The reproductive age woman category, now that's the ones -if she's trying to get pregnant, then obviously she's not on any kind of birth control and most likely they're functional. What do you do? Well you can watch them month to month, and if they resolve, which most of them will, the problem is gone. If such a cyst grows or causes more problems, then she should also have a laparotomy. Now, if that woman - well, the other way is of course, many of these women you’d say listen, what we need to do is put you on a short course of birth control pills to see if the cysts stop forming.

Birth control pills, the way they work, is they, they work on the complex mechanism that regulates ovulation, interrupting all those pathways that I briefly described earlier and that complex pathway interrupted, no more ovulation occurs, no more functional cysts occur. And the cyst that was there will most likely resolve because of less feedback from the other hormones so birth control pills in a way you could say could cure cysts. But these are the cysts-

That may not always be an option for some women that have problems with birth control pills or other side effects.

For those women, those group of women who cannot take birth control pills. If for whatever reason, and there's a litany we won't get into here of women who cannot take the pill for one reason or the other, then it would be expected management, that's basically just watching and seeing, cause most of these will go away within three menstrual cycles. If they do not, then, then most likely she's going to have a laparotomy. Obstetrician Gynecologist, Christopher Freville, recommends you could also do a laparoscopy. A laparoscopy again is a very common term, this is where a telescope like tube with a light on it is put in, the doctor is able to look through an incision in the naval, while of course I might add the patient is asleep and fully anesthetized, is able to look at the pelvic organs. But if the doctor sees a six-centimeter cyst, he is going to operate anyway, so most of the time that would be a procedure that would not have a purpose. She needs a laparotomy to make sure that this particular ovary cyst isn't one of the other cysts, of course the endometriomas, the sustatnomas, the dermoid cysts, the polycystic ovaries, which usually aren't going to show up as large cysts.

And of course, the last category is the rarer cystic tumor that would be cancerous. So, the management basically is one of just, in most women is, in the reproductive age group is going to be wait and see. You know, reassurance, come back in a month. You can take, if the cyst goes away, great, if it doesn't or if it slowly resolves fine, if it doesn't go away, you can offer a course of birth control pills. If that's not acceptable or not possible, then the last way is to of course to actually take a look through an incision, a laparotomy.

And that I think that pretty much sums up the actual treatment of cysts, at least as far as a diagnostic program. There are other treatments of cysts, and I will mention these each by the category. So we got a functional cyst that are self-resolving or you're going to use birth control pills. We've got the endometriomas which begin the endometriosis on the ovary. This is a case that needs to be treated with various medications. There are medications to suppress ovulations, stop the period which burns up in the endometriosis and it's generally about 90% effective, and also causes fertility when you get these to go away. So the chocolate cysts once they are, they're usually removed at laparotomy, you can also cauterize them, that's zapping them with electricity. Again, the patient is asleep because the endometriomas and endometriosis are usually multiple places in the pelvis, and then follow up with medications to suppress ovulation.