Cysts and Fibroids

Among the many technical terms used by medical professionals, the term “tumor” most often gives rise to misunderstanding and groundless, unnecessary anxiety. A typical example: the gynecologist discovers cysts on the woman’s ovaries during an examination. He notes the diagnosis “adnexal tumor” on the medical chart or in the hospital admission, meaning only that something tumor-like has formed on the “adnexa” (= appendix of the uterus), i.e. on the ovaries or fallopian tubes.

Cysts and fibroids are usually harmless

When most people hear the word “tumor,” they think of “cancer.” However, ovarian cysts are almost always benign structures that have nothing to do with cancer. The same is true for fibroids. The risk of malignant changes in these tumors of the uterine muscles is also extremely low. Both formations, cysts and fibroids, are widespread and are now increasingly detected by gynecologists during routine ultrasound examinations. In many cases, the doctor leaves it at the diagnosis and simply recommends that the patient wait and see. This is especially true for cysts. These fluid-filled cavities can occur at any age, singly or in larger numbers, on one or both ovaries. They grow not by proliferation of cells but by accumulation of tissue fluid. The most common cause of ovarian cyst formation is an egg follicle (follicle) that did not burst as normal during ovulation. Small cysts usually cause no discomfort, but sometimes there is unilateral, pulling lower abdominal pain or an uncomfortable feeling of pressure. Irregular or heavy bleeding also occurs. Large, pedunculated cysts may twist around their pedicle and cause sudden severe pain.

What gynecologists can do about it today

In many cases, it is worthwhile to observe the growth of the cyst at first, because it often recedes on its own. Taking the pill or other hormone medications can also stop its growth. Nevertheless, even cysts that are probably benign and do not yet cause any symptoms should be monitored regularly by ultrasound and palpation. If they grow particularly quickly, do not respond to medication, cause the woman more severe discomfort, or do appear suspicious on ultrasound examination, the gynecologist will advise their removal. Also fibroids are often harmless and only sometimes the reason for a surgical intervention. These benign tumors develop in the smooth muscles of the uterus and are found in almost every third woman after the age of 35. If they do not cause any symptoms, regular gynecological monitoring is sufficient. During menopause, they usually disappear completely due to the decrease in hormone production. Depending on their size, however, fibroids can cause heavy and prolonged menstrual bleeding and a feeling of pressure in the lower abdomen. Sometimes they also press on the bladder or intestines, causing discomfort. Low back pain is also often the result of fibroids.

When to wait, when to operate?

The gynecologist may try to shrink the fibroid with new types of hormonal antagonists to estrogen (called GnRH agonists). In this way, many women today are spared surgery. In other cases, it is sufficient to remove only individual fibroids, so that the uterus remains intact. However, if the fibroids are very numerous, keep growing back despite medication and cause discomfort, the gynecologist will recommend removal of the uterus (hysterectomy). The procedures used in the examination and treatment of cysts and fibroids have changed significantly in recent years, emphasizes the Professional Association of Gynecologists. In many cases, surgery can now be performed without an abdominal incision. With the help of so-called “keyhole surgery”, many cysts and also some fibroids can now be removed without opening the abdominal wall, in the course of an abdominal endoscopy (laparoscopy or pelviscopy). The advantages of endoscopic surgery are not limited to the favorable cosmetic effect. This method, originally developed by gynecologists, is also less stressful and causes less pain. Patients recover faster after the procedure and can leave the clinic soon. The anxiety and psychological stress caused by the operation are also less.In addition, because the patient recovers more quickly from the procedure, endoscopic surgeries help reduce health care costs, the gynecologists’ association’s release concludes.