Breast Cyst – Symptoms, Causes, Diagnosis, and Treatment

A breast cyst can be found in women across ages – but more common in premenopausal women between the age of 35 and 40. In fact, women aged over 50 years rarely develop breast cysts. Moreover, breast cysts can also develop in postmenopausal women who are taking hormone therapy.

In this article, we take a closer look at the symptoms, causes, diagnosis, and treatment of breast cysts.

What is a breast cyst?

A breast cyst is a fluid-filled, non-cancerous or benign sac inside the breast. You can have more than one breast cyst on either of your breasts. Usually described as round and lumpy with distinct edges, they feel smooth and rubber-like under the skin. Breast cysts are either painful or painless.

Moreover, breast cysts also vary in size; ranging from 2.5-5 centimeters to very small that are only visible via ultrasound scan. But if the cyst is large, it can put pressure on other tissues. This can be painful and uncomfortable. In such a case, large breast cysts are relived of fluid to ease the painful symptoms.

Now usually, breast cysts do not require any treatment. However, specific treatments are used if the cyst is large and uncomfortable.

Symptoms

You can have different sized breast cysts on one or both the breasts. Look for symptoms such as:

· Increase in breast tenderness and lump size before your period

· Decrease in lump size and symptom resolution after your period

· Pain or tenderness in the breast lump

· Nipple discharge (clear, yellow, dark brown, or straw-colored)

· A smooth, easy-to-move round or oval lump

Notice these symptoms? You may have breast cysts. However, this does not increase the risk of breast cancer. If anything, having breast cysts makes it difficult to find new lumps or breast changes that may need medical attention.

Be aware of how your breasts feel normally to detect the changes that may occur. Breast tissues normally feel nodular or lumpy. Visit your doctor if new breast lumps develop after your period or an existing lump changes.

Causes

The female breast contains lobes (organ extensions) of milk tissues. The lobes are divided into smaller lobules. These lobules are responsible for milk production during pregnancy and breastfeeding. However, the composition of the breast tissues can vary based on the function. For instance, breasts become fuller when the woman is breastfeeding.

Besides, the supporting tissues of the breasts contain fibrous connective tissues, blood vessels, fatty tissue, nerves, and lymph nodes. If your body experiences a hormonal change, each breast part will respond differently. This often changes the composition of your breasts.

Breast cysts usually develop when fluid accumulates inside the breast glands. However, the exact causes of breast cysts remain unclear. They commonly develop in response to normal female hormones. Excessive estrogen in the body can also affect breast tissue and cause breast cysts.

Diagnosis

Breast cysts are usually noticeable lumps. Your doctor can confirm if the lump is a cyst or not. Then based on your symptoms and health history, you can have a breast examination. Your doctor will physically check the breast lump and look out for other abnormalities.

Your doctor may suggest a diagnostic mammogram or a breast ultrasound scan if the breast examination is insufficient. The ultrasound scan will help your doctors to properly examine the lump and determine if the breast lump is fluid-filled or solid. A fluid-filled lump is usually a breast cyst. In such a case, your doctor will directly perform a diagnostic fine-needle aspiration.

Treatment

No treatment is required for fluid-filled breast cysts diagnosed by the breast ultrasounds. However, if the breast lump persists or becomes uncomfortable with time, it may need either of the treatments:

· Hormone use

· Surgery

· Fine-needle aspiration

Taking birth control pills can reduce the recurrence of breast cysts as they can regulate your menstrual cycles. However, birth control pills and other hormonal therapies often cause side-effects. They are usually recommended for women with severe symptoms.

As for fine-needle aspiration, your doctor will insert a thin needle into your breast lump to withdraw the liquid. When the fluid drains out completely, the breast lump is removed. And your doctor can diagnose the breast cyst immediately. However, you may have to undergo follow-up tests if the liquid appears bloody.

A cyst removal surgery is used for highly uncomfortable breast cysts. You may need surgery if the breast cyst contains blood-tinged liquid, recurs month after month, or shows other complications. But a surgery to remove the breast cysts is only required for unusual circumstances.

Nonetheless, breast cysts are nothing to worry about. Most of them usually disappear on their own. However, breast cysts can return or new cysts can develop over time. On such occasions, you should see your doctor for breast examination and treatments.

Understanding And Managing Pcod

Understanding And Managing Pcod

Polycystic Ovarian Disease (PCOD) or commonly known as Polycystic Ovary Syndrome (PCOS) is a condition that affects the level of hormones in a woman of reproductive age. Generally, all human bodies need a certain balance of both ‘male’ and ‘female’ hormones, but in women who have a PCOD/PCOS this balance is disturbed and there is more production of male hormones. In PCOD, many small sacs full of fluid tend to grow inside the ovaries. These sacs are follicles that contain an immature egg that never mature enough for ovulation. Due to lack of ovulation, the hormone levels are altered, causing various problems.

Some of the hormones that play a critical role in PCOD are:

Androgens: Most commonly found hormones in men but also can be found in women. However, in women with PCOD, the level of hormones is higher than normal.

Insulin: This hormone is responsible for managing the level of blood sugar in the body. In women with PCOD, the way the hormone may not function effectively to counteract diabetes.

Progesterone: This hormone is responsible for the periods and with PCOD, there is a shortage of this particular hormone in the body leading to irregularity in periods or no periods at all.

This tends to create a problem with the ovaries – there can be an irregularity in periods or no periods, the formation of a cyst and in extreme cases infertility. Even if a woman suffering from PCOD gets pregnant, she is likely to have higher chances of miscarriage, preeclampsia, high blood pressure due to pregnancy and premature delivery. There can also be several other problems such as excessive hair growth on face and body, baldness, acne and obesity.

Moreover, associated health risks include:

  • Type 2 diabetes
  • Infertility
  • High cholesterol
  • Increased lipids
  • Sleep apnea
  • Liver problem
  • Irregular urine bleeding
  • High blood pressure
  • Obesity
  • Depression
  • Fatty liver (non-alcoholic)
  • Anxiety
  • Heart disease

While the exact cause of PCOD is not known; however, it has been strongly linked to factors such as:

Genes: If someone in the family such as mother or sister is suffering from PCOD – there is a higher chance of the individual being affected by the condition.

Excess production of insulin in the body: Insulin is a hormone produced by the pancreas that helps the body use sugar from the food for energy. When cells of the body are not able to use insulin appropriately, they demand more insulin, causing the pancreas to produce more insulin to compensate. This, in turn, leads to ovaries increasing the production of male hormones in the body – causing PCOD.

Low-grade inflammation: Low-grade inflammation has been linked to excess production of androgen – a hormone whose excess production triggers PCOD. Low-grade inflammation can be due to obesity.

That said, PCOD is a common problem and treatable if detected timely. Early diagnosis, effective treatment aided with sustainable weight loss can help reduce long-term complications of PCOD.

Symptoms of PCOD

The time when a woman starts experiencing PCOD symptoms varies significantly on the intensity of the condition. While some women experience symptoms during the first period, some others might not witness any symptoms until they have gained excessive weight or have trouble getting pregnant. It may take years for some women to diagnose their condition and get appropriate treatment.

Some of the common symptoms that can help with the diagnosis of PCOD are:

Problem with Periods: The most common and significant symptoms of PCOD is irregularity or absence of periods. PCOD causes lack of ovulation which prevents the lining of the uterus from shedding monthly, causing issues with periods such as irregular periods or absence of periods. A woman with PCOD gets less than eight periods yearly on an average.

Heavy Menstrual Bleeding: Apart from problems with periods, women suffering from PCOD are also likely to experience heavy menstrual bleeding during periods. This happens because the uterine line builds up for a time longer than usual, causing excessive bleeding.

Excessive Hair Growth in Unwanted Areas: Another troubling symptom of PCOD that is easy to identify is excessive growth of hair in areas such as the face, breast, stomach, thumb, toes, back, etc. This condition is mainly referred to as ‘hirsutism’. 

Hair Loss: Simultaneous to the excessive growth of hair in unwanted areas, women with PCOD, tend to experience extreme hair loss or thinning from the head. This symptom tends to intensify with age.

Weight Problems: Women with PCOD suffer from overweight issue; they either tend to overweight or have a hard time losing weight. More than half of the women with PCOD are overweight or obese.

Acne or Oily Skin: Though these are general problems, but this can indicate PCOD in some women. Hormonal changes triggered by PCOD tend to cause breakouts in the form of acne on the face, chest and back. Moreover, due to the excessive production of male hormones caused by PCOD – the skin becomes more oiler than usual.

Darkening of the Skin: In women suffering from PCOD, dark patches of skin can develop in the creases on the neck, in the groin, under the breasts, etc.

Headaches: Change in hormonal levels caused due to PCOD can cause headache in some women.

Infertility: Infertility or problems in getting pregnant can be an indication of PCOD.

Sleep Issues: Most women with PCOD tend to have troubles falling asleep – a disorder known as sleep apnea. Moreover, even after a restful sleep, these women tend to experience fatigue and feel tired all the time.

Two or more of these symptoms indicate that there may be a PCOD problem. Hence, it is better to be alert for symptoms so that effective medical help can be sought timely. Early diagnosis and treatment help to better manage the condition.

Treatment for PCOD

The treatment for PCOD will depend on condition-to-condition. Some women might experience symptoms that they would want to be treated individually and at priority; such as women experiencing issues with getting pregnant will seek PCOD treatment that helps them improve fertility, whereas women who experience acne and other skin issues might seek treatment to improve skin health and reduce acne breakouts. Hence, the treatment of PCOD depends on the goal of the patient. That said, PCOD cannot be permanently cured; it can only be treated to manage symptoms and improve health generally. That said, the primary treatment for PCOD is the adoption of a healthy lifestyle and habits, followed by medication.

Healthy Habits

The most effective ways to treat symptoms of PCOD are to eat well, eat healthy and exercise regularly. Since most women with PCOD are overweight or obese, hence, losing some weight will ease symptoms of PCOD and also regularise periods, manage sugar levels and ovulation. Eating healthy is also another very critical constituent of managing PCOD. Avoiding high fat, trans fat, saturated fat, high-sugar and starchy foods help to control weight and systematise blood sugar levels.

Hormones and Medication

Several medications can be prescribed per case to normalise the hormonal level. For women not looking to get pregnant soon, birth control medication is the primary method to treat PCOD symptoms. More so, a skin patch, vaginal ring, shots or an intrauterine hormonal device can be used to manage the condition. This method helps to regularise periods and also treat acne and excessive hair growth in unwanted areas. The birth control hormonal pills also reduce the risk of endometrial cancer. In cases, where the birth control pills do not help with hair growth, spironolactone may be prescribed after six months to reduce the androgens – the sex hormone. However, this can cause serious issues with pregnancy; hence it is to be taken only if there is no desire for pregnancy in the near future.

In other simple cases, hormone pills of progestin can help with symptoms such as irregular periods, acne and unwanted hair growth. But this will only work in cases, where the PCOC problem is not intense.

Additionally, metformin can help lower the insulin production in the body, which will aid weight loss and also prevent diabetes and increase chances of getting pregnant.

On the other hand, in the case where a healthy diet and exercise have not been able to reduce weight, doctors might suggest different drugs or in severe cases, even weight loss surgery to help manage weight and PCOD symptoms. Moreover, to tackle fertility, certain targeted drugs might be prescribed, and in rare cases, a surgery called ovarian drilling can be undertaken to improve the ovulation and increase chances of getting pregnant.

Overall, even though PCOD cannot be entirely cured, it can be very easily managed provided, it is detected timely and appropriate treatment is received.

Know all about Endometriosis – A cause for concern

Know all about Endometriosis – A cause for concern

Endometriosis (en-doe-me-tree-O-sis) is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.

With endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.

Endometriosis can cause pain — sometimes severe — especially during menstrual periods. Fertility problems also may develop. Fortunately, effective treatments are available.

Symptoms

The primary symptom of endometriosis is pelvic pain, often associated with menstrual periods. Although many experience cramping during their menstrual periods, those with endometriosis typically describe menstrual pain that’s far worse than usual. Pain also may increase over time.

Common signs and symptoms of endometriosis include:

  • Painful periods (dysmenorrhea).Pelvic pain and cramping may begin before and extend several days into a menstrual period. You may also have lower back and abdominal pain.
  • Pain with intercourse.Pain during or after sex is common with endometriosis.
  • Pain with bowel movements or urination.You’re most likely to experience these symptoms during a menstrual period.
  • Excessive bleeding.You may experience occasional heavy menstrual periods or bleeding between periods (intermenstrual bleeding).
  • Sometimes, endometriosis is first diagnosed in those seeking treatment for infertility.
  • Other signs and symptoms.You may experience fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

The severity of your pain isn’t necessarily a reliable indicator of the extent of the condition. You could have mild endometriosis with severe pain, or you could have advanced endometriosis with little or no pain.

Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as pelvic inflammatory disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.

Causes

Although the exact cause of endometriosis is not certain, possible explanations include:

  • Retrograde menstruation.In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
  • Transformation of peritoneal cells.In what’s known as the “induction theory,” experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
  • Embryonic cell transformation.Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
  • Surgical scar implantation.After a surgery, such as a hysterectomy or C-section, endometrial cells may attach to a surgical incision.
  • Endometrial cell transport.The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
  • Immune system disorder.A problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.

Risk factors

Several factors place you at greater risk of developing endometriosis, such as:

  • Never giving birth
  • Starting your period at an early age
  • Going through menopause at an older age
  • Short menstrual cycles — for instance, less than 27 days
  • Heavy menstrual periods that last longer than seven days
  • Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
  • Low body mass index
  • One or more relatives (mother, aunt or sister) with endometriosis
  • Any medical condition that prevents the normal passage of menstrual flow out of the body
  • Reproductive tract abnormalities

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis may temporarily improve with pregnancy and may go away completely with menopause, unless you’re taking estrogen

 

Complications

Infertility Fertilization and implantation

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant.

For pregnancy to occur, an egg must be released from an ovary, travel through the neighboring fallopian tube, become fertilized by a sperm cell and attach itself to the uterine wall to begin development. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as by damaging the sperm or egg.

Even so, many with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise those with endometriosis not to delay having children because the condition may worsen with time.

Cancer

Ovarian cancer does occur at higher than expected rates in those with endometriosis. But the overall lifetime risk of ovarian cancer is low to begin with. Some studies suggest that endometriosis increases that risk, but it’s still relatively low. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in those who have had endometriosis.

 

Polycystic Ovarian Syndrome in Young Women

Polycystic Ovarian Syndrome in Young Women

Anindita[1] (29yrs) and her husband came to me complaining that she is not being able to conceive even after two years of marriage. She was over-weight and my first impression that she could have polycystic ovary was confirmed subsequently. Anindita’s is not a stray case. Nowadays, we encounter more and more women in clinic with Polycystic Ovarian Syndrome (PCOS).

Though ‘Polycystic Ovary’ means many cysts in ovary, these cysts are actually immature eggs and the disease is different from other cyts of ovary. PCOS is a manifestation of a hormonal disease which affects other systems of the body as well.

 The exact cause of PCOS is unknown.

PCOS is common among young girls and women of reproductive age. Roughly, now a days one in three women is diagnosed with PCOS. It is an emerging health problem during adolescence, therefore promotion of healthy lifestyles and early interventions are required to prevent future morbidities.

Early diagnosis of PCOS assumes significance as it may lead to complications such as infertility, gestational diabetes or pregnancy-induced high blood pressure, miscarriage or premature birth. As insulin resistance (where cells in muscles, fat, and liver do not respond well to insulin and cannot easily take up glucose from blood)is very common in PCOS, in later age, it may lead to diabetes mellitus. Chance of uterine cancer is also high.

Symptoms

Signs and symptoms of PCOS often develop around the time of puberty. But menstrual irregularities are normal in the initial years of puberty and this should not be reckoned as a symptom for diagnosing PCOS. If irregularities persist for more than two years, then diagnosing PCOS can be thought of.

 Sometimes PCOS develops later, for example, in response to substantial weight gain. A diagnosis of PCOS is made when one experiences at least two of the following signs:

  • Missed or delayed periods.
  • Excess facial and body hair (hirsutism) consequent to elevated levels of male hormone, androgen, in women with PCOS
  • Ultrasonography shows polycystic ovaries

PCOS signs and symptoms are typically more severe in obese women.

Diagnosis

No single test can determine the presence of PCOS, but a doctor can diagnose the condition through medical history, a physical examination, blood tests to measure hormones and an ultrasonography of uterus and ovaries.

Management of PCOS

Lifestyle modification is the mainstay of treatment in PCOS and the focus is to reduce risk factors such as obesity, central obesity (fat around the waist) and insulin resistance. Modifying additional lifestyle factors, such as alcohol consumption, psychosocial stressors and smoking, are also crucial in long-term treatment of PCOS.

Short-term weight loss has been consistently successful in reducing insulin resistance and restoring ovulation and fertility. Even a 7% weight reduction restores regular period.

Significance of exercise in management of PCOS

Regular exercise seems to be the most effective in improving insulin resistance, even without any noticeable change in weight or body fat measurement. Improving insulin resistance is very important as this is the cause of many of the complications in PCOS. Regular physical activity will help to reduce androgens, regulate cycles and improve fertility.

Research has shown that any type of regular exercise- moderate or vigorous aerobic exercise or resistance (using weights) exercise- is effective in improving PCOS symptoms. As long as you are moving and enjoying it, the type of exercise is not so important. The best thing to do is to include some type of physical activity every day for at least 20 minutes and build this up over time. This can also be broken up into smaller 10-15 min sessions spread out over the day.

Medical treatment

Hormone treatment with progesterone or estrogen-progesterone pills helps to maintain the cycle as well as to correct hormone imbalance. Insulin sensitiser like Metformin, Inositols helps to reduce symptoms.

To conclude, it must be kept in mind that PCOS cannot be cured, but can be well managed with early diagnosis, life-style modification and medication. The earlier the diagnosis, the better are the results.

[1] Name changed

City hospital saves a young mother from the rarest scar pregnancy

City hospital saves a young mother from the rarest scar pregnancy

The recent case of caesarean scar pregnancy with Itoshri Gangopadhyay from Kharagpur, a young mother who was expecting her second child is an eye opener towards this rarest disease which happens in 1 out of 4000 or 5000. The mother was counting days waiting for her second child to be born. However, she failed to understand that like a normal case of pregnancy the foetus was just not growing inside the womb. The growth was taking place around the scar on the lower part of the uterus which is a result of caesarean delivery of the first child.  When this fatal disorder was detected, by that time profuse internal bleeding in the uterus has already begun. Even under a life endangered situation, Kolkata’s CK Birla Hospitals has been able to combat the peril and save her life. An immature foetus was removed from the uterus so as to save Itoshri’s life who became victim to the rarest caesarean scar pregnancy.

Itoshri, a 31 year old mother to a 6 year child had conceived for the second time. The initial term of the pregnancy was fine. The gynaecologist had ignored the frequent primary bleeding symptom. Unexpectedly, the problem blew out of proportion on the 11th week. In middle of April, suddenly unbearable pain started on the lower part of the abdomen followed by excessive bleeding. Rudrapratim Gangopadhyay, her husband who is an employee of a private organization says that doctor immediately on checking warned us against such grave symptoms. Through Trans Vaginal Scan (TVS) post ultrasonography an abnormal pregnancy called caesarean scar pregnancy, also known as ectopic pregnancy was detected.

Dr. S M Rahman, Consultant obstetrics gynaecologist at CKBH – CMRI defines that caesarean scar pregnancy is one kind of ectopic or abnormal pregnancy which generally happens when a woman has a background of 3-4 caesarean cases and thereby a scar is formed around the wall of the uterus. Generally under caesarean cases when a uterus is cut and joined back, a scar is formed on the lower part of the uterus and with an implantation of pregnancy around that scar, it is called caesarean scar pregnancy. By implantation it is referred to the establishment of pregnancy. Any pregnancy occurs primarily in the fallopian tube and then gets established on the upper part of the uterus wherein in case of caesarean scar pregnancy it gets established on the lower part where the scar exists. 

The gravest consequence of this disorder is excessive bleeding which is so catastrophe in nature that it may lead to death. Such blood loss at a relatively lower degree of consequence can also lead to anaemia.  Besides, specialists are also of the opinion that untimely removal of the foetus also inevitably leads to death.

The prompt and diligent measures undertaken by the doctors at CKBH – CMRI have contributed to successfully avoiding any grave consequence for Itoshri from our neighbour town. On examining the reports, the family members were right away advised to bring her to Kolkata. When the family reached Kolkata on 24th April, on that very night itself operation was conducted post certain tests. Dr. Rahman and his expert team of doctors within few hours of endeavour have reduced the bleeding and removed the foetus from the scar in the uterus. The doctors have been further successful to restore Itoshri’s uterus.

Dr. Rahman says, “For the first time in Kolkata, we got a case of ectopic scar pregnancy. Itoshri was suffering from bleeding for 6 consecutive days. Internal bleeding had occurred too, which could not be washed employing the conventional methods. Laparoscopy results also detected that there has been bloodshed inside the stomach. If the stomach is dissected then tremendous bleeding can cause shock to a patient. Under such scenario the patient’s normalcy cannot be revived.”

There are two kinds of prognosis under this disorder. One is that the pregnancy can grow for 7-8 months or for the entire term around the scar and this is very dangerous since it develops a morbid adherent placenta which cannot be separated from the uterus post-delivery. Additionally such patients in the operation theatre during delivery start bleeding so profusely that uterus needs to be removed so as to save the patient. The second prognosis is that the pregnancy does not grow at all, however, there would be continuous bleeding.

Symptoms for precaution

  • Caesarean delivery of first child
  • Frequent bleeding from beginning
  • Pain in lower abdomen followed by excessive bleeding

Advices from gynaecologists to radiologists

  • During ultrasound even the slightest on outer and inner part of womb should not be avoided
  • Trans vaginal scan is recommended if a doubt arises
  • Ectopic pregnancy to be considered during ultrasound
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