Ovarian Cysts

What are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. Women have two ovaries—each about the size and shape of an almond—on each side of the uterus. Eggs (ova) develop and mature in the ovaries and are released monthly during childbearing.

Impact of Ovarian Cysts on Anatomy and Health

Ovarian cysts can vary significantly in size and impact on health. Many cysts are harmless and may even resolve on their own without treatment. However, some can cause symptoms and complications, including:

Asymptomatic Presence: Many ovarian cysts cause no symptoms and are found during routine pelvic exams.
Pain: Larger cysts can cause pelvic pain—a dull or sharp ache in the lower abdomen on the side of the cyst. Sudden, severe pain can occur if a cyst ruptures or causes the ovary to twist (ovarian torsion).
Menstrual Irregularities: Cysts can affect menstrual cycles, causing heavier or lighter periods, irregular periods, or spotting between periods.
Bloating and Fullness: A larger cyst can cause a feeling of fullness or heaviness in your abdomen.
Complications:
Rupture: When a cyst ruptures, it can cause severe pain and internal bleeding.
Ovarian Torsion: A large cyst can cause an ovary to move, potentially twisting it. This can lead to a decrease or stop in blood flow to the ovary, causing severe pain and requiring emergency surgery.

Risk Factors for Ovarian Cysts

Several factors may increase the risk of developing ovarian cysts, including:

Age: Ovarian cysts are most common in women of reproductive age.
Hormonal imbalances: Ovarian cysts are more likely to occur in women with conditions that affect the levels of hormones, such as polycystic ovary syndrome (PCOS) or endometriosis.
Family history: Women with a family history of ovarian cysts may be at an increased risk of developing them.
Previous ovarian cysts: Women who have previously had ovarian cysts are at a higher risk of developing new ones.
Lifestyle factors: Some lifestyle factors, such as obesity, a sedentary lifestyle, and a diet high in processed foods, may also increase the risk of developing ovarian cysts.

Causes Of Ovarian Cysts

Various factors, including hormonal imbalances, ovulation, and pelvic infections, can cause ovarian cysts.

Symptoms Of Ovarian Cysts

Many ovarian cysts do not cause symptoms and are found during routine pelvic exams or ultrasounds, but you should seek medical review if you experience the following:

Abdominal pain or discomfort can range from mild to severe and can be sharp or dull. The pain may be on one side of the lower abdomen and accompanied by a dull ache in the lower back and thighs.
Abnormal vaginal bleeding, spotting, or discharge.
Pressure, bloating, or fullness in the abdomen.
Difficulty emptying the bladder or bowel.
Nausea or vomiting.
Dizziness or lightheadedness.
Sudden weight gain or swelling of the abdomen.

Other less common symptoms include:

Pelvic or lower back and thigh pain
Trouble emptying the bladder completely
Pain during sexual intercourse
Weight gain
Abnormal vaginal bleeding
Breast tenderness
Urinary urgency

Reduce the Risk of Ovarian Cysts

While it's not always possible to prevent ovarian cysts, certain measures can help reduce the risk:

Regular Pelvic Examinations: Regular check-ups can help detect cysts early.
Manage Hormonal Imbalances: Proper management of hormonal conditions like PCOS can help reduce the risk.
Healthy Lifestyle: Maintaining a healthy weight, balanced diet, and regular exercise can help regulate hormones.
Birth Control Pills: Oral contraceptives can help prevent the formation of new cysts in women who frequently develop them.

Types of Ovarian Cysts

There are several types of ovarian cysts, classified mainly as functional or pathological:

Functional Cysts:
Follicular Cysts: Form when the follicle doesn’t release the egg and continues to grow.
Corpus Luteum Cysts: Develop if the follicle releases the egg but then doesn't dissolve and instead seals off and accumulates fluid.
Pathological Cysts:
Dermoid Cysts (Teratomas): Contain different types of tissues such as hair, skin, or teeth.
Cystadenomas: Develop from ovarian tissue and can contain a watery or mucous fluid.
Endometriomas: Form as a result of endometriosis when endometrial tissue attaches to the ovary.

Diagnosis of Ovarian Cysts

Pelvic Examination: During a routine pelvic exam, a healthcare provider may feel a swelling or mass on an ovary, which can indicate a cyst.
Ultrasound: A transvaginal ultrasound is the most common imaging test used to diagnose ovarian cysts. It uses sound waves to create an image of the ovaries and can help determine the cyst’s size, shape, and composition (whether it is filled with fluid, solid, or mixed).
MRI or CT Scan: In some cases, a magnetic resonance imaging (MRI) or computed tomography (CT) scan may be used for a more detailed view of the cyst and surrounding tissues.
Blood Tests: Blood tests, including the CA-125 test, can help determine if a cyst is likely to be cancerous, particularly in postmenopausal women. Elevated CA-125 levels can be a sign of ovarian cancer but can also be elevated in benign conditions.
Laparoscopy: In certain cases, a laparoscopy might be performed. This is a surgical procedure in which a thin tube with a camera (laparoscope) is inserted into the abdomen to view the ovaries and other pelvic organs directly.

Treatments of Ovarian Cysts

Some cysts will disappear by themselves, and some large cysts will require treatment.

Treatment options include non-surgical and surgical treatment. The non-surgical treatment includes:

Oral contraceptive pills help to decrease the formation of new cysts and prevent the formation of eggs that will become cysts.
Non-steroidal anti-inflammatory drugs such as ibuprofen help to relieve pain.

Surgical Treatment of Ovarian Cysts

Surgery will be recommended to remove the cyst or ovary for cysts 5 to 10 cm in diameter, causing pain and discomfort, or if they are highly suspicious to be cancerous.

Most smaller cysts can be treated using a surgical treatment for ovarian cysts called a laparoscopy (keyhole surgery) to remove the cysts.

Some larger or more complicated ovarian cysts may require an open surgery approach. This involves a larger incision on the abdomen and will require one to two days of an overnight stay in the hospital after the operation.

Laparoscopy for Ovarian Cysts

This is minimally invasive endoscopic surgery where:

Three to five small incisions are made on the abdomen,
a camera is inserted through one of the incisions,
instruments for excision of the cysts are inserted through the other incisions,
Carbon dioxide gas is then introduced into the abdominal cavity to create space for surgical cyst excision.
Laparoscopies are performed under general anaesthesia.

Either surgical approach to treating ovarian cysts aims to remove only the cyst, leaving the ovaries intact. However, sometimes, part or all of the ovary may need to be removed.

What if Ovarian Cysts are Untreated?

If ovarian cysts are left untreated, especially if they are large or symptomatic, they can lead to several complications, including:

Rupture: A cyst can burst, causing severe pain and internal bleeding. This can lead to infection and requires immediate medical attention.
Ovarian Torsion: Large cysts can cause the ovary to twist around the ligaments that hold it in place, cutting off blood supply. This can lead to ovarian damage and requires emergency surgery.
Persistent Pain and Discomfort: Untreated cysts can continue to grow, causing ongoing pelvic pain, bloating, and discomfort.
Impact on Fertility: Certain types of cysts, particularly those associated with conditions like endometriosis or PCOS, can affect fertility if left untreated.
Increased Risk of Cancer: While most ovarian cysts are benign, some types, particularly in postmenopausal women, can be cancerous. Untreated cysts that are potentially malignant can progress to ovarian cancer.
Menstrual Irregularities: Persistent cysts can continue to cause irregular periods and other menstrual issues, affecting overall reproductive health.