Causes | Ovarian cyst

Causes

The cause of the ovarian cysts allows a division into two large groups. A distinction is made between so-called functional cysts and retention cysts, whereby most cystic changes in the ovaries are so-called functional cysts. The main reason for ovarian cysts are functional ovarian cysts.

These cysts can form as a result of the usual cyclical changes in the ovaries, which can be explained by the different hormone levels during a cycle. That is why they occur mainly in the sexually mature woman, with an accumulation shortly after puberty and in the climacteric (menopause). Abnormalities of the hormonal control cycles in the organism or hormonal therapy can also cause functional cysts of the ovaries.

In this subgroup, one can again distinguish between different types of functional cysts: Follicular cysts (vesicle cysts), polycystic ovaries, corpus luteum cysts, thekalutein cysts, endometriosis cysts (endometriomas) and parovarian cysts.

  • Follicular cysts:Follicular cysts (vesicle cysts) occur mainly solitary in menstruating, young women before ovulation (pre-ovulatory). It is a Graaf follicle that has not jumped and has an egg cell inside.

    The Graaf follicle itself can grow to a size of about 2 cm. The transition into a functional cyst is seamless, and they can reach a size of up to 10 cm, and in pregnancy even up to 25 cm. Through the granulosa cells that the follicular cyst contains, the cyst can be hormonally active and produce estrogens.

  • Polycystic ovaries: If the ovaries contain a large number of cysts, these cysts may be considered a special form of follicular cysts.

    Polycystic ovaries occur in the so-called PCO syndrome (polycystic ovary syndrome) in combination with other clinical symptoms. Polycystic ovaries are caused by follicles (follicles) that develop below the surface of the ovaries but do not burst open.With each subsequent cycle, the number of follicles increases, which is why the ovary also increases in size.

  • Corpus luteum cysts: Corpus luteum cysts, which are on average 5.5 cm in size, occur after ovulation (postovulatory), i.e. in the second half of the cycle. The corpus luteum is formed from the remains of the cracked Graaf follicle.

    If bleeding into the corpus luteum occurs, this is called a corpus luteum cyst, another subgroup of functional cysts. Corpus luteum cysts occur more frequently in pregnant women and in women who are undergoing ovulation-inducing therapy.

  • Thecalutein cysts: Thekalutein cysts, which can grow up to 30 cm in size, are also functional cysts. These are generally due to increased or prolonged production of beta-HCG (human chorionic gonadotropin), a hormone produced by the placenta in the first three months of pregnancy.

    In addition to multiple pregnancies, ovarian stimulation during fertility treatment can also be a cause of a thecalutein cyst. A mole of the bladder or a chorionepithelioma that may subsequently occur can also cause a thecalutein cyst.

  • Endometriosis cysts (endometriomas): Endometriosis cysts occur in the course of endometriosis. The clinical picture of endometriosis is characterized by uterine mucosa that occurs outside the uterine cavity.

    Since the cystic cavities in the ovary contain old, thickened blood, they are also called tar or chocolate cysts. Endometriosis cysts are removed by surgery. It is essential that not only the fluid is drained off, but that the entire cyst is removed, as remnants may cause the endometriosis cyst to recur.

  • Parovarial cysts: Parovarial cysts develop from fetal neighboring tissue of the ovaries.

    Therefore, they are located next to the ovaries, as the name suggests. Parovarian cysts can be of different sizes and can be stalked. If the stalk is long, they can cause a twisting of the ovary and fallopian tube.

In addition to all the different types of functional cysts, there are also the so-called retention cysts, which, however, are less common than the functional cysts.

Retention cysts are caused by a lack of secretion from the glands. The lack of secretion causes an accumulation of glandular secretions (retention) and an enlargement of the affected gland, so that it appears in the first place. The mostly benign dermoid cysts are counted as retention cysts.

A dermoid cyst is a germ cell tumor that can have different tissue types such as hair, teeth, cartilage and bone tissue. It mainly affects girls who have not yet reached puberty and young women. Dermoid cysts are removed surgically.

This is usually possible during a laparoscopy. First indications of a possibly existing ovarian cyst can already be found by the systematic questioning by the doctor (anamnesis). In addition, large cysts can possibly be palpated during the vaginal palpation.

Finally, the ovarian cysts can be made visible by ultrasound. Therefore, the ultrasound examination is an extremely decisive examination. The examination is performed through the vagina and can be completed by ultrasound examination from the abdomen.

In order to exclude malignant masses in the ovary (ovarian cancer), other examination methods can be used. This is important for patients over 40 years of age and especially during the climacteric (menopause). Other examination methods include the determination of tumor markers in the blood (CA-125), whereby an increase in the tumor marker does not necessarily come from a malignant disease, a Doppler examination and magnetic resonance imaging (MRI).

If the results of these examinations are still inconclusive, only an examination of tissue can help. The tissue can be obtained by laparoscopy or, in rare cases, by abdominal surgery with an abdominal incision (laparotomy). Ovarian cysts (green) can be reliably detected in an MRI examination of the abdomen (MRI pelvis). Parts of the lumbar spine can be identified in blue.