Ovarian Pathology
Ovarian cyst
- 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
Clinical Features
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
Management
- simple analgesia eg NSAIDs
- ensure exclusion of complications and other more sinister differential diagnoses of abdo pain.
Polycystic Ovary Syndrome
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.
Ovarian Hyperstimulation Syndrome (OHSS)
- 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