Ovaries

Synonyms in a broader sense

ovary, ovaries (pl. ), ovary, ovarium, oophorone

Diseases of the ovaries

Since the function of the ovaries is regulated by the hormones of the pituitary gland (gonadotropins), special diseases that alter the amount of gonadotropins released into the blood can result in disorders of the function of the ovaries and thus also of the rhythm of menstrual bleeding. Ovarian pain in the lower abdomen can be caused by, for example, stem rotations, pelvic inflammation or ovarian vein thrombosis. A normal bleeding rhythm is between 25 – 31 days (eumenorrhoea).

If the rhythm is disturbed, the intervals between periods may be longer (oligomenorrhoea) or shorter (polymenorrhoea). A previously existing menstrual bleeding can also initially stop altogether. There is then no bleeding for more than three months (secondary amenorrhea).

As a result of the disruption of the hormonal circuit and the resulting disruption of the ovaries, the woman may suffer from infertility (sterility). Other reasons for amenorrhoea (absence of menstruation) include malnutrition or anorexia. In the context of anorexia, malnutrition and disturbances in the hormonal balance lead to a lack of menstruation (period).

Disturbances in the function of the ovaries can also result from ascending infections from the vagina (colpitis), the cervix (cervicitis), the uterine body (endometritis-myometritis-endomyometritis) or the fallopian tubes (salpingitis), which can trigger inflammation of the ovaries (oophoritis). An inflammation of the ovaries and the fallopian tubes is called adenexitis. The consequences of such inflammation can be abscesses and adhesions of the internal female sexual organs, which can result in infertility.

The function of the ovaries can also be irritated by cysts (ovarian cysts) or tumors (ovarian tumor = ovarian tumor). Ovarian cancer is a malignant tumour of the ovaries that can occur on one or both sides. The type of ovarian cancer is distinguished by its histological picture.

Thus, tumors are divided into epihelial tumors, germ cell tumors, and germ line and stromal tumors. Epithelial tumors are tumors that originate from the cells of the surface of the ovaries. They account for approximately 60% of all malignant ovarian tumors.

Germ cell tumors originating from the germ cells of embryonic development (body fruit development) account for about 20% of all malignant ovarian tumors. Stromal tumors are tumors that develop from the ovarian tissue and account for about 5% of all malignant ovarian tumors. Furthermore, about 20% of all malignant ovarian tumors are metastases, i.e. cells that have migrated from a tumor that was originally located elsewhere.

The metastases usually occur on both sides and originate from uterine cancer (uterus carcinoma) in about 30% and from breast cancer (breast cancer) or cancer of the gastrointestinal tract (gastrointestinal carcinoma) in about 20%. Cysts on the ovaries are benign masses of space, which present themselves as fluid-filled cavities. They can arise in the ovary from various causes and are very common.

In most cases, cysts are accidental findings without any further disease value. As a rule, a check-up is performed after a few weeks, after which the cyst usually disappears again. Cysts can be diagnosed very well by ultrasound.

They can be seen as black, round, smooth structures, as the fluid in them is dark. In the case of multiple cysts in the ovary, polycystic ovarian syndrome may be present, which is also associated with masculinization. This can lead to hair growth, acne and cycle disorders.

Most cysts regress on their own by bursting and the fluid is broken down. Sometimes, however, a large cyst can cause severe pain, in which case the cyst can be removed surgically after weighing the options. In most cases a laparoscopic operation is performed.

In this so-called “laparoscopy“, a camera and instruments are inserted into the abdominal cavity through small incisions and thus operate under visual control. This is a tissue-conserving procedure. The cyst rupture can be very painful and rarely leads to significant loss of fluid or blood.

The pain often subsides after the cyst bursts. A further complication can be a stem rotation of the ovary, in which the blood supply is cut off. This can be promoted by large cysts with a high dead weight.Often a stem rotation (torsion) occurs after an unfavorable movement or during sports.

In this case, immediate surgery is necessary, otherwise the organ dies and infertility follows, at least in this ovary on this side.

  • On the one hand there are functional cysts, such as follicular cysts. These are the most common cysts and represent a non-ruptured egg cell – a so-called Graaf follicle.

    Since such follicles are constantly developing and maturing in the ovary before the end of the menopause, such cysts are common in young women.

  • Corpus luteum cysts can occur during the menstrual cycle or in pregnant women and produce progesterone (pregnancy-maintaining hormone).
  • Thekalutein cysts can, for example, occur during fertility treatment due to the administration of hormones. They usually disappear after the hormone therapy has ended.
  • Endometriosis cysts develop when scattered uterine tissue settles in the ovaries. They are filled with blood because the dislocated mucous membrane participates in the cycle and is shed during menstruation, as in the uterus.

    Due to the accumulation of blood (coagulated brownish) they are also called chocolate cysts.

  • Retention cysts are caused by an accumulation of glandular secretion. They are rare in the fallopian tube.

Twisting of the fallopian tubes and ovaries can be extremely painful. The pain spreads above the groin and can easily be mistaken for appendicitis.

Vomiting and nausea can be a further indication of this so-called adnextorsion. This twisting represents a gynecological emergency – if not the most common gynecological emergency. In most cases, the torsion is caused by ovarian cysts or tumors.

Women who are undergoing hormone therapy because they want to have children are at increased risk. Adnextorsion also occurs particularly frequently during pregnancy. In contrast to the earlier approach, today, surgical removal of the adnexes is not performed because of the high risk of bleeding.

Instead, the ovary is returned to its normal position during an operation in which the cyst or tumor is removed. Incidentally, women who have suffered from endometriosis or have already suffered from inflammation of the abdominal cavity have a lower risk of suffering from adnexal torsion. It is assumed here that adhesions on the adnexes provide more stability.

The ovaries do not usually stick together, but if the fallopian tube does, this can lead to infertility. The function of the fallopian tube is firstly to catch the cracked egg with its so-called fimbrial funnel (which functions like small feelers) and secondly to transport it along the fallopian tube to the uterus. Therefore, sticking together the fimbriae or the fallopian tube, which is equipped with delicate hairs (ciliated epithelium) that move the egg towards the uterus within a few days, can lead to a loss of function.

If the egg no longer finds its way into the uterus, pregnancy is no longer possible by natural means. In addition, the fallopian tube is the place of fertilisation, as this is where the sperm usually meet the egg. Adhesions often occur after an inflammation.

The pathogens are usually intestinal bacteria (for example Escherichia coli, enterococci), which have ascended through the vagina and into the fallopian tube. Since the fallopian tube is open towards the abdominal cavity, the pathogens can spread practically throughout the entire abdomen and affect all abdominal organs. Adhesion can also occur in the opposite direction due to an open abdominal cavity inflammation, as occurs when organs (ruptured purulent cyst, perforated intestinal/appendicitis, gall bladder, etc.)

burst open. Dislocated uterine mucosa in the fallopian tube (endometriosis) can also cause adhesions. Therapeutically, antibiotics can be administered in the event of an infection to prevent the germs from rising or scarring/gluing.

There is also the possibility of surgically reopening a blocked fallopian tube. The chances of success depend on the severity of the adhesion. In addition, various methods can be used to conceive a child.

For example, an egg can be punctured from the ovary and fertilized in vitro (in a glass jar) with a sperm. The fertilised egg can then be implanted into the uterus and the embryo can mature naturally from then on. An inflammation of the ovaries is known in medical terminology as oophoritis or ovaritis.

This inflammation is usually caused by bacteria. There are various causes for a bacterial infection of the ovaries. It can be due to birth, abortion or menstruation.

The cause can also be of an iatrogenic nature.This means that there is a cause underlying the ovary that is determined by the doctor. This can be, for example, the insertion of a contraceptive coil and does not mean that there is a medical error in treatment. The causative pathogens include staphylococci, gonococci, streptococci and chlamydia.

Other causes of inflammation of the ovaries are a spread of inflammation in the context of other infectious diseases such as tuberculosis. This spreading occurs via the bloodstream. In addition, an infection of neighbouring organs (e.g. in appendicitis) can spread to the ovaries via the lymph.

An inflammation of the peritoneum, a so-called peritonitis, can also affect the ovaries. Finally, in rare cases, an autoimmune cause can also be behind oophoritis. In most cases, oophoritis is accompanied by inflammation of the fallopian tubes.

This is called salpingitis or pelvic inflammation. An acute inflammation of the ovaries manifests itself as fever, severe lower abdominal pain, nausea and vomiting. In addition, a defensive tension can be observed in those affected.

Defensive tension is understood to be a strong tensing of the abdominal muscles when the abdomen is touched. In the case of oophoritis, there is a risk that an ovarian abscess will develop or that the pathogens will spread into the abdominal cavity and ultimately cause peritonitis. Oophoritis therefore requires treatment in all cases.

The inflammation is treated with broad-spectrum antibiotics. Broad-spectrum antibiotics are antibiotics that are effective against a wide range of pathogens. In addition, non-steroidal anti-inflammatory drugs can also be used to treat the inflammation.

If the conservative therapy with drugs does not show any success, a surgical intervention can be considered. This operation involves an ovariectomy, the surgical removal of the ovaries. The diagnosis of oophoritis is made by means of various diagnostic measures.

Inflammation parameters, which include specific proteins, can be determined by laboratory diagnostics. Vaginal swabs can provide information about the type of pathogen. By means of a sonographic examination, the ovaries can be visualized and thus assessed with regard to their size and condition (e.g. abscesses).