Ovarian Cysts

Ovarian cysts are fluid-filled sacs present within or on the surface of an ovary. Ovaries have the size and shape of an almond and are located on each side of the uterus. The ova (egg) after development and maturation in the ovaries are released monthly during the fertility period. 

Many women have ovarian cyst at some point during their life. Most of the cysts are harmless and cause little or no discomfort and disappear within few months without requiring treatment. But some ovarian cysts pose serious problem especially when they rupture. 

So it is important to frequently schedule regular pelvic examination in order to protect your health.

In most cases, ovarian cysts are asymptomatic and disappear on their own. However, a large ovarian cyst can cause abdominal discomfort and the urge to urinate more often because of decreased bladder capacity. The signs and symptoms include:

• Pelvic pain often radiating to lower back and thighs. The pain may start soon before your menstrual cycle begins or just before it ends. Dyspareuria (pelvic pain during intercourse) may also be experienced.
• Nausea, vomiting or breast tenderness
• Difficult and frequent urination due to pressure on the bladder
• Pain during bowel movement

When to see a Doctor?

You need to immediately see your doctor if you experience:

• Sudden, severe abdominal or pelvic pain
• Pain along with fever or vomiting
• Cold or sweaty skin
• Increased respiratory rate
• Dizziness

Causes of ovarian cysts vary depending on its type.

Functional cysts, most common ovarian cysts, develop normally during your menstrual cycle. The ovaries produce follicles (cyst-like structure) every month. These follicles secrete hormones (estrogen and progesterone) and release ova during ovulation. The follicle keeps on growing into a functional cyst. 

These cysts cause no harm, little or no pain and mostly disappear after two or three menstrual cycles. There are two types of functional cysts namely follicular cyst and corpus luteum cyst. The egg is released during the midpoint of your menstrual cycle by rupture of follicles. 

Follicular cyst develops when follicles instead of releasing your egg grows itself and turn into cyst. The ruptured follicle after the release of egg is called the corpus luteum and starts secreting large amount of hormones required for conception. But sometimes the rupture point in the follicle is sealed and it starts accumulating fluid which causes corpus luteum to develop into cyst. 

The drug clomiphene (fertility drug) that induces ovulation increases the chances of developing corpus luteum cyst after ovulation. However, these cysts don't prevent or threaten pregnancy.

Some other types of cysts are not developed as the normal function of menstrual cycle. These cysts include:

• Dermoid Cysts which are developed from cells producing human egg. These cysts contain tissues such as hair, skin or teeth and are seldom cancerous.
• Cystadenomas which are formed from ovarian tissue and may contain water or mucous material.
• Endometriomas result due to endometriosis (a condition where uterine endometrial cells grow outside your uterus). Some tissues may get attached to the ovaries and grow into cyst.

Dermoid cysts and cystadenomas can enlarge thereby causing the ovary to shift out of its normal position in the pelvis which increases the risk of ovarian torsion (painful twisting of your ovary). 

A doctor may diagnose or suspect ovarian cysts during pelvic examination.

You may be examined by your primary care provider or gynecologist (a doctor specialized in women's health).

You may be suggested for further testing to determine the type of cysts and requirement of treatment. For accurate diagnosis and suitable management decision the doctor through the questions assesses:

• Size of the cyst (whether it is small or big)
• Composition of the cyst. The cyst may be filled with fluid, solid or mixed. The fluid filled cysts is less likely to be cancerous whereas cyst filled with solid and fluid may be cancerous hence further evaluation is required.

Following tests are done to determine the type of cyst:

• Pregnancy test: The pregnancy test is positive if the cyst is corpus luteum cyst.
• Pelvic ultrasound: In this test, ultrasound waves are used to create the image of your uterus and ovaries on video screen. Your doctor with the help of the image confirms the presence of cyst, discovers its location and determines its composition.
• Laparoscopy: With the help of laparoscope (instrument that is inserted inside the abdomen through small incision) your doctor removes the ovarian cyst. You are given anesthesia before this procedure is started.
• CA 125 blood test: Women with ovarian cancer, they have elevated level of cancer antigen 125 (CA 125). This blood test is done if you have ovarian cyst filled with solids since you pose a higher risk of developing ovarian cancer. This test helps to determine whether your cyst is cancerous or not. However, elevated CA 125 is seen in certain non cancerous cases such as endometriosis, uterine fibroids and pelvic inflammatory disease.

How to prepare yourself for the visit?

Getting prepared for the visit can optimize the therapy and help make the visit more fruitful.

• List out all the symptoms
• Write down your key medical information. 
• Write down the names of all your medications, vitamins or supplements. 
• Make a list of the questions to ask your doctor.

Some typical question can be:

• What could be the causes of my symptoms?
• Are there any tests that you I need to perform?
• Do I need any treatment?
• What are the treatment options and side effects of each option?
• What your doctor wants to know?

A clear talk with your doctor can optimize the therapy and improve the outcomes. Prepare yourself to answer some essential questions from your doctor. Your doctor might ask you typical questions like: 

• How long have you been experiencing the symptoms?
• How often do you experience the symptoms?
• Does anything improve or worsen your symptoms?
• Do your symptoms seem to be related to menstrual cycle?

Treatment of the ovarian cysts is highly dependent on your age, the type and size of your cyst and your symptoms.

In many cases, the doctor may suggest you to wait to check whether the cyst will disappear on its own. This option is chosen, in most of the cases, if you present no symptoms and ultrasound guidance shows rather small cyst. You may be recommended with follow-up pelvic ultrasound at definite intervals to check if the cyst has changed in its size.

• Oral contraceptives: The doctor may advise birth control pills since it not only lessens the chances of developing new cysts  but also appreciably decreases your chances of developing ovarian cancer. 
• Surgery: It is usually suggested when the cyst you have is larger, doesn’t seem like functional cyst, is continually growing and persists through few menstrual cycles. 

Cysts with symptoms or that causes pain may be surgically removed. The cysts can be removed by process called ovarian cystectomy (without removal of ovary) or oophorectomy (removal of affected ovary while other ovary is intact). 

Hysterectomy (removal of both ovaries) along with removal of fallopian tube and uterus is recommended if the cysts are cancerous. If cystic mass develops on ovaries after menopause your doctor is more likely to advise surgery.

There is no specific ways which help prevent the growth of ovarian cysts. Regular pelvic examinations help to diagnose changes in your ovaries. If you experience any changes in your monthly cycles or symptoms that are unusual for you immediately seek medical attention.

There are several risks and complications associated with ovarian cysts.

Some women despite having less common type of cyst may be asymptomatic but a doctor may find it during pelvic examination. The cystic mass that develops after menopause may be malignant.

Some of the complications (less common) are:

• Ovarian Torsion (painful twisting of your ovaries due to shifting of ovaries from its usual position by enlarged cysts)
• Severe pain and internal bleeding if cyst ruptures