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Ovarian Cysts

Ovarian cysts are fluid-filled sacs that develop in the ovaries. They can affect women at any age, predominantly during the reproductive age.

Condition

What are the common names for ovarian cysts?

Ovarian cysts are also called cystic ovarian mass.

What is the percentage of the population affected by ovarian cysts?

It is estimated that 8 to 18% of women suffer from ovarian cysts.

How do ovarian cysts affect you?
Most ovarian cysts are harmless and cause little or no discomfort. However, large cysts can cause pain.

The ovaries are paired organs that are a part of the female reproductive system. Situated on either side of the uterus, their main function is to produce ova and release sex hormones. Each month, one ovum matures, is released and picked up by the fallopian tubes for reproduction. The ovaries develop cyst-like structures every month called follicles. Each follicle has an egg surrounded by fluid, which provides protection as it develops. When the egg matures, the follicle bursts open, releasing the egg and the fluid.

There are two types of ovarian cysts:

  • Functional ovarian cysts are the most common. They do not cause any harm, are non-cancerous and short-lived.
  • Pathological cysts may be benign or cancerous (malignant).
The causes of ovarian cysts depend on the type.

These cysts are associated with the monthly menstrual cycle. They form when:

  • Fluid inside a follicle is not released at the time of egg release (corpus luteum cyst)
  • The follicle swells up but doesn’t release the egg (follicular cyst)

These cysts form as a result of abnormal cell growth of either the cells that form the egg or those that cover the ovary. They are not related to the menstrual cycle. Pathological cysts may include:

  • Dermoid cysts: develop from cells that form the egg and can contain tissues such as skin, hair or teeth. These are usually benign.
  • Cystadenomas: develop from cells that cover the ovary and are usually filled with liquid or mucous
  • Endometriomas: develop when tissue lining the uterus, called endometrium, begins to grow outside the uterus and on the ovaries

Dermoid cysts and cystadenomas can grow big and shift the ovary from its normal position. This increases the chance of painful twisting of your ovary, a condition called ovarian torsion.

Some cysts do not show any signs or symptoms. If symptoms present, the most common is pain, which may be characterised as follows:

Pelvic pain before your period starts or before it ends

Dull pelvic ache that radiates down your lower back and thighs

Pain during intercourse

Pain with bowel movements

Other symptoms may include:

  • Nausea, vomiting or tenderness in your breast like that experienced during pregnancy
  • Abdominal fullness or heaviness
  • Urination problems due to pressure on your bladder

The symptoms that indicate an emergency include:

  • Sudden extreme pelvic or abdominal pain
  • Fever or vomiting that accompanies pain
  • Shock
  • Rapid breathing
  • Weakness or light-headedness
  • Ovarian torsion: painful twisting of the ovary when they grow large and move out of their usual position
  • Rupture of a cyst, causing severe pain and internal bleeding

Cysts are common during pregnancy and can lead to complications such as torsion or rupture. Ovarian cysts present during pregnancy are closely monitored.

Ovarian cysts are mostly benign, but some can become cancerous. The risk increases with age as postmenopausal women are at a higher risk for ovarian cancer.
Ideally, ovarian cysts do not interfere with your fertility, but certain conditions associated with the cysts, such as endometriosis and polycystic ovarian syndrome (PCOS) can influence your chances of getting pregnant.
Ovarian cysts are usually detected during a pelvic exam. Other tests that could help in the diagnosis of cysts include a pregnancy test (for corpus luteum cysts), blood test to detect cancer protein, ultrasound and laparoscopy.

Treatment

What are the consequences of not treating ovarian cysts?
Some ovarian cysts do not require treatment as they resolve with time. However, some may lead to infection and infertility if left untreated.

In most cases, if you don’t have any symptoms, and your cysts are small and fluid-filled, you will be advised to wait. Your cysts will be closely monitored as most will resolve on their own.

The main treatment options for ovarian cysts are:

  • Birth control pills: reduces the risk of new cysts from forming and development of ovarian cancer
  • The surgeries that may be performed include:
    • Ovarian cystectomy: removal of only the cyst, leaving the ovary intact
    • Oophorectomy: removal of cyst along with the affected ovary
    • Total hysterectomy: removal of both ovaries, fallopian tubes as well as the uterus. This is considered if the cyst is cancerous.

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