Ovarian Cysts & Uterine Fibroids 

What are ovarian cysts and adnexal masses?

Ovarian Cysts  are fluid filled sacs within or on the surface of an ovary.  In many cases they are small, harmless, and do not cause symptoms. However, they may become symptomatic if they are large, rupture,  or cause the ovary to twist. They present as pain, pressure  or infertility. They some time are detected on scan with suspicious signs for cancer. They could be: 

• Functional cysts  are formed during the menstrual cycle and are the most common type.  Follicular Cysts form when an egg sac fails to burst and release a mature egg. The sac then grows into a cyst, but these often resolve gradually within a couple months and don't require treatment.  Corpus Luteum Cysts form after an egg sac bursts and releases a mature egg, but the remaining sac fails to shrink away and instead reseals itself and builds up fluid inside. These may grow large, bleed or twist the ovary (restricting blood supply), thereby necessitating treatment.

• Endometriotic cysts (Endometrioma)  result from endometriosis which is endometrial-like tissue grows outside the uterus, attaches to an ovary, responds to hormonal fluctuations, and accumulates as a cyst.  These can cause pain, infertility, and adhesions, and they have the potential to rupture.

• Benign cyst are not formed as part of the menstrual cycle and can have fluid or solid components.  Cystic teratomas (dermoid cysts) are formed from cells that are present at birth, grow slowly over many years, and do not resolve on their own.  They are formed during fetal development and result from entrapped skin structures (hair follicles, sweat glands, hair, teeth, or nerves). Mucinous Cystadenomas contain mucous material and Serous Cystadenomas contain clear yellow fluid. They can both become very large.

• Malignant cysts are ovarian cancer, however they are rare.  Any cyst may become cancerous, so it is crucial cysts are monitored. cancer cysts normally show suspicious features on scan

Adnexial masses refers to structures connected or related to the uterus, such as ovaries, fallopian tubes, and connective tissue.  Ovarian cysts and uterine fibroids are sub-types of adnexal masses.  Other common types of adnexal masses include:

• Ectopic pregnancy typically occurs in the fallopian tubes, but can occur elsewhere such as in the ovary, abdominal cavity or cervix.  It can cause pain, rupture and bleeding.

• Tubo-ovarian abscess which is a pocket of puss resulting from acute infection, or PID (pelvic inflammatory disease), requiring immediate intervention.

Adnexal masses can sometimes cause torsion of the ovary and cut off the blood supply, resulting in pain and possibly impeding ovarian function.

What are symptoms of ovarian cysts and adnexal masses?

• Pelvic pain

• Painful urination

• Bladder dysfunction

• Painful bowel movements

• Bowel dysfunction

• Painful intercourse

• Infertility

What treatment options does Mr Alazzam offer ovarian cysts and adnexal masses?

Mr Alazzam specialises in the application of minimally invasive surgical techniques to treat ovarian cysts and adnexal masses.  Laparoscopy and robotics are particularly well suited to treating these conditions due to increased magnification and reach of the surgical instrument

What are uterine fibroids?

Uterine fibroids are non-cancerous (benign) growths made up of muscle cells and connective tissue.  They are very common, affecting between 40% and 80% of women. They are also referred to as leiomyomas or myomas.

They are often small and do not cause issues, but depending on their size, location and quantity can be quite troublesome.

Their size and location vary dramatically and they are classified based mainly on their location.  Submucosal fibroids are located just under the layer of tissue lining the uterus (the endometrium).  Intramural fibroids are embedded in the wall of the uterus. Subserosal fibroids are located on the outer wall of the uterus.  Cervical fibroids are located in the cervix. Intraligamentary fibroids are located in the connective tissue next to the uterus.  Pedunculated fibroids are connected by a stalk to the surface of the uterus and may be submucosal or subserosal.

What are the symptoms of uterine fibroids?

Uterine fibroids most often cause symptoms between the ages of 20 and 50.  Though they often do not cause any symptoms, if they are larger they can push against neighboring organs such as the bladder and bowel causing various symptoms.

• Heavy menstrual bleeding

• Irregular menstrual bleeding

• Menstrual periods lasting more than one week

• Pelvic pain or pressure (severe, diffuse, or like menstrual cramping)

• Anemia (due to blood loss from heavy menstrual periods)

• Increased urge to urinate

• Urinary retention (difficulty emptying the bladder)

• Constipation

• Back or leg pain

• Miscarriage

• Infertility

Fibroids usually do not negatively impact fertility, but occasionally they do, particularly if they are located in the cavity of the uterus just under the layer of tissue lining the uterus (endometrium) where they may prevent implantation of the embryo.

What are the risk factors for uterine fibroids?

The cause of uterine fibroids is not known and there is no way to predict who will get them, but there are certain factors which make a woman more likely to develop fibroids.

• Black women are more likely to have fibroids (for unknown reasons)

• Never having been pregnant

• Having a mother or sister with fibroids

• Onset of menstruation at an early age

• Being overweight or obese

What treatment options does Mr Alazzam offer for uterine fibroids?

Mr Alazzam specialises in the application of minimally invasive surgical techniques to treat uterine fibroids.  Surgery for removal of fibroids is referred to as myomectomy. Myomectomy was historically performed via open surgery. 

Mr Alazzam performs myomectomy procedures either hysteroscopically (surgically through the vagina and cervix), or laparoscopically or robotically through small incisions. Mr Alazzam does not use morcellation during laparoscopic surgery.

Sometimes open surgery is required, but the ultimate goal is to utilise the smallest incisions to remove all the fibroids safely.