Follicular cyst is a functional retention formation of ovarian tissue formed from a non–ovulated follicle. In most cases, follicular cysts are not clinically manifested; sometimes there are pains in the lower abdomen, menstruation delay, infertility. Diagnosis involves gynecological examination, dynamic echography, laparoscopy. Recurrent and persistent cysts are subject to treatment: in this case, hormonal and anti-inflammatory therapy is carried out. With the preservation of the follicular cyst or the occurrence of complications, surgical treatment is indicated.
Follicular cyst is a benign ovarian formation that develops from a dominant follicle in the absence of ovulation. The increase in the size of the follicular cyst is due to the transudation of fluid from blood vessels or its continued secretion by granulose epithelial cells. Follicular cysts are mainly found in women of reproductive age, less often they can form during menopause or be congenital. In gynecology, they make up more than 80% of all ovarian cysts.
Macroscopically, the follicular cyst has the form of a round thin-walled single-chamber formation with smooth walls and liquid, straw-yellow contents, ranging in size from 3 to 8 cm in diameter. The location of the follicular cyst is one-sided. Follicular cysts never undergo malignancy and in most cases resolve independently by the beginning of menstruation or during 2-3 menstrual cycles.
The pathogenesis of the development of follicular cyst is based on endocrine-metabolic disorders leading to hyperestrogenism and the development of a single-phase anovulatory menstrual cycle. Physical overstrain and psychoemotional stress can contribute to these disorders. Ovarian dysfunction caused by abortions, nonspecific inflammations (oophoritis, adnexitis, salpingitis), uncontrolled contraception, acute infections, STDs, hyperstimulation of ovulation in the treatment of infertility often leads to the formation of follicular cysts.
In the development of follicular cysts in newborns, the determining influence of the mother’s estrogens on the developing fetus, as well as hormonal crises of the newborn period, is assumed. Follicular cysts tend to resolve themselves – disappear when hormonal balance is restored. Repeated episodes of occurrence are attributed by gynecology to recurrent follicular cysts; in the absence of regression for more than 2-3 months – to persistent cysts.
Small (up to 4-5 cm in diameter) cysts usually do not manifest themselves and are detected by chance. Follicular cysts of a larger size (up to 8 cm or more) may be accompanied by pain in the lower abdomen, a feeling of bursting or heaviness in the groin area. Discomfort and pain appear in the second half of the menstrual cycle, are often provoked or intensified during sexual intercourse, physical activity, sudden movements. A number of patients are concerned about the irregularity, abundance and duration of menstruation, the appearance of scanty intermenstrual secretions.
The presence of a persistent follicular cyst indicates a persistent anovulatory menstrual cycle, therefore it may be accompanied by infertility. If ovulation occurs in an unchanged ovary, the onset of pregnancy becomes possible. During pregnancy, the follicular cyst can spontaneously regress or cause serious complications, up to miscarriage.
With a large follicular cyst, as well as during pregnancy and physical activity, there is a possibility of twisting of the cyst leg, capsule rupture, necrosis of ovarian tissue, ovarian apoplexy with the development of intra-abdominal bleeding. The resulting acute abdominal clinic is characterized by sudden piercing pain, dizziness, nausea and vomiting, weakness, hypotension, tachycardia, pallor of the skin.
Clinical recognition of ovarian cyst is performed on the basis of vaginal-abdominal examination, echography, laparoscopy. During gynecological examination, a rounded tumor with a tight elastic consistency, smooth surface, slightly painful and mobile is palpated from the side and anterior to the uterus.
Ultrasound scanning determines a spherical single-chamber formation from 3 to 8 cm in diameter, filled with homogeneous anechoic contents. The inner walls of the cyst are smooth, smooth, and 1-2 mm thick. Areas of intact ovarian tissue are visualized against the background of a follicular cyst. Dopplerometry reveals areas of blood flow with a low velocity located on the periphery. A follicular cyst is differentiated from an ovarian cyst. In unclear situations, diagnostic laparoscopy is resorted to.
Small (up to 5-6 cm in diameter) follicular cysts, as a rule, resolve themselves by the beginning of the next menstruation or during 2-3 menstrual cycles. In this case, dynamic monitoring with repeated ultrasound is established for the patient. To stimulate the reverse development of recurrent follicular cyst, combined oral contraception, anti-inflammatory therapy, vitamins, homeopathic remedies are prescribed. From physiotherapy procedures, electrophoresis, magnetotherapy, ultraphonophoresis are used.
Surgical removal of the follicular cyst is performed with a persistent form of the disease, a progressive increase in formation, cyst diameter > 8 cm. In typical cases, laparoscopic cyst exfoliation with wall suturing or ovarian resection is performed. In case of complications, the operation is performed urgently; in case of ovarian apoplexy, oophorectomy or adnexectomy is performed.
To prevent the formation of follicular cyst, timely treatment of inflammatory and dishormonal pathology of the ovaries, preventive observation by a gynecologist is necessary. With a recurrent course of the cyst, it is necessary to identify and eliminate the cause of the pathological condition.
The management of pregnancy occurring against the background of an follicular cyst requires careful monitoring of the dynamics of the state of ovarian formation.