What Are Ovarian Cysts?
Ovarian cysts are small, fluid-filled pockets either on the surface of the ovary or within the ovary itself. Most are tiny—as the ovary is no bigger than an almond itself—and resolve on their own, disappearing harmlessly and with little to no discomfort within a few months of appearing. Many women have harmless cysts at some point, and they are usually no cause for concern. Occasionally however, they may cause serious symptoms, especially if they have ruptured. To protect your health, make sure to get regular pelvic exams and ultrasounds, and understand the symptoms that are merely uncomfortable, and those that can indicate more serious issues.
What Are the Common Symptoms of Ovarian Cysts?
Most cysts disappear on their own, but large ovarian cysts can cause:
- Pelvic Pain, dull or sharp aching in the lower abdomen, typically on the side the cyst is present.
- Unusual fullness or heaviness in the abdomen
- Unusual bloating and discomfort
More severe symptoms can include sudden, severe abdominal or pelvic pain, fever, or vomiting. If you experience these, you should seek medical attention as soon as possible. If you have these symptoms or those of shock—cold clammy skin, rapid breathing, light-headedness, or weakness—see a doctor immediately. A ruptured ovarian cyst can trigger sepsis, a potentially life-threatening immune response to harmful bacteria.
What Causes Ovarian Cysts?
Most forms of ovarian cysts develop as a result of your menstrual cycle. These are known as functional cysts. Functional cysts arise from the follicles of your ovaries, which produce oestrogen and progesterone during ovulation. If a normal monthly follicle continues to grow, it becomes a functional cyst, which can be categorised into two main types:
- Follicular Cysts. Around the middle of your menstrual cycle, a cell bursts out of its follicle and travels down the fallopian tube. Follicular cysts begin when the egg is not released, and the follicle grows without rupturing normally.
- Corpus Luteum Cyst. Once a follicle has released its egg, it begins producing hormones in preparation for conception, and is now called the corpus luteum. Sometimes, fluid accumulates inside the follicle, causing it to become a cyst.
These cysts are usually harmless, rarely painful, and often disappear on their own within a few menstrual cycles. Other cysts are much less common, but often more serious:
- Dermoid Cysts. These are also called teratomas, and can contain abnormal tissue such as hair, skin or even teeth, because they form from embryonic cells. They are rarely cancerous.
- Cystadenomas. These develop on the surface of the ovary, and might be filled with a watery material, or mucous.
- Endometriomas. These develop as a result of endometriosis, a condition where uterine cells can grow on tissues outside the uterus by mistake. Some of these cell clumps can attach to your ovary and form a growth.
These can become large, or displace the ovary itself, increasing the chance of painful twisting (or torsion). This may also decrease or outright stop sufficient blood flow to the ovary.
While most women can simply develop cysts through the menstrual cycle, your risk of developing a harmful cyst is somewhat heightened by hormonal problems, pregnancy, severe infections, or uterine abnormalities like endometriosis. Some cystic masses that develop after menopause might be cancerous, and these less common types can be found during a routine pelvic exam— it is important to get regularly checked.
How Can Ovarian Cysts be Diagnosed and Treated?
Although there is no way to outright prevent ovarian cysts, regular pelvic exams can help ensure that changes in your ovaries are diagnosed early, before they cause significant problems. Depending on the size of the cyst, and its composition, your doctor will likely recommend tests to determine its type, and what kind of treatment will be most effective. Possible tests might include:
- Pregnancy Tests. A positive pregnancy test can suggest the presence of a corpus luteum cyst.
- Pelvic Ultrasound. Transvaginal ultrasound scans can be used to capture images of your uterus and ovaries on a video screen. Your doctor will then be able to analyse the image to confirm the presence of cysts, as well as their location and composition.
- Laparoscopy. Using a narrow telescopic instrument inserted through a small incision in the abdomen, your doctor can see your ovaries and remove cysts through small cutting tools. This is a surgical procedure that requires anaesthesia.
- CA 125 Blood Test. Blood levels of a protein called cancer antigen 125 (CA 125) are often elevated in women with ovarian cancer. If your cyst us partially solid and you’re at a high risk of ovarian cancer, your doctor might order this test. Elevated levels of CA 125 can also occur in non-cancerous conditions, such as endometriosis, uterine fibroids and pelvic inflammatory disease (PID).
Once the presence of cysts is confirmed through methods like those above, you can discuss treatment with your doctor. Depending on your age and symptoms, as well as the type of cyst and its size, your doctor might suggest certain options:
- Watch and Wait. In many cases, you can wait to see if the cyst goes away within a few months. This is typically an option if you show no symptoms, and preliminary ultrasound suggests you have a simple, small, fluid-filled cyst. It is recommended that you get follow-up ultrasounds at regular intervals to see if your cyst has changed in size.
- Medication. Your doctor might recommend hormone treatment in the form of contraceptives to keep ovarian cysts from recurring. It is important to note that birth control pills won’t shrink an existing cyst, but by regulating hormone levels, they can help prevent them coming back.
- Surgery. Your doctor might suggest this if a cyst is unusually large, painful, continues to persist longer than a functional cyst, or continues to grow. Some cysts can be removed without removing the ovary, but in some cases, you doctor might suggest removing the affected ovary and leaving the other intact. If a cystic mass becomes cancerous, your doctor will likely refer you to a gynaecologic cancer specialist, who might recommend a total hysterectomy, or chemotherapy. Your doctor will also likely recommend surgery if a cyst develops after menopause, as there is an increased risk of cancerous growth.
If you are experiencing the symptoms of Ovarian Cysts, make an appointment with Dr.Nicole Stamatopoulos here.