Adnexal Cyst and Mass: An adnexal mass, or adnexal cyst, is a growth that occurs in or near the organs attached to the uterus in women. This is what is called the adnexa region and includes the fallopian tubes, ovaries, uterus, and the connecting tissues.
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Usually, an adnexal mass or cyst affects the adnexa, but when it is metastatic in nature, it may originate somewhere else, such as in the breast or stomach.
An adnexal cyst can be found in women of all ages. A malignant adnexal cyst may develop in females as young as 15, but more often, the mass is a functional cyst that will likely disappear on its own without treatment.
Women aged 40 and above with an adnexal cyst or mass have a greater chance of developing ovarian cancer.
Symptoms of Adnexal Cyst and Mass Growth
Some women with the condition will not experience adnexal cyst symptoms while being unaware an
adnexal mass growth is even present. It is through a routine pelvic exam that an adnexal mass is typically discovered.
In some cases, adnexal cyst symptoms will occur, but this depends largely on the size of the mass. It is important to consult your doctor if you experience any of the following adnexal cyst symptoms, since they may also be present in other conditions and further investigation is likely required.
- Pain or pressure in the pelvic region
- Abdominal distension
- Constipation and gastrointestinal disorders
- Bleeding at the site of the cyst or mass
- Back pain
- Irregular periods in women experiencing pre-menopause
- Difficulty with urination
- Frequent urination
Causes of Adnexal Cyst and Mass Growth
There are a variety of different adnexal cysts and masses. Some fluid-filled growths arise in the woman’s ovaries; others have both solid and liquid matter (called septated) and are especially dangerous.
There is also what is called a complex adnexal cyst or mass, which will evolve from an ovarian adnexal mass or cyst. A complex adnexal mass or cyst can be further classified into categories of dermoid cysts, endometriomas, and low malignant tumors.
There are thought to be hundreds of adnexal mass causes. Adnexal cyst symptoms are often similar between the potential causes, especially endometriomas, ectopic pregnancy, and ovarian cancer. That being said, an adnexal mass differential diagnosis will be made based on the unique cause.
The following are some of the most common:
Ectopic Pregnancy
Ectopic pregnancy occurs when a fertilized egg doesn’t make it to the uterus. Instead, the egg implants in the fallopian tube, and therefore the pregnancy is unable to grow to term.
When the egg continues to grow in the fallopian tube, it will lead to a rupture, severe abdominal or pelvic pain, and heavy internal bleeding. An untreated ectopic pregnancy can be fatal for women.
Ovarian Cancer and Other Cancers
Ovarian and fallopian tube cancers commonly form a tumor in women that can grow and spread to areas other areas of the body. Common ovarian cancer symptoms include back pain, constipation, heartburn, indigestion, fatigue, irregular periods, difficulty urinating, abdominal or pelvic distension, and painful sex.
Breast and gastrointestinal tract cancers may spread to the adnexal region as well.
Ovarian Cysts
Ovarian cysts will also cause adnexal cysts. These liquid-filled sacs will develop on the ovaries; however, ovarian cysts are often painless and don’t produce symptoms.
When it contains tissue from the endometrium or uterine lining, this type of ovarian cyst is called an endometrioma. This will produce abnormal uterine bleeding and worsening pain from menstruation. This process can lead to endometriosis—a painful disorder of the endometrium.
Benign Ovarian Tumors
An ovarian tumor is solid, whereas a cyst is filled with fluid. However, when the cells inside the tumor are not cancerous, it is a benign tumor. As such, it won’t invade or spread to other parts of the body. It may not even produce symptoms.
Common benign ovarian tumors that may produce an adnexal cyst or mass include dermoid cysts, fibromas, and cystadenomas.
Polycystic Ovary
Small follicles lead to the development of an enlarged polycystic ovary. It is common in women with polycystic ovarian syndrome. Symptoms will include multiple cysts, irregular periods, high testosterone levels, and excessive hair growth.
Tubo-Ovarian Abscess
This is a collection of pus in the ovaries and tubes due to pelvic inflammatory disease (PID). Symptoms will include fever, abdominal pain, and vaginal discharge. PID can be sexually transmitted, and can also lead to infertility. A tubo-ovarian abscess is considered an acute infection; therefore, immediate attention is necessary.
Hydrosalpinx
This is a benign condition in which fluid becomes trapped inside a fallopian tube. Pain and reduced fertility rates may result.
Adnexal Cyst and Mass in Pregnancy
To avoid complications, it is ideal to discover an adnexal mass and treat it before a woman gets pregnant. That being said, adnexal masses are sometimes exposed in pregnancy during a routine pelvic exam or ultrasound.
Since most adnexal cysts or masses are not harmful and resolve without treatment, many doctors choose to simply monitor the mass very closely during pregnancy. Women will only require surgery if a complication occurs, the mass is so large that it will likely cause an issue with the pregnancy, or the doctor suspects the adnexal cyst or mass is malignant and therefore may be cancerous.
A clinical review published in OBG Management in 2007 found that about 10% of adnexal masses discovered during pregnancy are considered malignant. However, since the cancer is in often its early stages, this is good news for the mother.
If the malignant tumor is discovered during pregnancy, the doctor will only interfere with a pregnancy if it is no longer safe for the mother.
How to Treat Adnexal Cyst and Mass
When an adnexal mass or cyst is small and no symptoms are present, treatment may not be required. That being said, your doctor may want to monitor the situation with regular ultrasounds and pelvic exams. In the U.S., a pelvic ultrasonography is considered the most used imaging modality for detecting an adnexal mass.
Surgery is needed when the mass begins to grow, the cyst becomes solid, or the patient develops adnexal cyst symptoms. Adnexal masses that exceed eight centimeters (cm) to 10 cm in size should be managed with a type of abdominal surgery called a laparotomy.
After it is removed, the adnexal cyst or mass will be examined to determine whether the cells within it are cancerous. If cancerous, further treatment may be needed to ensure all the cancer has been removed from the body.
Diagnosis
A physical pelvic exam will help the doctor diagnose an adnexal cyst or mass. The doctor will feel the woman’s ovaries, uterus, vagina, bladder, and rectum, and make note of a lump or anything else unusual. The doctor will also retrieve information about the woman’s medical history, symptoms, and a possible family history of cancer or adnexal cysts.
An ultrasonography is done after the physical exam. This pelvic ultrasound will confirm if a cyst or mass is near or in the adnexa region. After being diagnosed, the doctor will decide if the adnexal cyst or mass is cause for emergency. Often, it is not an emergency, and this is when the doctor will look to discover the cause of the cyst or mass.
A MRI or CT scan may be used to determine the underlying cause of an adnexal cyst or mass. A pregnancy test may also be given to rule out an ectopic pregnancy.
Final Thoughts
An adnexal mass or cyst is often non-cancerous and will resolve without treatment. That being said, when uncomfortable symptoms are experienced, a pelvic exam and ultrasonography may be needed to determine the cause of the adnexal cyst or mass.
Adnexal cyst symptoms are similar to those of many of the potential causes of this condition, including ectopic pregnancy or ovarian cancer. When treated before it spreads outside the ovary, the five-year survival rate of ovarian cancer is considered 92%.
When a liquid-filled cyst becomes solid, surgery may help manage an adnexal cyst or mass. If cancerous, further treatment may be necessary to ensure all cancer has been eliminated from the body.
Homeopathic Treatment of Adnexal Cyst Cysts
Lachesis Muta
Lachesis Muta is best for left sided ovarian cysts. Swelling and pain in the left ovary that gets better during menses, short and scanty menses, and menstrual bleeding that is blackish in color. Climacteric troubles, palpitation, flashes of heat, haemorrhages, vertex headache, fainting spells; worse, pressure of clothes. Menses too short, too feeble; pains all relieved by the flow (Eupion). Left ovary very painful and swollen, indurated. Mammae inflamed, bluish. Coccyx and sacrum pain (ovarian cysts), especially on rising from sitting posture. Acts especially well at beginning and close of menstruation.
Lycopodium Clavatum
Lycopodium Clavatum is best for right side ovarian cysts. Burning or boring pains may be felt in the ovary. Menses too late; last too long, too profuse. Vagina dry. Coition painful. Right ovarian pain, Ovarian cyst. Varicose veins of pudenda. Leucorrhoea, acrid, with burning in vagina. Discharge of blood from genitals during stool. Nymphomania with terrible teasing desire in external organs.-Itching, burning, and gnawing in vulva.
Menstruation too late; lasts too long; sometimes suppression of; profuse, protracted; flow partly black, clotted, partly bright red or partly serum; with labour-like pains followed by swooning. Varices on the genitals.
Colocynthis
Boring pain in ovary. Must draw up double, with great restlessness. Round, small cystic tumors in ovaries or broad ligaments. Wants abdomen supported by pressure. Bearing-down cramps, causing her to bend double. Ovarian Cysts.
The pain varies in character, ranging from cramping, stitching to tensive. Burning sensation in the ovaries that gets better upon bending over double and a sensitive ovarian region that seems hard and swollen are the symptoms that indicate the need for this medicine.
Apis Mellifica
Cysts that cause pain during intercourse. A stinging, sharp, cutting pain from the ovary radiating down the thigh, soreness and tenderness over the ovarian region, heaviness in the ovarian region and pain in the ovaries during menstruation. Edema of labia; relieved by cold water. Soreness and stinging pains; ovaritis; worse in right ovary.
Amenorrhoea or menorrhagia. Inflammation, induration, swelling, and dropsy of the ovaries. Weight and pain in either ovarian region, predominantly right side. Ovarian cysts. The ovaries feel better by lying on right side. Enlargement of the right ovary with pain in the left pectoral region and cough. Sharp, cutting, stinging pain in the swollen ovary; worse during menstruation.
Ovarian tumours, with stinging pains like bee-stings. Metritis, peritonitis, with stinging, thrusting pains. Dropsy of the ovaries; dropsy of the uterus. Threatened miscarriage in the early months. Abortion. Dropsy in the latter part of pregnancy attended with puerperal convulsions. Ulceration and engorgement of os uteri. Large and painful swelling of the labia, with heat and stinging pains.
Erysipelatous inflammation of the breasts. Swelling and hardness of the mammae threatening to ulcerate. Scirrhous or open cancer of the mammae, with stinging, burning pains. Dysmenorrhoea, with severe ovarian pains. Ovarian cysts. Metrorrhagia profuse, with heavy abdomen, faintness, stinging pain. Sense of tightness. Bearing-down, as if menses were to appear. Ovarian tumors, metritis with stinging pains. Great tenderness over abdomen and uterine region.
Pulsatilla Nigricans
Nymphomania. Drawing, pressive, spasmodic and contractive pain extending towards uterus with qualmishness, ovarian cysts. Burning (sticking) pain in vagina and pudenda. Metrorrhagia (discharge now stopping, and then stronger again, of coagulated, clotted blood, or with false labour-pains). Menstrual blood black, with clots of mucus, or pale and serous. Catamenia irregular, tardy, or premature, of too short or too long duration, or entirely suppressed, with colic, hysterical spasms in abdomen, hepatic pains, gastralgia, pain in loins, nausea and vomiting, shivering and paleness of face, megrim, vertigo, moral affections, tenesmus of anus and bladder, stitches in side, and many other sufferings before, during, or after period.
Suppression of menses (especially in elderly women in whom they usually occur at full moon). Delay of first menses.
Leucorrhoea, thick, like cream. False pregnancy. During pregnancy: nausea, morning sickness; varicose veins, bluish (cyanotic).
Sabina Officinalis
Almost insatiable desire for coition with corresponding gratification. Sexual desire greatly increased (almost amounting to nymphomania). Contractive pain in region of uterus. Ovarian cysts. Stitches deep in vagina. Sanguineous congestion in uterus. Haemorrhages of partly pale red, partly clotted, or of very thin, discoloured, offensive-smelling blood.
Metrorrhagia with discharge of clotted or bright-red blood, and pains resembling labour pains in the sacrum and in the groins. Metrorrhagia, bright blood. Menses continue too long. Menstrual discharge partly fluid, partly clotted and offensive; it may be either bright red or dark and coagulated; flows mostly in paroxysms, which are brought on by slightest motion; or flow ceases when walking about (menses only when lying down).
Suppressed catamenia with very offensive-smelling leucorrhoea (like rotten meat). Miscarriage (especially in the third month). Perceptible swelling of mammae. Tingling in mammae. Inflammation of the uterus after parturition. Retained placenta. After-pains with sensitiveness of abdomen.
Sepia Succus
Pelvic organs relaxed. Bearing-down sensation as if everything would escape through vulva, must cross limbs to prevent protrusion, or press against vulva. Leucorrhoea yellow, greenish; with much itching. Menses Too late and scanty, irregular; early and profuse; sharp clutching pains. Violent stitches upward in the vagina, from uterus to umbilicus. Ovarian cysts. Prolapse of uterus and vagina. Morning sickness. Vagina painful, especially on coition.
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