Ovarian Cysts

Ovarian Cysts


Most ovarian cysts are normal functional cysts on the ovary. A small proportion of ovarian cysts can get enlarged, bleed, cause pain and / or become cancerous.

To understand, one needs to know how the normal ovary functions during a menstrual cycle. The ovaries are part of the female reproductive system that are regulated by the hormones estrogen and progesterone. Ovulation occurs every month, when the ovary releases an egg under the influence of the hormones. The egg grows inside a tiny fluid-filled sac called a follicle. The follicle breaks open to release the egg as it matures.

The various types of cyst are as follows:


Follicle Cysts:

When the follicle fails to release the egg, it continues to grow to form a follicular cyst. Often, these cysts do not cause any symptoms and resolve spontaneously over the next 2-3 menstrual cycles. Cysts that do not resolve or become enlarged beyond 4-5 cm are at risk of rupture, torsion and may require to be surgically removed.

Ovarian cysts are common in women with regular periods. It is rare to develop ovarian cyst after menopause and large cyst in this age group should always be investigated.

Corpus Luteum Cysts:

When an egg is released, the empty follicle shrinks to form a Corpus Luteum. Corpus Luteum is important as it produces hormones that support a pregnancy, should it occur. Rarely, the Corpus Luteum reforms a cyst with fluid & blood inside it. Most Corpus Luteum cysts also resolve in few weeks. However, they can grow to large sizes and may bleed or twist the ovary and cause pain.

Dermoid Cyst:

A dermoid cyst is an abnormal ovarian cyst that develops from totipotent cells (Cells present from birth). They grow very slowly and contain mature tissue (hair, fat, and other tissues), and hence almost always benign (non-cancerous). Rarely, they can be found on both ovaries. They usually do not cause symptoms, but can reach large proportions. They are also at risk of torsion and rupture. Dermoid ovarian cysts that are larger or cause complications might require removal by either laparoscopy (Key hole) or laparotomy (Open surgery). Most dermoid cysts can be managed safely and successfully by performing a laparoscopy.

Cystadenomas:

These are non-cancerous ovarian growths that can develop on the outer surface of ovaries.

Endometriomas:

Endometriomas are ovarian cysts that are lined by endometriotic implants. These ovarian cysts are filled with old blood that resembles dark brown fluid and hence the name chocolate cyst. This is a severe type of endometriosis, and surgical success depends on the experience of the gynaecological surgeon. Read more about endometriomas in our section on endometriosis.

Polycystic Ovary Syndrome (PCOS):

Multiple small immature cysts on an ovary cause the ovary to swell up. PCOS can cause irregularities with the menstrual cycle and sub fertility. The management of PCOS is mostly medical.

Malignant (cancerous) ovarian cysts are rare.

They are more common in older women and hence need to be evaluated by medical doctors as soon as possible. Women who are past menopause and develop ovarian cysts have a higher risk for ovarian cancer.

Symptoms

Most ovarian cysts are small and don’t cause symptoms. However, the cysts that have enlarged can cause symptoms of pressure, bloating, swelling, or pain in the lower abdomen. This pain may be sharp or dull and may be constant in nature. A cyst rupture or a twisting of the ovarian cyst pedicle can cause severe pain.

Other possible presentations may be:

• Pelvic pain
• Pain during sex
• Pain during your period
• Backache
• Unexplained weight gain or loss
• Needing to urinate more often
• Problems emptying the bladder or bowel completely

If you have above symptoms, speak to you GP. Your GP will be able to establish if you require a specialist referral. Following a pelvic exam, your doctor will recommend an ultrasound. Ultrasound is a non-invasive way to get more information on the nature of the ovarian cyst. Typically the things that will be noted on the ultrasound are the size, shape, content, presence or absence of solid components, increased vascularity and the status of the other ovary.

Additionally, Blood test are recommended to note hormonal levels and to measure the amount of cancer antigen 125 (CA-125). Ca124 levels increase in ovarian cancer.

Treatment

If a cyst persists or if it grows larger, it requires treatment. The available methods of treatment are:

Oral Contraceptive Pills (OCP) – Birth Control Pills
Beneficial if you suffer from recurrent ovarian cysts. OCP inhibit ovulation and thereby prevent the development of new cysts. Oral contraceptives can also reduce your risk of ovarian cancer. This is, however, not useful if the cyst is enlarged.

Laparoscopy
If the primary investigations rule out a malignancy, Laparoscopic Cystectomy (removal of the cyst from the ovary) may be suggested. This is easier and safer in the hands of an gynaecologist who is an expert in laparoscopy.

Laparotomy (open surgery)
If you have a very large cyst, which cannot be safely removed via laparoscopy or if the suspicion of ovarian cancer is very high, a laparotomy is considered. A frozen section (immediate biopsy) is done, and if the cyst is cancerous, a hysterectomy with removal of your ovaries is performed.

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