Ovaries are important organs essential for carrying out a multitude of functions related to womanhood. Ovaries play an important role in menstruation cyclical changes with each menstrual period, pregnancy, and several important hormonal functions in woman. Being a reproductive and endocrine (hormone-related) organ, it is subject to influence from various organ systems such as the brain, the uterus and insulin system. It can therefore be affected in various circumstances
Endometriosis refers to the growth of the lining of the uterus (endometrium) outside the uterine cavity. The endometrium can sometimes grow within the ovary. In such cases, these bleed with each menstrual cycle and form a cyst filled with blood. These are referred to as 'chocolate cysts' due to their appearance. Endometriosis can affect the function of the ovary and cause infertility. In such cases, ovarian surgery to decompress and eliminate areas of endometriosis may be required for reproductive function to normalize.
Polycystic ovarian disease (PCOD) results in the formation of multiple fluid filled cavities called cysts with the ovaries. PCOD impedes the functioning of the ovary and is a leading cause of infertility. Medical management with hormonal medicines is the first line of management. Ovarian drilling may however be required in cases with resistant PCOD.
As ovary is a reproductive organ with a high turnover of cells, it is liable to the formation of cysts and cancers. Simple cysts of the ovary may be followed carefully in a majority of cases with no further intervention required. If they are symptomatic or there is a suspicion for malignancy, surgery may be required. Ovarian cystectomy refers to the removal of the cyst alone. Oophorectomy refers to the removal of the entire ovary. The particular option chosen for you will depend on the individual condition of the mass.
The ovary is normally suspended in the peritoneal cavity by a pedicle. It may twist around its pedicle resulting in strangulation of blood vessels that supply the ovary. This condition is called torsion and is more common in ovaries with cysts. This results in acute and severe pain and usually needs immediate surgical correction.
Removal of simple cysts and ovarian drilling are usually done with laparoscopic techniques. The ovarian cysts which are not cancerous usually contain fluid/ blood inside the cyst. The fluid is aspirated first and the cyst gets collapsed. The cyst wall is excised through the laparoscope. Thus simple cysts of the ovary, even when large, can be removed with laparoscopic techniques. If the cyst is cancerous or has solid elements, open technique with a standard incision is required to ensure complete and precise removal. Please refer to our section on laparoscopic surgery to know more about the expected perioperative course with a laparoscopic surgery.
Ovarian drilling and cystectomy usually allow the ovary to function well after the surgery. The ovary needs to be monitored after the surgery to ensure that the problem does not recur. However, if all or a major part of the ovary is removed, it compromises the ovarian function. The hormonal support provided by the ovary is lost and women attain early menopause. In women with early menopause and menopausal symptoms such as flushes, hormonal support with medicines may be required. They also need to guard against the risk of osteoporosis from premature menopause.