• Most are functional or follicular cysts and generally >1cm in size
• Less common include PCOS, cystadenomas, and dermoid cysts
• Usually symptom free unless complication
  • risk of torsion when >4cm
  • <2cm are virtually risk free from torsion

Most tend to be asymptomatic but can cause:

• Dull pelvic pain or fullness; they can be significantly painful if ruptured
• Dyspareunia
• Pressure on the bladder

If there is bleeding into the cyst and it ruptures, it can be life threatening, with signs of peritonitis, shock

• simple analgesia eg NSAIDs
• ensure exclusion of complications and other more sinister differential diagnoses of abdo pain.

Exact pathophysiology = unclear

• often have raised testosterone
• inappropriate gonadotrophin secretion - probably as a result of ovarian dysfunction rather than cause
• most common hormonal abnormalities: excess Luteinising hormone (LH) and Insulin resistance

Diagnostic criteria have varied over the years and vary according to authority group! Include the following:

• evidence of ovarian dysfunction
• exclusion of other disorders - eg other hormonal causes (Hypothyroidism, Hyperprolactinaemia, Cushing’s disease)
• biochemical evidence of hyperandrogenism
• ?USS evidence

Major features

• menstrual dysfunction - usually a chronic pattern
• anovulation
• signs of hyperandrogenism - male hair distribution, acne
• ~50% are obese
• Acanthosis nigricans - possibly due to insulin resistance
• Hypertension
• chronic pelvic pain

treatments aimed at so-called metabolic derangements, such as anovulation, hirsutism, and menstrual irregularities.

• a rare, complication of IVF
• characterized by ovarian enlargement due to multiple ovarian cysts and an acute fluid shift into the extravascular space.
• Complications of OHSS include ascites, hemoconcentration, hypovolemia, and electrolyte imbalances
• Enlargement of the ovaries causes abdominal pain, nausea, and vomiting
• 3rd space losses due to hyperpermeability and ovarian cyst rupture
• peritonitis when blood in fluid of ruptured follicles
• ovarian torsion
• symptoms:
  • SOB in most
  • abdo pain in most, nausea, vomiting and diarrhoea in around 50%
• beware: hypercoagulability, electrolyte and fluid disturbances

https://emedicine.medscape.com/article/256806-overview
https://teachmeobgyn.com/gynaecology/ovarian/polycystic-ovary-syndrome/