Follicular Ovarian Cyst
Description
A follicular ovarian cyst is a functional ovarian cyst that develops from a normal ovarian follicle during the menstrual cycle as a result of hormonal changes. Follicular cysts develop when excessive stimulation by follicle-stimulating hormone (FSH) prevents ovulation. As a result, the dominant follicle fails to rupture and continues to enlarge. In some cases, the follicle fails to mature and loses its ability to regress. Follicular cysts are usually solitary and range in size from a few millimeters to approximately 15 cm. They have a thin wall and contain clear, serous fluid.
Symptoms
Most follicular cysts are asymptomatic or cause only mild symptoms, including:
- Frequent urination.
- Dull lower abdominal or pelvic pain.
- Unilateral pelvic pain.
- Irregular or mildly painful menstruation.
- Increased abdominal girth.
Diagnosis
Follicular ovarian cysts are most often detected incidentally during a gynecological examination, where they are palpated as a painless adnexal mass, or during pelvic ultrasonography.
Treatment
Most follicular ovarian cysts resolve spontaneously without treatment. Combined oral contraceptives may be prescribed for 3–6 months, and follow-up ultrasonography is typically performed on days 4–6 of the menstrual cycle after menstruation. If the cyst persists or cannot be reliably distinguished from an ovarian neoplasm, surgical treatment is recommended.
In postmenopausal women, serum CA-125 levels should be measured when a cystic ovarian lesion is detected. If the CA-125 level is normal and the cyst measures up to 5 cm, periodic observation is appropriate. If the cyst is larger than 10 cm, has irregular features, or the CA-125 level is elevated, surgical removal with histopathological examination is recommended to exclude malignancy. In women of reproductive age, cystectomy is generally preferred, whereas oophorectomy is usually recommended after menopause.
Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology