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Endometriosis: Clinical Manifestation and Differential Diagnosis
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
This symptom is not fully qualified in searching the recent literature and mostly is considered a normal phenomenon called ‘Mittelschmerz'. The pain is midcycle, acute, moderate, unilateral, and self-resolving. New symptoms or an increasing pattern of midcycle pain are noted in endometriosis. It is a trigger to exclude other pathologies, like pelvic inflammatory disease and pelvic scarring for any reason. A therapeutic trial with oral contraceptives is justified (33).
Hemorrhagic and Ruptured Ovarian Cysts and Acute Complications of Uterine Fibroids
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Youssef Youssef, Mostafa A. Borahay
The exact etiology of cyst rupture is not clear; however, the increased vascularity in the luteal phase may predispose the corpus luteal cyst to rupture [4]. The ovary has an outer cortex rich in primordial follicles and an inner vascular medulla. Under the influence of hormonal changes during the ovarian cycle, the avascular granulosa cells and stromal cells are vascularized. At the time of ovulation, the LH surge leads to Graafian follicle rupture, resulting in mid-cycle pain commonly referred as mittelschmerz pain, thought to be due to release of fluid in the peritoneal cavity. The corpus luteum is formed from the ruptured leading follicle. The stromal cells are luteinized, and the granulosa cell layer becomes vascularized. The vessels within the corpus luteum wall are thin and tend to bleed, forming a hemorrhagic cyst. The ovary is surrounded by a thin connective tissue layer called the tunica albuginea. The ovarian tunica is thin and malleable, which then allows distention of the ovary by growing follicles. As the tunica distends, stretched blood vessels subsequently tear, resulting in an insignificant amount of bleeding. However, bleeding from larger vessels would result in much more substantial pain and would also result in hemoperitoneum [2, 5].
A Functional Approach to Gynecologic Pain
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Most of the time, routine ovulation of this follicle will be of no clinical significance. Some women have pain with ovulation, and this is known as mittelschmerz. It is usually sharp, one-sided, and self-limited. Once the egg is released, the space left behind becomes the corpus luteum. The cells within the corpus luteum secrete hormone designed to maintain the pregnancy should the egg be fertilized. The corpus luteum can stretch the capsule of the ovary and cause discomfort. Similarly, the space left behind from the ovulation can fill with blood. This is known as a hemorrhagic cyst. The hemorrhagic cyst can quite literally function as a bruise on the ovary and can grow quite large and symptomatic.
The diagnosis, natural history, and management of von Willebrand disease in women in the age of guidelines
Published in Expert Review of Hematology, 2023
Sanjana Kalvehalli Kashinath, Peter A. Kouides
Other types of gynecological bleeding experienced in women with VWD include hemorrhagic ovarian cysts from 16% to 60% and increased incidence of midcycle pain (Mittelschmerz) up to 49%. Women with bleeding disorders may have a high risk of endometriosis. In a survey of 102 women with VWD, about 30% reported a history of endometriosis compared to 13% in the controls (P-0.005). Possible causes include retrograde menstruation (menstrual blood reaches the peritoneal cavity via the fallopian tube) and ovarian cyst rupture. Women with VWD have a statistically significant higher prevalence of endometrial hyperplasia of 10% compared to 1% in controls, 8% have endometrial polyps compared to 1%, and 32% of females with VWD have fibroids compared to 17% in controls. It is not surprising that due to all these bleeding complications, they are more likely to undergo hysterectomy (26% of VWD patients) compared to controls (9%). Bleeding complications during hysterectomy were also higher in women with bleeding disorders ranging from 30% to 60% [31,32] (Figure 1)