OVARIAN CYSTS: The Highlights

Ovarian cysts:

Ovarian cysts are fluid-filled sacs in the ovary. They are common during childbearing years of a woman and usually form during ovulation. In most cases, cysts are harmless and go away on their own. In other cases, they may cause problems and need treatment. A woman can develop one cyst or many cysts in one or both ovaries and can vary in size.

Common facts about ovarian cysts:

  • Ovarian cysts are common in women with regular periods. In fact, most women make at least one follicle or corpus luteum cyst every month. You may not be aware that you have a cyst unless there is a problem that causes the cyst to grow or if multiple cysts form. About 8% of premenopausal women develop large cysts that need treatment.
  • Ovarian cysts are less common after menopause. Postmenopausal women with ovarian cysts are at higher risk for ovarian cancer.
  • At any age, see your doctor if you think you have a cyst. See your doctor also if you have symptoms such as bloating, needing to urinate more often, pelvic pressure or pain, or abnormal (unusual) vaginal bleeding. These can be signs of a cyst or other serious problem.
  • In some women, the ovaries make many small cysts. This is called polycystic ovary syndrome (PCOS). PCOS can cause problems with the ovaries and with getting pregnant.
  • Ovarian cysts are common during pregnancy. Typically, these cysts are benign (not cancerous) and harmless. Ovarian cysts that continue to grow during pregnancy can rupture or twist or cause problems during childbirth. Your doctor will monitor any ovarian cyst found during pregnancy.
  • Most ovarian cysts do not affect your chances of getting pregnant. Sometimes, though, the illness causing the cyst can make it harder to get pregnant. Two conditions that cause ovarian cysts and affect fertility are:
      • Endometriosis, which happens when the lining of the uterus (womb) grows outside of the uterus. Cysts caused by endometriosis are called endometriomas.
      • Polycystic ovary syndrome (PCOS), one of the leading causes of infertility (problems getting pregnant). Women with PCOS often have many small cysts on their ovaries.

Types of ovarian cysts:

There are different types of ovarian cysts. Most cysts are benign (not cancerous). Rarely, a few cysts may turn out to be malignant (cancerous). Malignant (cancerous) cysts are rare. They are more common in older women. Cancerous cysts are ovarian cancer. For this reason, ovarian cysts should be checked by your doctor.

The most common types of ovarian cysts (called functional cysts) form during the menstrual cycle. They are usually benign (not cancerous).

Two most common types of cysts are:

Follicle cysts. In a normal menstrual cycle, the ovaries release an egg each month. The egg grows inside a tiny sac called a follicle. When the egg matures, the follicle breaks open to release the egg. Follicle cysts form when the follicle doesn’t break open to release the egg. This causes the follicle to continue growing into a cyst. Follicle cysts often have no symptoms and go away in one to three months.

Corpus luteum cysts. Once the follicle breaks open and releases the egg, the empty follicle sac shrinks into a mass of cells called corpus luteum. Corpus luteum makes hormones to prepare for the next egg for the next menstrual cycle. Corpus luteum cysts form if the sac doesn’t shrink. Instead, the sac reseals itself after the egg is released, and then fluid builds up inside. Most corpus luteum cysts go away after a few weeks. But, they can grow to almost four inches wide. They also may bleed or twist the ovary and cause pain.

Other types of benign ovarian cysts are less common:

Endometriomas. These are caused by endometriosis. Endometriosis happens when the lining of the uterus (womb) grows outside of the uterus.

Dermoids. These come from cells present from birth and do not usually cause symptoms.

Cystadenomas. These are filled with watery fluid and can sometimes grow large.

Causes of ovarian cysts:

The most common causes of ovarian cysts include:

Hormonal problems. Functional cysts usually go away on their own without treatment. They may be caused by hormonal problems or by drugs used to help you ovulate.

Endometriosis. Women with endometriosis can develop a type of ovarian cyst called an endometrioma. The endometriosis tissue may attach to the ovary and form a growth. These cysts can be painful during sex and during your period.

Severe pelvic infections. Infections can spread to the ovaries and fallopian tubes and cause cysts to form.

Signs and Symptoms of ovarian cysts:

  • Most ovarian cysts are small and don’t cause symptoms.
  • If a cyst does cause symptoms, you may have pressure, bloating, swelling, or pain in the lower abdomen on the side of the cyst. This pain may be sharp or dull and may come and go.
  • Sometimes, large, ruptured cysts can cause heavy bleeding. You need to consult your doctor immediately if you have this symptom.
  • If a cyst causes twisting of an ovary, you may have pain along with nausea and vomiting.
  • If a cyst ruptures, it can cause sudden, severe pain. If your doctor told you that you have an ovarian cyst and you have any of the following symptoms, get medical help right away as these symptoms could mean that your cyst has broken open, or ruptured. :
    • Pain with fever and vomiting
    • Sudden, severe abdominal pain
    • Faintness, dizziness, or weakness
    • Rapid breathing

Less common symptoms include:

  • Pelvic pain
  • Dull ache in the lower back and thighs
  • Problems emptying the bladder or bowel completely
  • Pain during sex
  • Unexplained weight gain
  • Pain during your period
  • Unusual (not normal) vaginal bleeding
  • Breast tenderness
  • Needing to urinate more often

How are ovarian cysts found!

Patient’s Symptoms.If you have symptoms of ovarian cysts, talk to your doctor.

Pelvic Examination. An ovarian cyst may be found during a routine pelvic examination. If your health care provider finds an enlarged ovary, tests may be recommended to provide more information:

Tests include:

  • Ultrasound. It will help your doctor to see the cyst’s Shape, Size, Location, Composition of Mass (whether it is fluid-filled, solid, or mixed)
  • Pregnancy test to rule out pregnancy
  • Hormone level tests to see if there are hormone-related problems
  • Blood test. If you are past menopause, your doctor may give you a test to measure the amount of cancer-antigen 125 (CA-125) in your blood. The amount of CA-125 is higher with ovarian cancer. In premenopausal women, many other illnesses or diseases besides cancer can cause higher levels of CA-125.

Laparoscopy—In this type of surgery, a laparoscope—a thin tube with a camera—is inserted into the abdomen to view the pelvic organs. Laparoscopy also can be used to treat cysts.

Treatment for ovarian cysts:

Medication

Birth control pills may be prescribed to treat some types of ovarian cysts. This treatment will not make cysts you already have go away. This may lower your chances of getting more cysts.Your doctor may also recommend medicine for pain relief.

Surgery

  • If your cyst is large or causing symptoms, your health care provider may suggest surgery. The extent and type of surgery that is needed depends on several factors including size and type of cyst, your age, your symptoms and your desire to have children.
  • Cyst may require surgery if you are past menopause OR if your cyst:
    • Does not go away after several menstrual cycles
    • Gets larger
    • Looks unusual on the ultrasound
    • Causes pain

Types of surgeries to remove ovarian cysts:

If your cyst requires surgery, your doctor will either remove just the cyst (cystectomy) or the entire ovary (oophorectomy).

Surgery can be done in two different ways:

Laparoscopy. With this surgery, the doctor makes a very small cut above or below your belly button to look inside your pelvic area and remove the cyst. This is often recommended for smaller cysts that look benign (not cancerous) on the ultrasound.

Laparotomy. Your doctor may choose this method if the cyst is large and may be cancerous. This surgery uses a larger cut in the abdomen to remove the cyst. The cyst is then tested for cancer. If it is likely to be cancerous, it is best to see a gynecologic oncologist, who may need to remove the ovary and other tissues, like the uterus.