Definition and Overview
Ovarian cysts are sac-like, often fluid-filled structures that develop in a woman’s ovary. Women’s ovaries are two bean-shaped organs that release egg cells (as part of the menstrual cycle) and release female sex hormones necessary for proper functioning of the female reproductive systems. Cysts that grow in the ovaries often do not cause unwanted symptoms. However, there are times when cysts become a health risk and require medical attention.
Symptoms of Ovarian Cyst
Ovarian cysts often do not cause observable symptoms. Many cysts grow and resolve without being noticed. However, if a cyst grows to a significant size due to causes that will be outlined later, symptoms may start to appear which usually comes in the form of pain in the abdomen or pelvis. This pain is often dull, radiates to the lower back, and heightens before your period. This pain is a result of pressure and distortion with adjacent body organs. Other common symptoms include:
- abdominal bloating or the unexplained feeling of fullness
- urinary urgency or incontinence
- pain, inability to control or difficulty in bowel movement
- pain during sexual intercourse (dyspareunia)
- feeling of nausea and breast tenderness similar to symptoms of pregnancy
Types and Causes of Ovarian Cysts
Ovarian cysts are classified into various kinds, depending on their nature and cause. Two of the most common types of cysts are:
Follicular Cysts - Ovarian eggs grow inside tiny sacs called follicles, which breaks open to release egg cells on a monthly basis. When a follicle doesn't go through the natural breaking process, the unreleased egg forms into a cyst. Follicular cysts usually resolve spontaneously in a few months.
Corpus Luteum Cysts - Once a follicle successfully releases the egg, it shrinks into a mass called corpus luteum, which is responsible for the release of hormones in preparation for the next menstrual cycle. Also related to abnormal cycle, this second type of cyst forms when, instead of shrinking, the corpus luteum reseals itself and builds up fluids inside. Although some corpus luteum cysts resolve in time, some can grow up to four inches in diameter and can cause pain and bleeding.
Other less common types of ovarian cysts include the following:
Dermoid cysts: growth of sac-like materials in the ovaries containing tissues like fat or hair (usually congenital in nature)
Cystadenomas: non-cancerous cysts that grow on the outer surface of the ovaries
Polycystic ovary syndrome: a condition wherein the ovaries house a number of small cysts; when left untreated, these may cause infertility problems
Endometriomas: these are tissues that accumulate inside the uterus then later attach to the ovaries, resulting in a cyst
Most cysts that grow in the ovaries are non-cancerous or benign, although a small number may be malignant or cancerous and have to be surgically removed. These cysts, known as pathological cysts, are often caused by abnormal growth of cells and are not related to the menstrual cycle.
The exact reason for the formation of ovarian cysts has yet to be fully comprehended. Cysts can develop for no apparent reason in women who have normal menstrual periods. They can also affect women who have already undergone menopause (over 50 years old). The formation seems to be hereditary in nature or influenced by hormonal occurrences in the body. Experts have also identified risk factors for the development of cysts and tumours, which include: smoking, obesity, intake of fertility drugs and age.
When to See a Doctor
Many women tend to develop at least one ovarian cyst in their lifetime. In many cases, these cysts are painless and do not cause any significant symptoms. However, if you have been experiencing the aforementioned symptoms, it is best to consult a doctor immediately. More so, it important to seek immediate medical help if you experience sudden severe abdominal or pelvic pain that is accompanied by chills, rapid breathing, weakness, fever or unexplained vomiting.
Meanwhile, since ovarian cysts are often asymptomatic (does not show symptoms) women who have high risk factors and those aged 40 and above are highly encouraged to see a doctor once or twice a year for regular pelvic exam.
Diagnosis and Treatment of Ovarian Cysts
If you or your doctor suspects the presence of ovarian cysts, an ultrasound scan will most likely be suggested. An intra-vaginal ultrasound scan can detect the presence of cysts in the ovaries. This scan may be supplemented by other imaging methods such as CT or MRI scan, as well as blood tests to rule out other conditions. Your GP will also refer you to a gynecologist, a doctor specializing in female reproductive health.
The treatment for ovarian cysts will depend on the doctor’s findings, specifically: the cyst’s appearance and size, the symptoms involved and whether you have already undergone menopause. In most cases, the cyst can disappear in a few months without significant medical intervention. In post-menopausal women, there is a considerable risk for the cyst to be cancerous such that ultrasound scans and blood tests will have to be regularly performed to monitor the cyst over the course of at least a year. Large cysts that cause bleeding and pain need to be removed surgically through laparoscopy or laparotomy (open abdominal incision). When the cyst is suspected to be cancerous, a biopsy, wherein the cyst (or a sample of it) is removed for analysis, may be suggested to determine whether it is malignant.
Contrary to popular belief, ovarian cysts don’t usually affect fertility although their presence can sometimes make it more challenging for a woman to conceive. There is a considerable risk for the surgical removal of ovarian cyst, which is why it is not easily recommended unless absolutely necessary. If an operation is established to be a necessity, the surgeon will take extra precaution to preserve your fertility. However, there are rare cases when the removal of large cysts also requires the removal of one or both of the ovaries.
- The American College of Obstetricians and Gynecologists. “Ovarian cysts.” Available: http://www.acog.org/~/media/For%20Patients/faq075.pdf?dmc=1&ts=20140523T1226073428
- Office on Women's Health, U.S. Department of Health and Human Services. “Ovarian cysts fact sheet.” Available: http://www.womenshealth.gov/publications/our-publications/fact-sheet/ovarian-cysts.html