Ovarian Cysts

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What is an Ovarian Cyst?

Ovarian cysts are sacs or pouches filled with fluid and formed on the ovaries located inside a women’s uterus. While small cysts that develop on the ovaries are normal and harmless, others may cause problems and require treatment.

Types of cysts

There are different types of cysts, most are benign and some are rarely found to be malignant or cancerous. The types of cysts are explained below:

Functional Cysts

The most common type of ovarian cyst is known as a "functional cyst" because it forms as a result of ovulation, a normal function. Each month, an egg, encased in a sac called a follicle, grows inside the ovary. The egg is released from the ovary at the middle of the menstrual cycle.

There are two types of functional cysts:

  • Follicle cysts form when the follicle does not open to release the egg.
  • Corpus luteum cysts form when the follicle that held the egg seals off after the egg is released.

Both types of cysts usually cause no symptoms or only mild ones. They go away in 6–8 weeks.

Dermoid Cysts

Dermoid cysts form from a type of cell capable of developing into different kinds of tissue, such as skin, hair, fat, and teeth. Dermoid cysts may be present from birth but grow during a woman’s reproductive years. These cysts may be found on one or both ovaries. Dermoid cysts often are small and may not cause symptoms. If they become large, they may cause pain.

Cystadenomas

Cystadenomas are cysts that develop from cells on the outer surface of the ovary. Sometimes they are filled with a watery fluid or a thick, sticky gel. They usually are benign, but they can grow very large and cause pain.

Endometriomas

Endometriomas are ovarian cysts that form as a result of endometriosis. In this condition, endometrial tissue—tissue that usually lines the uterus—grows in areas outside of the uterus, such as the ovaries. This tissue responds to monthly changes in hormones. Eventually, an endometrioma may form as the endometrial tissue continues to bleed with each menstrual cycle. These cysts are sometimes called “chocolate cysts” because they are filled with dark, reddish- brown blood.

Symptoms

Most ovarian cysts are small and do not cause symptoms. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause torsion (twisting) of the ovary that causes pain. Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.

In rare cases, a cyst may be cancerous. In its early stages, ovarian cancer often has no symptoms, so you should be aware of its warning signs (see below). Be sure to see your doctor if you have any of these signs. Ovarian cancer is very rare in young women, but the risk increases as a woman ages.

Warning Signs of Cancer of the Ovary

  • Bloating
  • Pelvic or abdominal or back pain
  • Enlargement or swelling of the abdomen
  • Inability to eat normally
  • Unexplained weight loss
  • Urinary frequency or incontinence
  • Constipation
  • Feeling tired
  • Indigestion
Diagnosis:

If the ovarian cysts are not causing any symptoms, then your doctor while doing a routine vaginal examination as part of your smear might find an enlarged ovary. This can then be confirmed by a pelvic ultrasound scan. This will show the size, nature and location of the cyst. Also, laparoscopy for other reasons or some symptoms will show the ovarian cyst too. This can then be removed if abnormal and the woman has been consented for the same. Blood tests like CA 125, CEA may be requested by your doctor to check the nature of the cysts.

Treatment

Several treatment options are available. Choosing an option depends on many factors, including the type of cyst, whether you have symptoms, your family history, how large the cyst is, and your age.

Expectant management

If your cyst is not causing any symptoms, your health care provider may simply monitor it for 1–2 months and check to see whether it has changed in size. Most functional cysts go away on their own after one or two menstrual cycles.

Even if you are past menopause and have concerns about cancer, your doctor may recommend regular ultrasound scans to verify changes to the cyst and determine treatment needed.

Birth Control Pills

If you keep having functional cysts, birth control pills may be prescribed to prevent you from ovulating. You are much less likely to form new cysts if you do not ovulate. This treatment will not make cysts you already have go away. But it will prevent new functional cysts from forming.

Surgery

If your cyst is large or causing symptoms, your health care provider may suggest surgery. The extent and type of surgery that is needed depends on several factors:

  • Size and type of cyst
  • Your age
  • Your symptoms
  • Your desire to have children

Sometimes, a cyst can be removed without having to remove the ovary. This surgery is called cystectomy. In other cases, one or both of the ovaries may have to be removed. The surgery can be performed by a laparoscopy or laparotomy (open procedure). This will be decided based on the above factors.