Massive Ovarian Cyst - Is Surgery the Only Option?

Reproductive age group women face many challenges and disorders including ovarian masses. Ovarian cyst diagnosed in the reproductive age group are generally benign.1 Benign ovarian cysts, if diagnosed early when small (< 5 cm diameter), usually resolve spontaneously and do not require surgical intervention whereas very large cysts (> 10 cm in size) usually require surgical removal.2 A case of massive benign ovarian cyst in a reproductive age group woman, treated without a major surgical intervention is being reported.Ovarian tumours like simple benign cysts (thin-walled cysts with no solid structures or calcifications) less than 5 cm diameter usually resolve over 2 menstrual cycles, out of which 10 percent of patients may undergo surgical intervention at some point during their lifetime,2 because of pain or perceived risk of torsion. But, on the other hand giant ovarian cysts undergo surgical removal by laparotomy or by endoscopy. Laparoscopy for removal of giant cysts (> 10 cm) has gained importance. On its flipside, laparoscopic surgery has a few morbidities like formation of post-operative adhesions, which can compromise future fertility, although, less than laparotomy.In the present case, a young unmarried childbearing age woman underwent ultrasound guided needle drainage of benign massive ovarian cyst for over 5 hours and 7.5 liters of fluid was removed with shorter duration of hospital stay and follow up was done in OPD. After 3 months of follow up, the patient has no symptoms, cyst size had not increased, and she was leading a normal life. In young women, it is also desirable to avoid unnecessary surgery as much as we can, to avoid complications and risks, keeping future fertility in mind. The management rationale is to do conservative management where possible and prevent or reduce patient morbidity by avoiding surgical methods like laparotomy and laparoscopic operations wherever possible after proper patient selection.

Bicornuate Uterus with Unilateral Fibroid - Surgical Procedure or LNG-IUS - A Conservative Approach in a Patient Who Opted LNG as Contraception

Bicornuate uterus with leiomyoma is rare. A 30 - year - old patient with bicornuate uterus with fibroid presented with abnormal - uterine - bleeding and was treated non - surgically with LNG - IUS. Uterine fibroids and AUB affect the quality of life and remain a leading indication for hysterectomy. In young women, uterine preservation approaches should be preferred as far as possible.Abnormalities in fusion or formation of Mullerian duct results in uterine structural and functional abnormalities.1 One of the Mullerian duct anomalies, bicornuate uterus, occurs due to incomplete fusion of utero-vaginal horns at the level of fundus. Bicornuate uterus is the most common Mullerian duct anomaly (25 % of cases )2,3 and association of bicornuate uterus with leiomyoma is very rare and there have been very few cases reported till now.4,5 A case of bicornuate uterus with unilateral fibroid is being reported who presented with abnormal uterine bleeding and pelvic pain and was treated non-surgically with LNG - IUS.

Role of LNG-IUS in adenomyosis in reproductive age group women: a prospective interventional study

Background: The objective of the present study was to observe the efficacy of LNG-IUS in the treatment of heavy menstrual bleeding and dysmenorrhoea associated with adenomyosis.Methods: LNG-IUS was inserted in forty women between 20-50 years of age presenting with heavy menstrual bleeding and dysmenorrhoea associated with adenomyosis diagnosed on transvaginal ultrasonography and followed up after 1 month, 3 months and 6 months of insertion. Subjective assessment of menstrual blood loss was done by pictorial blood loss assessment chart and dysmenorrhoea was assessed on the basis of universal pain assessment tool and side effects were noted at each visit.Results: Mean patients’ age was between 31-40 years (72.5%) and the follow up duration was 6 months. Significant improvements in dysmenorrhea, HMB and haemoglobin levels were observed. There was no significant change in the uterine volume. The most common side effect was prolonged vaginal spotting (n=26, 65%) and pain abdomen (n=13, 32.5%). LNG-IUS expulsion was observed in 1 patient (n=1, 2.5%). 3 patients underwent hysterectomy (n=3, 7.5%). The overall success rate of LNG-IUS was 82.5%.Conclusions: The LNG-IUS appears to be an effective method in alleviating dysmenorrhoea and heavy menstrual bleeding associated with adenomyosis during 6 months of study. It may be a valuable long-term alternative for the treatment of adenomyosis in young and perimenopausal women and it is a good strategy to reduce the number of hysterectomies in women with adenomyosis.

Impact of levonorgestrel intrauterine system on metabolic parameters

Background: Hormonal contraceptive is suggested to affect parameters like body mass index, body weight, blood pressure (BP), blood sugar, lipid protein, and liver function test (LFT) but effect of LNG-IUS on those parameters is still uncertain. The aim of the present study was to study the effects of LNG-IUS on the metabolic parameters.Methods: Sixty women who opted for LNG-IUS for various indications were included in the study. Lipid profile, liver function tests (LFT), glucose levels [fasting and post prandial (PP)], and hemoglobin (Hb) were tested. Bimanual genital examination and transvaginal-ultrasonography was done prior to LNG-IUS insertion. Any problems observed were recorded. The subjects were re-evaluated after 6 and 9 months on their subsequent visits. Data were analyzed using paired “t” test. P value of <0.05 was considered statistically significant.Results: Mean age of the patients was 35.5±6.79 years. Maximum number 50 (83.3%) had abnormal uterine bleeding (ovulatory dysfunction, endometrial, iatrogenic, not yet classified) [AUB (OEIN)]. Mean pictorial blood loss assessment chart (PBAC) score of patients was 164.7±56.72 and mean Hb level 11.15±1.75g/dL. LNG-IUS showed no significant adverse effects on anthropometric parameters at 6- and 9-month follow-up. Significant change was seen in total cholesterol (TC), very low-density lipoprotein (VLDL) and high density lipoproteins (HDL) values at follow-up (p<0.0001).Conclusions: In conclusion, amongst Asian population, the LNG-IUS does not have any adverse effects on metabolic parameters, TGs, LDL and blood sugar levels.