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|Female Conditions - Ovarian Cyst|
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A cyst on an ovary. When associated with other disorders of the hypothalamic-pituitary-ovarian axis, and many cysts are present, it is termed Polycystic Ovary Syndrome (aka Stein-Leventhal Syndrome). Ovarian cysts may
be due to endometriosis, follicular or corpus luteum cysts, malignancy, or dermoid cysts. In Polycystic Ovary
Syndrome, follicular cysts develop as a result of pituitary overproduction of LH to try to initiate ovulation.
Ovarian cysts are products of failed or disordered ovulation. One or more ovarian follicles are developed monthly
by the effects of follicle stimulating hormone (FSH). Luteinizing hormone (LH) promotes actual ovulation and the transformation of the follicle (after ovulation) into the corpus luteum which produces progesterone. In young women, during the early years of menstrual cycles, ovulation may coincide with a small amount of hemorrhage
at the follicle site. This will cause abdominal pain, often with a slight fever, at the time of ovulation (in the middle days between periods) is commonly called mittelschmerz (German for "middle" and "pain"). Treatment consists only of mild analgesics, reassurance, rest, and perhaps a warm pack. It is unlikely to recur and portends no future problems.
Later in life, usually after her mid-30's, a woman may develop an ovarian cyst which may be asymptomatic or may cause variable pelvic pain. Palpation may detect a smooth, tender mass at one ovary site or a cyst may be found by sonogram visualization. The cyst may simply collapse and disappear after a month or two; or it may persist and increase in size and discomfort during succeeding months. Such cysts are caused by a failed ovulation
in which, for reasons presently unknown, the ovulation did not proceed to completion. With each succeeding month's surge of LH, the follicular site swells and stretches the surface membrane, causing pain and possible bleeding at the site. Some cysts may become as large as a golf ball or lemon before discovery. Treatment may require surgery during which the entire ovary may be lost.
An alternative treatment for ovarian cysts is natural progesterone. Biofeedback mechanisms dictate that sufficient gonadal hormones inhibit hypothalamic and pituitary centers, such that FSH and LH production are also inhibited. That is, in the usual circumstances, the successful response to FSH and LH hormones is the rise in progesterone from the corpus luteum. If sufficient and natural progesterone is supplemented prior to ovulation, LH levels are inhibited and regular ovulation does not occur. This is the effect of contraception pills, for example. Similarly, the high estriol and progesterone levels throughout pregnancy successfully inhibit ovarian activity for nine months. Therefore, adding natural progesterone from day 10 to day 26 of the cycle suppresses LH and its luteinizing effects. Thus, the ovarian cyst will not be stimulated and, in the passage of one or two such monthly cycles, will very likely regress and atrophy without further treatment.
Signs and Symptoms
Often, these cysts are asymptomatic; abdominal pressure, discomfort, pain with palpation, heaviness (there is rarely sharp sudden pain that would tend to indicate a different pathology such as rupture, hemorrhage, or ovarian torsion); bleeding with ovulation; metrorrhagia.
Lab Findings : endometrial biopsy in women over 35 years old; laparoscopy.
Normal maturation of sexual development; hirsutism (usually only on the face); obesity; anovulating periods;
irregular periods with extended periods of amenorrhea; infertility; ovaries are enlarged and polycystic.
Lab findings: increased serum LH and normal FSH; serum testosterone (increased); urine 17-KS (increased);
endometrial biopsy (in women over 35 years old); serum androstenedione (increased); with luteal cysts.
NOTE: Metabolic Syndrome is often associated with polycystic ovary syndrome.
Course and Prognosis
In non-polycystic cysts, treatment is only needed if the cyst becomes symptomatic (unless there is a malignancy).
Conventional treatment is usually surgery.
In polycystic ovary syndrome, while the course is typically benign, achieving pregnancy may be problematic (usually fertility must be drug-induced). Otherwise, normal conventional treatment consists of suppressing the pituitary release of LH by giving low-dose estrogen BCPs.
Suggested Nutritional Supplementation
Daily foundation nutrition with added support for healthy hearts and bones.
Targeted nutritional support for healthy estrogen metabolism.
240 mg gamma-linolenic acid.
Highly absorbable zinc/true amino acid chelate.
Progesterone Deficiency, if indicated by laboratory assessment
Higher potency enriched moisturizing creme with 980 mg progesterone, phtoestrogen compounds and antioxidant
|Last Updated on Saturday, 14 March 2009 01:08|