It is no wonder to know that ovarian cysts are very common in women during their reproductive years. Many women will develop at least one ovarian cyst during their lifetime.
Ovaries are the most important organs of the female reproductive system. They are a pair of tiny glands in the female pelvic cavity. Each ovary is about the size and shape of an almond on each side of the uterus. Ovaries are responsible for secreting female sex hormones estrogen, progesterone and release of eggs for possible fertilization.
What are Ovarian Cysts?
Ovarian cysts are fluid-filled closed, sac-like structures within an ovary.
Types of ovarian Cysts:
Ovarian cysts are mainly divided into two types, which include:
- Functional cysts
- Pathological cysts
Functional cysts are the most common type of ovarian cysts and they develop as a part of the normal menstrual cycle. Each month, ovaries naturally grow cyst-like structures called follicles. These follicles produce the female sex hormones estrogen, progesterone and release an egg when the woman ovulates. When a normal monthly follicle keeps growing, it is known as a “functional cyst”. Functional cysts are further divided into two types, such as:
- Follicular cyst: This kind of cysts usually develop as a result of a failed step in a woman’s reproductive cycle. Every month when an egg is released from the ovaries, it’s cell is first formed in the follicle that contains a fluid which protects the growing egg. When the egg cell gets released, the follicle bursts.
So, if the follicle doesn’t shed the fluid and shrink after releasing the egg cell or doesn’t release the egg cell, it can swell and develops into a follicular ovarian cyst. However, these types of cysts require no treatment and usually go away within a few weeks.
- Corpus luteum cyst: When an egg is released from the follicle, the follicle begins to produce the female sex hormones estrogen and progesterone for conception. This follicle is now known as corpus luteum or luteal ovarian. Sometimes, the fluid gets accumulated inside the follicle, causing the corpus luteum to grow into a cyst. These types of cysts are generally found on only one side, do not trigger any symptoms and disappear within few months. But, in rare cases, some corpus luteum cysts can split or rupture causing sudden pain and internal bleeding.
These types of cysts are usually uncommon. Unlike functional cysts, pathological cysts are developed as a result of abnormal cell growth. Pathological cysts are categorized into three types based on certain characteristics, these include:
- Dermoid cysts: This type of cysts are a combination of different types of cells and tissues, such as skin, hair, fatty tissue or teeth that eventually become a part of the cyst. Women may experience no particular pain during the development of dermoid cysts. Though dermoid cysts are benign, they can grow large enough and cause ovarian torsion.
- Cystadenomas: Similar to dermoid cysts, cystadenomas are benign. But, these cysts develop on the surface of an ovary and are filled with either a watery liquid or a thick mucous substance. Cystadenomas are attached to the ovary by a stalk, instead of growing within the ovary. These cysts can also grow exceptionally large in size and can cause ovarian torsion.
Endometriomas: Endometriomas are developed in women suffering from endometriosis, a condition in which the uterine lining grows outside the uterus. When the endometrial tissue gets attached to the ovary, it often undergoes a rapid growth and develops into a large ovarian cyst and causes pain, hinder sexual intercourse and eventually leads to infertility. Endometriomas are referred to “chocolate cysts” because of the dark and reddish-brown blood found in them.
Symptoms of Ovarian Cysts:
Most ovarian cysts do not cause any symptoms. Even if the symptoms are present, they are not always used to diagnose the presence of ovarian cysts as they are similar to that of other conditions, such as endometriosis and pregnancy. As the cyst grows, women may experience some symptoms which may include:
- Abdominal bloating or swelling
- Lower back pain
- Pelvic pain
- Painful intercourse
- Breast tenderness
- Unexplained weight gain
- Irregular and painful menstruation
- Unusual vaginal bleeding
- Difficulty in emptying the bladder or bowel completely
- Urge to urinate more often
In case of ruptured cyst or an ovarian torsion, women may experience severe symptoms which need immediate medical attention, such as:
- Severe or sharp pelvic pain
- Faintness or dizziness
- Rapid breathing
Causes of Ovarian Cysts:
Ovarian cysts often develop naturally in women during their reproductive years i.e, who have monthly periods. The most common causes of ovarian cysts may include:
- Hormonal problems: Hormonal problems or medication which help to ovulate can cause functional cysts in women. These types of cysts usually go away on their own without any treatment.
- Endometriosis: In women with endometriosis, the endometrial tissue may get attached to the ovary and form a growth. These types of cysts are called endometriomas and can cause pain during intercourse and periods.
- Pregnancy: In early pregnancy, an ovarian cyst normally develops to support the pregnancy until the placenta forms. In some cases, the cyst stays on the ovary until later in the pregnancy and may need to be removed.
- Pelvic infections: Severe pelvic infections which spread to the ovaries and fallopian tubes can cause cysts to develop.
Diagnosis of Ovarian Cysts:
An ovarian cyst can be detected during a routine pelvic examination. The doctor may notice swelling on either of the ovaries and may ask to get any of the following tests to determine the presence of an ovarian cyst or the size, shape, location, and composition of the cyst that is present. The possible tests include:
- Pelvic ultrasound: A pelvic ultrasound uses high-frequency sound waves and creates images of the uterus and ovaries. The doctor analyzes these images and confirms the presence of a cyst. A pelvic ultrasound also helps to identify the location and the composition of the cyst, whether solid or fluid-filled or mixed.
- Laparoscopy: In laparoscopy, a small lighted instrument called laparoscope is inserted into the abdomen through a small incision. It is a surgical procedure that requires anesthesia and is performed in an operating room. During laparoscopy, the doctor identifies the cyst through the scope and can remove the cyst at the same time or take a biopsy of it.
- Hormone tests: Blood tests to check levels of hormones such as LH, FSH, estradiol, and testosterone can indicate the imbalances in hormone levels. These tests can diagnose Polycystic Ovarian Syndrome.
- Pregnancy test: A corpus luteum cyst contains hCG (human Chorionic Gonadotropin) hormone, a positive pregnancy test even when a woman is not pregnant might indicate the presence of a corpus luteum cyst. Also, the treatment of ovarian cysts might be different for pregnant women. During the diagnosis of an ovarian cyst, a pregnancy test is usually performed in order to rule out an ectopic pregnancy. Most of the signs of an ovarian cyst are similar to those of an ectopic pregnancy
Click here to read more about “ectopic pregnancy”
- CA – 125 blood test: This test measures the blood levels of a protein called CA 125 (cancer antigen 125). Women with ovarian cancer often have high levels of this protein. This test helps in evaluating epithelial ovarian cancer and also determines if an ovarian mass is cancerous or harmless. Also, in women with some non-cancerous conditions like endometriosis or uterine fibroids, would have high levels of CA-125 in the blood.
Risks & Complications of Ovarian Cysts:
Most of the cysts are benign and rarely ever cause any harm. But, in some cases, they may develop serious complications. The risks and complications of ovarian cysts depend on their type and the stage of the treatment. The severe complications associated with ovarian cysts include:
- Ruptured ovarian cyst: Cysts can rupture causing internal bleeding and intense pain. Ovarian cyst rupture can cause life-threatening complications as the cystic fluid can leak into the stomach cavity, which leads to sepsis or hemorrhagic problems. It can also affect fertility and may lead to possible infertility. Though ovarian cyst rupture is a rare condition, it is a severe condition which requires immediate medical attention.
- Ovarian torsion: When an ovarian cyst grows large enough to cause the ovary to move out of its usual position in the pelvis, it leads to either partial or complete rotation or twisting of the ovary along with its fallopian tube. Ovarian torsion restricts the blood vessels that carry oxygen and nutrients through blood to the ovaries. The blocked blood supply to the ovaries can damage the ovarian tissue and eventually leads to its death. If left untreated, ovarian torsion can cause serious complications.
- Peritonitis: Peritonitis is a condition in which the peritoneum, a thin layer of tissue that lines the inner wall of the abdominal cavity is inflamed. This can occur when the fluid in the cyst gets spilled into the peritoneal cavity when a cyst is ruptured. It can be life-threatening and can cause excruciating pain.
- Infertility: Ovarian cysts can damage a woman’s reproductive system to such an extent that they can lead to temporary or permanent infertility. Hence, women suffering from ovarian cysts who are trying to conceive should diagnose the type of the cysts and seek proper treatment in order to restore their reproductive health.
- Cancer: In rare cases, ovarian cysts can turn out to be cancerous. Though most ovarian cysts resolve by themselves without any treatment, some may possess the risk of becoming cancerous, especially in postmenopausal women. In cases of ovarian cancer, the women need to undergo usual cancer treatment along with the surgery which involves removal of the ovaries.
Treatment for Ovarian Cysts:
Most ovarian cysts resolve on their own, but some need attention. The treatment for ovarian cysts depends on the women’s age, the type, size and the likely cause of the cysts and whether the cyst is producing any symptoms or not. The possible treatments for ovarian cysts include;
- Watchful waiting: As most ovarian cysts go away on their own, the doctor may suggest waiting and getting re-examined to see if the cyst goes away within a few months. This is an option regardless of woman’s age and if she does not experience any symptoms and most importantly when a cyst found is simple, small and fluid-filled. The doctor may suggest getting pelvic ultrasound at regular intervals to see if there are any changes in the size of the cyst.
- Medication: If a woman has recurrent ovarian cysts, she might be prescribed with hormonal contraceptives, such as birth control pills, to prevent the development of new cysts. Though birth control pills won’t shrink the existing cysts, they keep ovarian cysts from recurring and reduces the risk of ovarian cancer.
- Surgery: If the cyst is large or if it continues to grow or causes pain, the doctor may suggest removing the cyst. The surgical procedures to remove ovarian cysts include:
- Ovarian cystectomy: It refers to the removal of ovarian cysts while preserving the ovaries. This procedure is usually recommended for women who desire fertility.
- Oophorectomy: It is a surgical procedure to remove either one or both ovaries. If the cyst is large and non-cancerous, oophorectomy is performed to remove the affected ovary while leaving the other intact.
- Hysterectomy: In case of large cysts which are diagnosed to be cancerous, hysterectomy is performed to remove the uterus along with the surrounding organs, such as ovaries, fallopian tubes. This minimizes the spread of ovarian cancer. Hysterectomy is usually recommended if an ovarian cyst is developed after menopause.
How can Ovarian Cysts be Prevented?
Ovarian cysts cannot be prevented as they are a normal part of the ovulation. However, getting regular pelvic examinations can detect the changes in the ovaries as early as possible. Also, women should keep track of the changes in their monthly cycles, including abnormal menstrual symptoms and bring their concerns to the gynecologist at the earliest in order to diagnose a condition at initial stages.
https://en.wikipedia.org/wiki/Ovarian_cyst – Ovarian cyst
https://www.acog.org/Patients/FAQs/Ovarian-Cysts – Ovarian cysts
https://intermountainhealthcare.org/blogs/topics/live-well/2018/02/ovary-pain-understanding-ovarian-cysts/ – Ovary pain? Understanding ovarian cysts
http://brochures.mater.org.au/brochures/mater-mothers-hospital/women-s-health-ovarian-cysts – Women’s health— ovarian cysts
https://www.pennmedicine.org/updates/blogs/fertility-blog/2016/august/ovarian-cysts – Ovarian Cysts and Pregnancy: Could A Cyst Stop Me from Having a Baby?
https://www.healthnavigator.org.nz/health-a-z/o/ovarian-cysts/ – Ovarian cysts
https://www.uofmhealth.org/health-library/hw181644 – Functional Ovarian Cysts