Ovarian cysts: Things you need to know

An ovarian cyst develops as the fluid builds up within the ovary inside a thin membrane. The size can vary from as small as a pea to greater than an orange.

A cyst is a closed structure that resembles a sac. This is separated by a membrane from the surrounding tissue. It is an abnormal fluid pocket, similar to that of a burn. It comprises material which is either liquid, gaseous or semi-solid. The outer or capsular portion of a cyst is called the cyst wall.

It’s different from an abscess, because it’s not pus-filled. A pus-filled sac is an abscess.

The majority of ovarian cysts are small and harmless. They occur most commonly during reproductive years but at any age they can appear.

Sometimes there are no signs or symptoms, but occasionally the ovarian cysts may cause pain and bleeding. When the cyst has a diameter of more than 5 centimetres, it may need to be removed surgically.

Important facts about ovarian cysts:

  • An ovarian cyst is a buildup of fluid within an ovary surrounded by a thin shell, or membrane.
  • Ovarian cysts are usually harmless, but a large one may need to be removed.
  • There are two main types of ovarian cysts: functional ovarian cysts and pathological cysts.
  • In most cases, ovarian cysts will cause no signs or symptoms.

Causes

There are two main types of ovarian cysts:

A doctor working with microscope
Cysts can develop anywhere on the body, some may be microscopically small and others very large.
  • Functional ovarian cysts – the most common type. These harmless cysts form part of the female’s normal menstrual cycle and are short-lived.
  • Pathological cysts – these are cysts that grow in the ovaries; they may be harmless or cancerous (malignant).

The causes are different for each type. We will look at each type in turn.

Functional ovarian cysts

There are two types of functional ovarian cysts:

1) Follicular cysts

The most common form of follicular cysts is. A woman does have two ovaries. The egg travels into the womb from an ovary, where it can be fertilized by sperm. The egg is produced in the follicle, containing fluid that protects the growing egg. The follicle bursts, as the egg is released.

For certain cases, after release of the egg, the follicle either does not lose its fluid and contract, or it does not release an egg. The follicle swells with blood, becoming an ovarian follicular cyst.

Usually one cyst emerges at any given time, and it usually goes away within a few weeks.

2) Luteal ovarian cysts

These are less common. This leaves tissue behind, known as the corpus luteum, after the egg is released. Luteal cysts can form when blood is filled in to the corpus luteum. Typically this form of cyst goes away within a few months. Often, however, it may split, or crack, causing sudden pain and internal bleeding.

Pathological cysts

There are two types of pathological cysts:

1) Dermoid cysts (cystic teratomas)

In general, a dermoid cyst is benign. They are created from the cells which produce eggs. Such cysts ought to be surgically removed. Dermoid cysts are the most common form of pathologic cyst for women under the age of 30.

2) Cystadenomas

Cystadenomas are ovarian cysts that grow out of cells covering the outer ovary. Others are filled with a thick, mucous substance while others are filled with a watery liquid.

Cystadenomas are normally connected to the ovary by a stem, instead of developing inside the ovary. They can grow very large by living outside of the ovary. They are rarely cancerous but need surgically removed.

Cystadenomas are more common in women over 40 years old.

Signs and symptoms

Most cysts are non-symptomatic. If signs are present, they are not necessarily helpful to diagnose an ovarian cyst since other disorders have similar symptoms, such as endometriosis.

Symptoms of an ovarian cyst may include:

  • Irregular and possibly painful menstruation: It may be heavier or lighter than before.
  • Pain in the pelvis: This may be a persistent pain or an intermittent dull ache that spreads to the lower back and thighs. It may appear just before menstruation begins or ends.
  • Dyspareunia: This is pelvic pain that occurs during sexual intercourse. Some women might experience pain and discomfort in the abdomen after sex.
  • Bowel issues: These include pain when passing a stool, pressure on the bowels or a frequent need to pass a stool.
  • Abdominal issues: There may be bloating, swelling, or heaviness in the abdomen.
  • Urinary issues: The woman may have problems emptying the bladder fully or she may or feeling the need to urinate frequently.
  • Hormonal abnormalities: Rarely, the body produces abnormal amounts of hormones, resulting in changes in the way the breasts and body hair grow.

Some symptoms may resemble those of pregnancy, for example, breast tenderness and nausea.

Complications

An ovarian cyst often causes no problems, but sometimes it can lead to complications.

  • Torsion: The stem of an ovary can become twisted if the cyst is growing on it. It can block the blood supply to the cyst and cause severe pain in the lower abdomen.
  • Burst cyst: If a cyst bursts, the patient will experience severe pain in the lower abdomen. If the cyst is infected, pain will be worse. There may also be bleeding. Symptoms may resemble those of appendicitis or diverticulitis.
  • Cancer: In rare cases, a cyst may be an early form of ovarian cancer.

Treatment

Treatment will depend on:

  • the person’s age
  • whether they have undergone menopause or not
  • the size and appearance of the cyst
  • whether there are any symptoms

Watchful waiting (observation)

Watchful waiting is often recommended , especially if the cyst is a tiny, functional cyst (2 to 5 centimeters) and the woman has not yet had a menopause

An ultrasonography scan will check the cyst a month or so later to see if it has gone

Birth control pills

The doctor can prescribe birth control pills to reduce the risk of new cysts forming in future menstrual cycles. Oral contraceptives may also reduce the risk that ovarian cancer can develop.

Surgery

A female doctor with her patient
Surgery may be used as a treatment for persistent cysts.

Surgery may be recommended if:

  • there are symptoms
  • the cyst is large or appears to be growing
  • the cyst does not look like a functional cyst
  • the cyst persists through 2 to 3 menstrual cycles.

Two types of surgery are:

  • Laparoscopy, or keyhole surgery: The surgeon uses very small tools, to remove the cyst through a small incision. In most cases, the patient can go home the same day. This type of surgery does not usually affect fertility, and recovery times are fast.
  • Laparotomy: This may be recommended if the cyst is cancerous. A longer cut is made across the top of the pubic hairline. The cyst is removed and sent to the lab for testing. The patient usually stays in the hospital for at least 2 days.

Cancer treatment

Unless the cyst is cancerous, a biopsy can be performed for examination.

When the test indicates cancer, more organs and tissue, such as the ovaries and the uterus, can need to be removed.

Diagnosis

Ultrasound is a common method of diagnosis of ovarian cyst.
Ultrasound is a common method of diagnosis of ovarian cyst.

Most ovarian cysts do not exhibit signs or symptoms, so they still remain undiagnosed.

A cyst not causing symptoms may often be detected through an unrelated pelvic or ultrasound scan.

Diagnosis is aimed at determining the cyst ‘s form, size and composition, whether it is filled with solid or liquid.

Tests for Diagnosis can include:

  • an ultrasound scan
  • a blood test
  • a pregnancy test
  • laparoscopy

Prevention

There is no way to prevent development of the ovarian cysts.

Regular pelvic checks, however, may allow early treatment where appropriate. This can also avoid complications from happening.

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