1. Adult Medical-Surgical Nursing Reproductive Health Module: Ovarian Cyst Polycystic Ovary Syndrome

2. Ovarian Cyst: Description Enlargement of a: Enlargement of a: Graafian Follicle Graafian Follicle Corpus Luteum Corpus Luteum Other ovarian material Other ovarian material Cysts are usually benign in younger women Cysts are usually benign in younger women In post-menopausal women about 50% are malignant In post-menopausal women about 50% are malignant

3. Ovarian Cyst: Aetiology Related to hormone activity: Related to hormone activity: Oestrogen and progesterone Oestrogen and progesterone

4. Ovarian Cyst: Clinical Manifestations Abdominal or pelvic pain often related to ovulation: “Mittelschmerz” syndrome Abdominal or pelvic pain often related to ovulation: “Mittelschmerz” syndrome Pain related to one side (may be confused with appendicitis or diverticulitis) Pain related to one side (may be confused with appendicitis or diverticulitis) Abdominal swelling and tenderness Abdominal swelling and tenderness

5. Ovarian Cyst: Complications Rupture and peritonitis Rupture and peritonitis Tortion of the ovary interfering with blood supply Tortion of the ovary interfering with blood supply Adhesions and intestinal obstruction Adhesions and intestinal obstruction Malignancy especially in post- menopausal women Malignancy especially in post- menopausal women

6. Ovarian Cyst: Diagnosis Pelvic and vaginal ultrasound scan Pelvic and vaginal ultrasound scan Laparoscopy (may include treatment) Laparoscopy (may include treatment)

7. Ovarian Cyst: Management If large: surgical removal attempting to conserve the ovary If large: surgical removal attempting to conserve the ovary If small: oral contraceptives (oestrogen and progesterone) to suppress ovarian activity: plans for pregnancy deferred If small: oral contraceptives (oestrogen and progesterone) to suppress ovarian activity: plans for pregnancy deferred Follow-up to assess growth and avoid complications Follow-up to assess growth and avoid complications If post-menopausal, surgery (probably oophrectomy) to avoid malignancy If post-menopausal, surgery (probably oophrectomy) to avoid malignancy

8. Polycystic Ovary Syndrome Polycystic Ovary Syndrome

9. Polycystic Ovary Syndrome: Description An endocrine problem of the hypothalamus, pituitary and ovaries where multiple cysts form in the ovaries An endocrine problem of the hypothalamus, pituitary and ovaries where multiple cysts form in the ovaries Androgen excess Androgen excess Associated with amenorrhoea and infertility Associated with amenorrhoea and infertility Affects 5-10% women of child- bearing age Affects 5-10% women of child- bearing age

10. Polycystic Ovary Syndrome: Pathophysiology Androgen excess Androgen excess No ovulation (or irregular ovulation ) → multiple cyst formation in ovaries No ovulation (or irregular ovulation ) → multiple cyst formation in ovaries Associated with insulin resistance, Diabetes Mellitus or hyper- insulinaemia and cardiac disorders Associated with insulin resistance, Diabetes Mellitus or hyper- insulinaemia and cardiac disorders

11. Polycystic Ovary Syndrome: Clinical Manifestations Irregular menstrual periods or amenorrhoea Irregular menstrual periods or amenorrhoea Weight gain Weight gain Hirsutism Hirsutism Suspected abdominal/ pelvic mass Suspected abdominal/ pelvic mass

12. Polycystic Ovary Syndrome: Management Medication to stimulate ovulation (Clomiphene) Medication to stimulate ovulation (Clomiphene) May require surgery: May require surgery: Hysterectomy and Bilateral Salpingo- oophrectomy Hysterectomy and Bilateral Salpingo- oophrectomy

13. Ovarian Cyst/ Polycystic Ovary Syndrome: Nursing Considerations Psychological and emotional support Psychological and emotional support Health education related to the condition Health education related to the condition