Adult Medical-Surgical Adult Medical-Surgical Nursing Nursing

Reproductive Health Module: Reproductive Health Module: Ovarian CystOvarian Cyst

Polycystic Ovary SyndromePolycystic Ovary Syndrome

Ovarian Cyst: DescriptionOvarian Cyst: Description

Enlargement of a:Enlargement of a: Graafian FollicleGraafian Follicle Corpus LuteumCorpus Luteum Other ovarian materialOther ovarian material Cysts are usually benign in younger Cysts are usually benign in younger

womenwomen In post-menopausal women about In post-menopausal women about

50% are malignant 50% are malignant

Ovarian Cyst: AetiologyOvarian Cyst: Aetiology

Related to hormone activity: Related to hormone activity:

Oestrogen and progesterone Oestrogen and progesterone

Ovarian Cyst: Ovarian Cyst: Clinical ManifestationsClinical Manifestations

Abdominal or pelvic pain often Abdominal or pelvic pain often related to ovulation: “Mittelschmerz” related to ovulation: “Mittelschmerz” syndromesyndrome

Pain related to one side (may be Pain related to one side (may be confused with appendicitis or confused with appendicitis or diverticulitis) diverticulitis)

Abdominal swelling and tendernessAbdominal swelling and tenderness

Ovarian Cyst: ComplicationsOvarian Cyst: Complications

Rupture and peritonitisRupture and peritonitis Tortion of the ovary interfering with Tortion of the ovary interfering with

blood supplyblood supply Adhesions and intestinal obstruction Adhesions and intestinal obstruction Malignancy especially in post-Malignancy especially in post-

menopausal womenmenopausal women

Ovarian Cyst: DiagnosisOvarian Cyst: Diagnosis

Pelvic and vaginal ultrasound scanPelvic and vaginal ultrasound scan

Laparoscopy (may include treatment)Laparoscopy (may include treatment)

Ovarian Cyst: ManagementOvarian Cyst: Management

If large: surgical removal attempting to If large: surgical removal attempting to conserve the ovaryconserve the ovary

If small: oral contraceptives (oestrogen If small: oral contraceptives (oestrogen and progesterone) to suppress ovarian and progesterone) to suppress ovarian activity: plans for pregnancy deferredactivity: plans for pregnancy deferred

Follow-up to assess growth and avoid Follow-up to assess growth and avoid complicationscomplications

If post-menopausal, surgery (probably If post-menopausal, surgery (probably oophrectomy) to avoid malignancy oophrectomy) to avoid malignancy

Polycystic Ovary SyndromePolycystic Ovary Syndrome

Polycystic Ovary Syndrome: Polycystic Ovary Syndrome: DescriptionDescription

An endocrine problem of the An endocrine problem of the hypothalamus, pituitary and ovaries hypothalamus, pituitary and ovaries where multiple cysts form in the where multiple cysts form in the ovariesovaries

Androgen excessAndrogen excess Associated with amenorrhoea and Associated with amenorrhoea and

infertilityinfertility Affects 5-10% women of child-bearing Affects 5-10% women of child-bearing

ageage

Polycystic Ovary Syndrome: Polycystic Ovary Syndrome: PathophysiologyPathophysiology

Androgen excess Androgen excess

No ovulation (or irregular ovulation ) No ovulation (or irregular ovulation ) → multiple cyst formation in ovaries → multiple cyst formation in ovaries

Associated with insulin resistance, Associated with insulin resistance, Diabetes Mellitus or hyper-Diabetes Mellitus or hyper-insulinaemia and cardiac disordersinsulinaemia and cardiac disorders

Polycystic Ovary Syndrome: Polycystic Ovary Syndrome: Clinical ManifestationsClinical Manifestations

Irregular menstrual periods or Irregular menstrual periods or amenorrhoeaamenorrhoea

Weight gain Weight gain

HirsutismHirsutism

Suspected abdominal/ pelvic massSuspected abdominal/ pelvic mass

Polycystic Ovary Syndrome: Polycystic Ovary Syndrome: ManagementManagement

Medication to stimulate ovulation Medication to stimulate ovulation (Clomiphene)(Clomiphene)

May require surgery: May require surgery: Hysterectomy and Bilateral Salpingo-Hysterectomy and Bilateral Salpingo-

oophrectomyoophrectomy

Ovarian Cyst/ Polycystic Ovary Ovarian Cyst/ Polycystic Ovary Syndrome: Nursing ConsiderationsSyndrome: Nursing Considerations

Psychological and emotional supportPsychological and emotional support

Health education related to the Health education related to the conditioncondition