Chapter 31: Ovarian Cysts: Evaluation and Treatment

Hilgers TW

Uterine and Pelvic Conditions Ovarian and Adnexal Conditions

Chapter 31: Ovarian Cysts: Evaluation and Treatment

Hilgers TW

The Medical and Surgical Practice of NaProTECHNOLOGY, 381-386, 2004

RRM Academy Synopsis

Functional ovarian cysts usually resolve with progesterone injection

A 2004 NaProTECHNOLOGY textbook chapter on ovarian cysts reports that progesterone injections usually clear functional ovarian cysts without surgery. Charting and serial ultrasound often enable identification of the cyst type. The chapter calls for careful monitoring of cysts that persist.

Key Findings

A persistent follicular cyst appears on a Creighton Model FertilityCare System chart as a prolonged Peak-type mucus discharge with a delayed Peak Day, reflecting estrogen unopposed by progesterone.
A persistent luteal cyst, or luteinized unruptured follicle, forms when a follicle grows to the time of ovulation without rupturing and generally makes suboptimal progesterone.
Progesterone by intramuscular injection disrupts estrogen dominance in follicular cysts, assists dissolution of luteal cysts and markedly reduces pain; follow-up early in the next cycle confirms resolution.
Among patients with an apparent ovarian cyst treated with intramuscular progesterone, the cyst disappeared in most; the rest included cystadenomas, large peritubal cysts and a mucinous tumor of borderline malignancy.
For recurrent cysts, charting, a post-Peak hormone evaluation and long-term post-Peak progesterone therapy allow the cysts to be controlled, and experience suggests improved ovarian function.

RRM Context

The chapter reflects the restorative principle of finding the hormone pattern behind an ultrasound finding. Treatment then targets that pattern directly, with charting timing the hormone evaluation. The chapter states that oral contraceptives suppress signaling between brain and ovary and may harm a hormone pattern that is already dysfunctional. It cites studies reporting little or no effect of oral contraceptives on the resolution of ovarian cysts. If surgery is needed, NaProTECHNOLOGY surgical techniques aim to preserve fertility by limiting adhesion formation.

Our editorial summary of this paper, not the article's abstract.

Abstract

This chapter describes the evaluation and treatment of functional ovarian cysts, chiefly persistent follicular cysts and persistent luteal cysts (luteinized unruptured follicles). The chapter links each type to a CrMS chart pattern: a prolonged Peak-type mucus discharge with a delayed Peak Day for follicular cysts, and a post-Peak phase prolonged to 16 or more days for luteal cysts. Hilgers describes treatment with intramuscular progesterone and follow-up on day 5 of the next cycle, and reports that in a series of 45 patients the cysts that did not disappear included cystadenomas, large peritubal cysts and a mucinous tumor of borderline malignancy. The chapter questions the use of oral contraceptives for these cysts, stating that they suppress the hypothalamic-pituitary axis and may be detrimental to an already dysfunctional hormone pattern.

Topics

Uterine and Pelvic Conditions › Ovarian and Adnexal Conditions › Ovarian Cysts · Menstrual Cycle › Cycle Disorders › Ovulatory Disturbances · Diagnostics › Cycle Biomarkers › Ovulation Detection

Thomas W Hilgers

Tom Hilgers, T Hilgers

Hilgers et al. 2004, Hilgers 2004

Chapter 31: Ovarian Cysts: Evaluation and Treatment

Functional ovarian cysts usually resolve with progesterone injection

Key Findings

RRM Context

Abstract

Topics

By this author

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