Oöphoritis (infection of the ovaries) rarely occurs alone, except in viral infections such as mumps. Usually it is associated with infection of the FALLOPIAN TUBES (SALPINGITIS). It may occur as a complication of a miscarriage, a therapeutic abortion, or the birth of a baby. Cases not associated with pregnancy typically result from sexual activity: the most common organisms involved are Chlamydia, E. coli, and Neisseria gonorrhoea. Cervical swabs should be sent for culture and analgesics given, together with the appropriate antibiotics.
Failure of OVULATION is the cause of INFERTILITY in around a third of couples seeking help with conception. It may also lead to menstrual problems (see MENSTRUATION), such as an irregular menstrual cycle or MENORRHAGIA. An uncommon cause of failure of ovulation is POLYCYSTIC OVARY SYNDROME, often associated with acne, hirsutism, and obesity. Treatment depends on the symptoms. Early ovarian failure is the cause of premature MENOPAUSE. Treatment consists of hormone replacement therapy using a combination of oestrogen and progestogen.
Ovarian cysts (for example, follicular cysts) result from ovulation. They may be symptomless but sometimes cause abdominal pain, pain during intercourse or disturbances in menstruation. Twisting or rupture can cause severe pain, pyrexia (fever) and nausea, and explorative surgery – endoscopic laparotomy – may be needed to establish a diagnosis (symptoms of ECTOPIC PREGNANCY are similar). The ovary may have to be removed. Simple cysts often disappear of their own accord but a large cyst can cause pressure on surrounding structures and therefore should be surgically removed.
In young women the most common benign tumour is a dermoid cyst, while in older women, ﬁbroma (see under UTERUS, DISEASES OF) is more common. All benign tumours should be removed surgically in order to be sure they are not malignant.
Malignant tumours may be primary (arising in the ovary) or secondary (metastases from a cancer developing in another organ). Treatment depends upon the site and type of the primary tumour.
Around 5,000 women a year are diagnosed as having ovarian cancer in England and Wales. Unfortunately it is not readily detected in its early stages; around 85 per cent of women do not see a doctor until after the tumour has spread. Early tumours present with symptoms similar to benign tumours, while late ones present with abdominal distension, pain and vague gastrointestinal symptoms. The disease is most common in menopausal women. Earlier diagnosis and treatment can be achieved by ULTRASOUND screening. Treatment is surgical, aimed at totally removing the tumour mass. Nowadays RADIOTHERAPY is only used for palliation. CHEMOTHERAPY is often given to patients with ovarian metastases, or who have residual disease after surgery. The most active cytotoxic agent is the taxane, PACLITAXEL – especially when it is combined with cisplatin.