Therapy | Ovarian cyst

Therapy

The therapeutic options for ovarian cysts are wide and range from a wait-and-see attitude without therapy to laparoscopy or even surgery. Which route is chosen depends on the type of cyst, the clinical symptoms, the length of time the ovarian cysts have existed and the patient’s age.The most frequently occurring functional cysts usually do not require treatment, as they usually do not cause any symptoms and in the majority of cases disappear on their own. Nevertheless, a regular ultrasound check every three months should be performed.

In addition, a hormonal therapy for a period of three months with a progestin-emphasized “pill” can also be considered. Reasons for starting therapy are extremely large ovarian cysts, cysts that cause symptoms, those that persist for a long period of time and do not regress on their own. Ovarian cysts that have appeared after the climacteric (menopause) and complications in the context of an existing ovarian cyst are also reasons for initiating therapy.

A therapeutic option for the removal of a benign ovarian cyst is laparoscopy. Here, one can differentiate between an organ-preserving and an organ-removing procedure. In the organ-preserving procedure, only the ovarian cyst is removed; the ovary itself is preserved.

With this procedure, pregnancy is still possible. If, in addition to the ovarian cyst, both ovaries are also removed, this is called organ removal. This is an option for women after the climacteric (menopause), as the ovaries have mostly stopped producing hormones.

After the removal of the ovaries, pregnancy is no longer possible. In addition to removal by means of laparoscopy, an ovarian cyst can also be removed by means of an abdominal incision (laparotomy). This can be considered in the case of very large ovarian cysts, or if a malignant mass is suspected.

• Benefits:The benefits of surgical removal of ovarian cysts are primarily based on alleviating existing symptoms, avoiding complications such as bleeding and cyst bursting, and preventing the spread of suspicious (possibly malignant) looking tumors. Benign cysts that are to be treated may be conspicuous during check-ups by rapid growth, increasing symptoms in the form of lower abdominal pain and painful menstrual bleeding, and by non-response to medication.
• Disadvantages:The disadvantages of surgical removal of ovarian cysts include the general surgical risks such as bleeding, injury to neighboring organs, etc. The majority of cysts that occur are so-called functional cysts within the female cycle (enlargement of an existing follicle or corpus luteum).

  With a 90% tendency to regression, a too rapid surgical intervention would have more disadvantages than benefits. If bilateral removal of the ovaries is necessary, this is associated with infertility and menopausal-like symptoms. If new ovarian cysts appear after the menopause, both ovaries are usually removed. According to current knowledge, this can be associated with a higher cardiovascular risk of stroke and coronary heart disease.