What is Ovarian Cysts?
An ovary is a reproductive organ of women, present in pairs on each side of the uterus. They are roughly the size and shape of an almond. Development and maturity of eggs (ova) take place in the ovaries, which are released in monthly cycles during a woman's childbearing years. Sometimes cysts, which are fluid-filled sacs or pockets, develop inside or on the surface of the ovary. These cysts are known as ovarian cysts.
Quite a number of women develop ovarian cysts at some point during their lifetime. Usually these ovarian cysts are harmless and cause little or no discomfort. Most of the ovarian cysts do not require treatment and disappear on their own within a few months. However, sometimes ovarian cysts can cause serious problems, especially those cysts which have ruptured. Patient can avert these problems by looking out for signs and symptoms which indicate a more serious problem and also by getting regular pelvic examinations. Treatment of ovarian cyst depends on patient's age, symptoms, the type and size of the cyst. Treatment includes watchful waiting, oral contraceptive pills and surgery.
Causes and Types of Ovarian Cysts
Majority of the ovarian cysts are formed during the normal functioning of the menstrual cycle and are known as functional cysts. Fertility drugs, such as clomiphene (Clomid, Serophene), which are given to induce ovulation, increases the risk of formation of a corpus luteum cyst after the ovulation takes place. However, these cysts do not hinder or pose any danger to the resulting pregnancy. Functional cysts are generally harmless and rarely cause pain. These cysts usually disappear on their own within two or three menstrual cycles. There are other types of cysts which are less common.
Ovaries normally produce cyst-like structures known as follicles every month. These follicles are responsible for production of the hormones estrogen and progesterone and help in releasing the egg during ovulation. In some cases the normal, monthly follicle keeps on growing and results in a cyst known as a functional cyst. There are two types of functional cysts:
- Follicular Cyst: During the middle of the menstrual cycle, the egg bursts out of its follicle and starts to migrate down the fallopian tube, so that it can fertilize with a sperm. A follicular cyst is formed when there is some problem and the follicle doesn't rupture or release its egg leading to its growing and forming a cyst.
- Corpus Luteum Cyst: When the egg gets released from its follicle, the ruptured follicle starts producing large quantities of estrogen and progesterone in order to prepare for conception. This ruptured and transformed follicle is known as corpus luteum. In some cases, the opening from which the egg has released gets closed and results in accumulation of fluid inside the follicle. This causes the corpus luteum to develop into a cyst.
Other Types of Cysts:
- Dermoid Cysts: These cysts may contain tissue such as skin, hair or teeth as they develop from cells which produce human eggs. They are seldom cancerous.
- Cystadenomas: These cysts are formed from ovarian tissue and may be filled with a mucous material or a watery liquid.
- Endometriomas: These cysts are formed as a result of endometriosis, which is a condition where the uterine endometrial cells grow outside the uterus causing some of that tissue to attach to the ovary and form a growth or a cyst.
Dermoid cysts and cystadenomas may increase in size and cause the ovary to displace from its normal position in the pelvis. This increases the chances of having an ovarian torsion (painful twisting of the ovary).
Signs and Symptoms of Ovarian Cysts
Majority of the cysts don't cause any symptoms and vanish on their own. If the ovarian cyst is very large, then it can cause abdominal discomfort or if a large cyst presses on the bladder, patient may feel the urge to urinate more frequently as the capacity of the bladder is reduced.
The Symptoms Of Ovarian Cysts Include:
- Irregularities in the menstrual cycle.
- Pelvic pain which is constant or intermittent and dull in nature. It may radiate to the lower back and thighs.
- Pelvic pain soon before the period starts or just before it ends.
- Dyspareunia, which is pelvic pain during intercourse or painful intercourse.
- Feeling of pressure on the bowels.
- Pain during bowel movements.
- Pregnancy symptoms such as nausea, vomiting or breast tenderness.
- Fullness or heaviness in the abdomen.
- Pressure on the rectum or bladder is felt due to which the patient feels an urge to urinate more frequently or has difficulty emptying the bladder completely.
Serious Symptoms of Ovarian Cysts Include:
- Sudden and intense abdominal or pelvic pain.
- Pain accompanied by vomiting or fever.
- Symptoms of shock, such as cold, clammy skin, lightheadedness or weakness, rapid breathing etc. should be taken seriously and immediate medical attention should be sought.
Treatment for Ovarian Cysts
Treatment depends on patient's age, symptoms, the type and size of the cyst.
- Watchful waiting is done in many cases where the doctor waits before commencing any treatment and re-examines the patient to see if the cyst has disappeared on its own in a few months. This is done when the patient has no symptoms and if the cysts are small in size and fluid-filled. Follow-up pelvic ultrasounds at periodic intervals are recommended to check for any changes in the size of the cyst.
- Birth control pills can be given to decrease the chances of development of new cysts in future menstrual cycles. Oral contraceptives also significantly reduce the risk of ovarian cancer.
- Surgery is recommended to remove the cyst if it is large in size and isn't a functional cyst or if the cyst continues growing or persists through two or three menstrual cycles. Cysts which produce symptoms, such as pain, may also be removed.
- Cystectomy can be done which is a procedure where the cysts are removed without removing the ovary. In some cases, oophorectomy is done where the affected ovary is removed, but the other one is left intact.
- Hysterectomy is recommended by the doctor if the cystic mass is cancerous, where both the ovaries and the uterus are removed. Surgery is also recommended if the cystic mass develops on the ovaries after menopause.
- Complications of ovarian cysts include ovarian torsion and rupture of the cyst.
Prevention of Ovarian Cysts
There is no specific way to prevent the growth of ovarian cysts; however, getting regular pelvic examinations done help in assessing the changes in ovaries and diagnosis of the ovarian cyst in early stages. Another way of ovarian cysts prevention is that the patient should monitor for any changes in their monthly menstrual cycle, such as symptoms accompanying menstruation which are unusual for them and if they persist for more than a few cycles. Patients should not hesitate to consult with their doctor about any worrying changes or symptoms which they may be having as that could very well play an important role in preventing ovarian cyst growth.
Tests to Diagnose Ovarian Cysts
- Pelvic examination.
- Further tests to find out the type of the ovarian cyst and its treatment such as the size of the cyst, its composition (fluid, solid or mixed) etc. To determine the type of cyst, the doctor may perform the following procedures:
- Pregnancy test: A positive pregnancy test may indicate that the cyst is a corpus luteum cyst.
- Pelvic ultrasound: This is a painless procedure which helps the doctor in confirming the presence of a cyst and identifying its location and composition.
- Laparoscopy: This procedure is done using a laparoscope and helps in viewing the ovaries and removing the ovarian cyst.
- CA 125 blood test: It measures blood levels of a protein called cancer antigen 125 (CA 125) which are usually elevated in women having ovarian cancer. Elevated CA 125 levels can also be present in noncancerous conditions, such as uterine fibroids, endometriosis and pelvic inflammatory disease.