excessive red meat and high-fat dairy, may help lower the risk. COMPLICATIONS  Severe anaemia due to heavy menstrual bleeding.  Infertility. Fibroids can interfere with the implantation of a fertilized egg or block the fallopian tubes.  Pregnancy complications. Increased risk of miscarriage, preterm birth, abnormal fetal position, or need for caesarean section.  Urinary or bowel problems. From pressure on nearby organs REFERENCES 1. "Comprehensive Gynecology" by Gretchen M. Lentz, Rogerio A. Lobo, David M. Gershenson, and Vern L. Katz 2. "Clinical Gynecologic Endocrinology and Infertility" by Marc A. Fritz and Leon Speroff 3. "Berek & Novak's Gynecology" by Jonathan S. Berek 4. "Williams Gynecology" by Barbara L. Hoffman, John O. Schorge, Joseph I. Schaffer, and Lisa M. Halvorson 5. "Benign Disorders and Diseases of the Female Genital Tract" by Annabelle B. Rodri 6. "Management of Common Gynecological Problems" by T. Justin Clark and Janesh Gupta