Luteal cyst

Luteal cyst is a delimited cavity formed from the elements of the yellow body of the ovary with a liquid of benign origin. Luteal cysts do not have a "favorite" age period, so they are diagnosed equally often in young and mature pores, that is, while the ovaries perform a hormonal function. The luteal cyst is usually not caused by any gynecological pathology and correlates with the physiological state. However, in some situations it is accompanied by inflammatory processes in the fallopian tubes and ovaries, as well as hormonal dysfunction.

The formation of the luteal cyst is closely related to the cyclical functional and structural changes that occur in the ovaries every month. Since the ovary is endowed with one of the most important functions of reproduction, nature reliably protected it from adverse external influences. Outside, it is sheltered by a dense connective tissue( white) shell, and inside it is located a cortical zone. In it there is a huge number of small cavities, similar to vesicles, at different stages of maturation, called primordial follicles. Each such follicle is an egg in the environment of epithelial cells of flattened form. As the egg "grows up," the follicle ripens with it. At the end of maturation, the primordial follicle reaches a value of 6 to 20 mm, from inside it fills the follicular fluid, and its wall is formed by one layer of epithelial cells and two layers of connective tissue.

The maturing follicle not only serves as a receptacle for the egg, it is also a hormone-producing structure. During maturation, the follicle secretes androgens and transforms them into estrogens( estradiol).The mature follicle is filled with a fluid( follicular) and is called a graaff bubble.

When the egg finally ripens, the concentration of the estrogen produced by the follicle becomes maximal, and the pituitary gland with the help of luteinizing hormone( LH) initiates ovulation - rupture of the wall of the graafovaya bubble so that the egg can freely leave the ovary.

After ovulation, a yellow body forms from the shell of the destroyed follicle. It exceeds the size of the graphs of the vial, is filled from inside with fibrin, and at the edges has a scalloped rim of characteristic yellow color( hence the name "yellow body") formed by luteal cells.

The yellow body acts as a temporary hormonal gland, as it synthesizes progesterone. It is formed regardless of the presence or absence of fertilization. If an unfertilized egg dies, the yellow body does not function for more than 12 days, after which it is self-reduced shortly before the onset of menstrual bleeding. In pregnant women, the yellow body begins to develop intensively, continuing to produce progesterone to preserve the developing pregnancy. After 3,5 - 4 months, the yellow body completes functioning, and its function is assumed by the formed placenta.

Sometimes, after ovulation, the yellow body does not regress, but continues to accumulate fluid, increases and transforms into a luteal cyst. As a rule, these cysts are present in the ovary asymptomatically, and after 2 - 3 months they undergo reverse development without external intervention.

If the yellow body accumulates non-transparent liquid, but blood, it is transformed into a hemorrhagic cyst.

The luteal cyst of the left ovary by the mechanism of formation does not differ from that on the right. However, since the right ovary is better than the left ovary, the luteal cyst of the right ovary is diagnosed more often.

Causes of the luteal cyst of the ovary

So, the luteal cyst is formed from a non-regressed corpus luteum as a result of a change in the normal blood and lymphatic supply of the ovary.

The causes of luteal cysts are studied and so far have the nature of assumptions, but a reliable relationship has been established between the appearance of the luteal cyst in the ovary with hormonal dysfunction. It is fair to say that any circumstance that led to hormonal breakdown can also induce the yellow body to form a cyst. There is an opinion that the luteal cyst can correlate with the physiological state, if it is small, formed in a healthy ovary, does not manifest clinically and regress without external involvement. In all other situations, the luteal cyst is left without attention.

A luteal cyst may appear in the ovary and with an unchanged menstrual cycle when the yellow body is oversized, or after a hemorrhage into its cavity.

Predisposing factors for the appearance in the ovary of the luteal cyst are more often:

- Strong psychoemotional disorders. Expressed long-term stress, fatigue or physical overload negatively affect the hormonal function of the ovaries.

- Artificial( abortion) termination of pregnancy. Simultaneous artificial extraction of the fetal egg from the uterine cavity provokes a serious hormonal failure, so the yellow body can not collapse in the proper time, but continue to function, transforming into a cyst. In addition, after an abortion, due to considerable traumatization of mucous membranes, an inflammatory process often develops.

- Infectious and inflammatory changes in ovarian tissue. The inflammatory process provokes hormonal dysfunction. It also affects the condition of the blood and lymphatic vessels of the ovary. If the blood vessels under the influence of inflammation are damaged, the blood enters the yellow body and accumulates, that is, a cyst is formed, filled with hemorrhagic contents.

- Pathology of the endocrine glands. Hormonal activity of the ovaries is integrated into the endocrine system together with other glands( thyroid and pancreas, adrenal glands), if one of the links of this system is functioning incorrectly, hormonal dysfunction develops.

- Deficiency of weight, especially against the backdrop of inadequate measures to reduce it. The pronounced deficiency of adipose tissue leads to a decrease in the concentration of estrogens, which, in turn, causes hormonal disorders.

- Incorrect hormonal contraception. Making a decision to independently choose a contraceptive, women can do it wrong and thus provoke hormonal disorders. In such situations, after the abolition of taking a hormonal contraceptive in the ovary, a luteal cyst may appear.

It should be noted that the term "cyst" to the cyst, formed on the site of the yellow body, can be reliably applied only in part. Indeed, like any cyst, the cyst of the yellow body is a cavitary fluid formation, but the mechanism of its formation and structure are significantly different from those in ordinary cysts.

The luteal cyst is formed by the accumulation of liquid by a yellow body, after which its wall is stretched, and the cavity is enlarged. A follicular and parovarial cyst is formed in a similar way. Such a growth mechanism is not typical for a true cyst, which grows due to the multiplication of cells of a multilayer capsule, so it can sometimes grow into a fairly large formation. To mark the difference between luteal, follicular and parovarial cysts from true cysts, they are called functional, or retentional.

Symptoms and signs of the luteal cyst of the ovary

Since the yellow body is the result of the transformation of the tissues of the graafov vesicle that has freed from the ripe egg, the luteal cyst can only form in the second half of the menstrual cycle.

Luteal cyst is a single entity. In a time equal to one intermenstrual interval, in the ovary only one follicle( and one egg respectively) is capable of completing a full cycle of maturation, so after ovulation there is one yellow body that can become a source of cyst formation. Simultaneously, only one luteal cyst of the left ovary or luteal cyst of the right ovary can be located in the ovary.

Because the function of the capsule of the luteal cyst is performed by the thin shell of the yellow body, which is not capable of stretching too much, the luteal cyst differs in a relatively small( usually 4-8 cm) size, as well as in the absence of any clinical symptoms.

Luteal cysts are not diagnosed infrequently. Obviously, this is due to their asymptomatic course and the ability to self-reduce within two or three subsequent cycles.

In rare cases, especially in the presence of local infectious inflammation, the presence of a luteal cyst in the ovary can provoke a number of symptoms:

- Soreness in the projection of cyst localization. Sometimes instead of soreness there is a feeling of raspiraniya, heaviness or discomfort. Similar symptoms appear when the cyst becomes large, or when the ovary is inflamed.

- Hormonal dysfunction. Prolonged presence in the ovary of a luteal cyst may lead to excessive accumulation of progesterone and, as a consequence, the delay of another menstrual bleeding. Monthly on a background of cystic transformation of a yellow body sometimes become more long and / or plentiful.

Complications of luteal cysts are rare. These include:

- Torsion of the legs of the cyst. The luteal cyst is attached to the surface of the ovary by means of a small outgrowth - a leg that is incapable of holding the cyst in one position ensures its mobility. If the cyst rotates around its axis, it entrains the leg. As a result, due to the twisting of the legs, the vessels feeding the cyst are clamped, and a necrotic process develops.

- Cyst rupture. During the formation of the yellow body( the second phase), the processes of vascularization can be disrupted. As a result, the vessels located in the cyst shell are destroyed, and the blood enters the cavity of the cyst and accumulates in it. The increasing amount of blood in the cystic cavity leads to the formation of a hematoma, it increases until the cyst and, consequently, the capsule of the ovary is broken.

All the listed complications of luteal cyst are classified as acute surgical pathology, because they provoke the clinic of "acute abdomen", internal bleeding and hemorrhagic shock.

Asymptomatic luteal cysts can also be diagnosed in pregnant women. Pregnancy with the luteal cyst of the ovary often proceeds perfectly normal. As a rule, specialists adhere to the tactics of conventional ultrasound observation.

Treatment of luteal ovarian cyst

Most luteal cysts do not need treatment, as they reduce themselves. However, since any asymptomatic cyst can be complicated, it is necessary to observe it for the next three menstrual cycles to make sure that the cyst actually decreases gradually, and then disappears completely. A single ultrasound scan is performed monthly, which is able to visually assess the condition of the cyst and, accordingly, the ovary, and measure their size. This tactic is used only for asymptomatic luteal cysts.

If the luteal cyst is formed against an inflammatory or disgormonal process, the chances of its self-extinction are small. After appropriate diagnostic measures, conservative therapy is performed to help the ovary get rid of the luteal cyst. It can include hormonal correction of existing disorders and / or anti-inflammatory therapy.

Pregnancy in the luteal ovarian cyst does not require special therapeutic measures. As a rule, the luteal cyst in pregnant women is liquidated by the time the placenta formation is completed, therefore the entire period of its existence in the ovary requires only observation.

Surgically luteal cysts are removed extremely rarely, when, in spite of the ongoing medical measures, they do not regress.