OVARIAN CYSTS

• Ovarian cysts are fluid-filled sacs within the ovary
• The most common types are functional follicular cysts, corpus luteum cysts, and theca lutein cysts, all of which develop as part of the menstrual cycle and are usually harmless and resolve on their own
• Nonfunctional cysts include chocolate cysts, which are related to endometriosis, dermoid cysts, cystadenomas, and malignant cysts (a type of ovarian cancer)

• Most ovarian cysts occur as part of normal functioning ovaries

Functional cysts

• Result from a disruption in the development of follicles or the corpus luteum 

Follicular cyst

• Develops when a Graafian follicle does not rupture and release the egg (ovulation) but continues to grow. Eventually develops into a large cyst (7 cm) lined with granulosa cells and associated with hyperestrogenism and endometrial hyperplasia

Corpus luteum cyst

• Fluid in the corpus luteum after failed regression following the release of an ovum. Associated with progesterone-only contraceptive pills and ovulation-inducing medication

Theca lutein cysts

• Result from exaggerated stimulation of the theca interna cells of the ovarian follicles due to excessive amounts of circulating gonadotropins such as β-hCG. Strongly associated with gestational trophoblastic disease and multiple gestations

Nonfunctional cysts

• Chocolate cysts
• Dermoid cysts
• Cystadenoma 
• Malignant cysts (a form of ovarian cancer)

• Follicular cysts are the most common cysts seen in the reproductive age and usually asymptomatic. Menstrual disturbances can be seen. A period of amenorrhoea followed by irregular and prolonged bleeding is the usual pattern
• If the size is > 6 – 8 cm, further investigations are necessary to confirm the nature of the cyst
• In older women, epithelial tumours are common
• The commonest cyst diagnosed in pregnancy is a dermoid cyst
• Symptoms include abdominal swelling or fullness of the abdomen
• Pressure symptoms are common – GIT symptoms, urinary symptoms, oedema of the leg, varicose veins, haemorrhoids
• Hormonal effects – Irregular bleeding, amenorrhoea, post-menopausal bleeding 
• Chronic pelvic pain, dysmenorrhoea, dyspareunia
• Infertility especially in chocolate cyst
• Acute pain - if any complication like torsion, rupture, or haemorrhage into the cyst

• General examination: to rule out the evidence of malignancy such as lymphadenopathy, cachexia, breast lumps, etc
• Abdominal examination and Bimanual examination: To find the mass, whether it is from uterus or ovary, or to suspect malignant changes
• Ultrasound: confirms whether it is a simple cyst, complex cyst or solid mass
• Serum CA – 125
  • Predictive value is not good in the reproductive age group as it may be increased in other conditions also
  • Levels > 200 IU/mL suggests ovarian cancer
  • Levels ≥ 25 U/mL is very sensitive for the diagnosis of an ovarian epithelial tumour in postmenopausal women

• Functional cyst- often regress spontaneously
• NSAIDs – Painful cysts
• Surgery – in case of complications 
• Treatment of underlying conditions such as PCOS, endometriosis, etc.

Ayurvedic Treatment

Internal Medicines

• Varunadi Kashaya
• Dashamoola Kashaya
• Sukumara Kashaya
• Munditaka Kashaya
• Kulathadi Kashaya
• Punaranvadi Kashaya
• Chitraka Grandyadi Kashaya 
• Trayantyadi Kashaya
• Guggulu thiktaka Kashaya 
• Chandraprabha Vati
• Kanchanara Guggulu
• Gomutra Hareetaki
• Kalyanaka Kshara 
• Palasa kshara

In simple functional cyst 

• Hinguvashtaka Choorna
• Abhayaarishta 

In Bleeding phases

• Haemostatic measures should be followed

Procedures

• Snigdha Virechana- Gandharava eranda, Sukumara eranda, Erandabhrishta hareetaki (especially in endometriotic cysts & cysts with heavy and irregular bleeding )
• Vasti – Yoga vasti, Lekhana vasti
• Snehapana and Sneha vasti – Varunadi gritha, Maha thiktaka gritha, Guggulu thiktaka gritha, Maha narayana taila
• Kashaya vasti – Erandamoola kwatha, Sukumara kwatha, Dashamoola kwatha, Palashadi vasti