-An ovarian cyst: Definition : any collection of fluid, surrounded by a very thin wall, within an ovary. that is larger than about two centimeters is termed an ovarian cyst. - An ovarian cyst can be as small, or large. -Most ovarian cysts are functional in nature, and harmless (benign)  -ovarian cysts are found in nearly all premenopausal women, and in postmenopausal women.

-Ovarian cysts affect women of all ages. - occur during a woman's childbearing years. -Some ovarian cysts cause problems, such as bleeding and pain. - Surgery may be required to remove cysts larger than 5 centimeters in diameter.

Classification: 1-Functional cyst : harmless and without treatment resolve spontaneously These normal cysts will often shrink and disappear within two or three menstrual cycles. Because this type of cyst is formed during ovulation, it rarely occurs in menopausal women because eggs are no longer being produced.

Non-functional cysts ( dysfunctional) 1-Dermoid cyst These are ovarian cysts that are filled with various types of tissues, including hair and skin. 2-Chocolate cyst of ovary: Endometrioma Cysts An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst is caused by endometriosis, and formed when a tiny patch of endometrial tissue bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries.

3-A polycystic cyst Ovarian Disease This disease refers to cysts that form from a build up of follicles. These cysts cause the ovaries to enlarge and create a thick outer covering, which may prevent ovulation from occurring, and are often the cause of fertility problems. - is diagnosed based on its enlarged size - usually twice normal with small cysts present around the outside of the ovary. -It can be found in "normal" women, and in women with endocrine disorders. -An ultrasound is used to view the ovary in diagnosing the condition.

4- adenoma Cysts These are ovarian cysts that develop from cells on the outer surface of the ovaries.

Signs and symptoms: Some or all of the following symptoms may be present, though it is possible not to experience any symptoms: -dull aching, or severe, sudden, and sharp pain or discomfort in the @lower abdomen (one or both sides)  @pelvis @ vagina @ lower back @thighs pain may be constant or intermittent

Fullness, heaviness, pressure, swelling, or bloating in the abdomen Mammary glands Breast tenderness Reproductive system : Infertility, Pain during or shortly after beginning or end of menstrual period.( dysmenorrheal either primary or secondary ), Pain during intercourse(dyspaurnia) Irregular periods (metorrhagia AUB,or spotting Urinary system :Change in frequency or ease of urination (such as inability to fully empty the bladder) Elementary canal : Nausea or vomiting, difficulty with bowel movements due to pressure on adjacent pelvic anatomy

Weight gain Fatigue Increased level of hair growth Increased facial hair or body hair Headaches Strange pains in ribs, which feel muscular Bloating Strange nodules that feel like bruises under the layer of skin (ovary )

-Pain& its degree according to 1- size of cyst 2- bleeding 3- bursting of a cyst, which irritates the abdominal tissues. 4-a cyst twisted (called torsion), which can block the flow of blood to the cyst.

Diagnosis 1-an annual pelvic examination 2- ultrasound  3- CT scan. 4- laparoscopy

treatment -About 95% of ovarian cysts are benign, meaning they are not cancerous. -Treatment for cysts depends on: 1- the size of the cyst 2- the type of the cyst 3- what symptoms she is experiencing 4- the woman's age 5- general health 6- her future pregnancy plans -small, asymptomatic cysts: regular monitoring

Pain may be treated with:  a warm bath, or heating pad, or hot water bottle applied to the lower abdomen near the ovaries can : 1-relax tense muscles 2- relieve cramping 3- lessen discomfort 4- stimulate circulation 5-promote healing in the ovaries.  - limiting strenuous activity may reduce the risk of cyst rupture or torsion.

pain relievers, including acetaminophen/paracetamol (Tylenol)  no steroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil), NSAIDs usually work best when taken at the first signs of the pain.  narcotic pain medicine (by prescription) may help reduce pelvic pain (pethidine ,morphine,tramadol). -combined methods of hormonal contraception ; the combined oral contraceptive pills will able to 1-regulate the menstrual cycle 2- prevent the formation of follicles that can turn into cysts 3- shrink an existing cyst. N.B: Oral contraceptives are not an effective treatment for other types of benign ovarian cysts, but they do offer some protection against malignant ovarian cysts (ovarian cancer).

-if : -Cysts that persist beyond two or three menstrual cycles - or occur in post-menopausal women may indicate more serious disease and should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer.

-ovarian cancer diagnosis : 1-surgical biopsy. 2-a blood test  before surgery to check for elevated CA-125, a tumor marker elevated ,remember false positives result. - serious cases where cysts are large and persisting, doctors may suggest surgery. - Some surgeries can be performed to successfully remove the cyst(s) without hurting the ovaries, while others may require removal of one or both ovaries.

Indications for surgical intervention : 1-ovarian cysts that do not disappear after a few menstrual cycles  2-extremely large cysts. 3-Ovarian cysts in post menopausal women, cause symptoms such as severe pain or bleeding, or have become twisted -Surgery can involve anything from simply removing the cyst to removing the ovary. In some severe cases, hysterectomy is recommended.

-Things to Remember About Ovarian Cysts *Because ovarian cysts often cause no symptoms, it is especially important for women who have previously had cysts to have regular pelvic examinations. *Women who have previously had ovarian cysts are at a greater risk of developing further cysts. *endometriosis may be worsened by the presence of ovarian cysts, and chance of needing to ovaries removed increases. *In case of malignant ovarian cysts, early treatment offers the best hope for recovery. *Women who develop ovarian cysts after menopause are more likely to have malignancies.