Ovarian Cysts

What is an Ovarian Cyst?

Cysts are solid or liquid-filled sacs or pockets (cysts) within or on the surface of an ovary. Many ovarian cysts are benign and do not cause symptoms, but some can be painful or interfere with normal ovarian function. In some cases, cysts may also be cancerous, but this is relatively rare. 

Depending on the presentation, age of the woman, and time of her menstrual cycle, a cyst could be nothing but a space filled with fluid that develops in the ovaries. Ovarian cysts are common in women, especially of childbearing age. 

Cysts sometimes are formed when the follicle that contains an egg fails to break and release the egg out of the ovary, resulting in an accumulation of fluid and sometimes blood in the follicle.

Symptoms of Ovarian Cysts

Many ovarian cysts do not cause symptoms and are found during routine pelvic exams or ultrasounds, but you should seek medical review if you experience the following:

• Abdominal pain or discomfort can range from mild to severe and can be sharp or dull. The pain may be on one side of the lower abdomen and may be accompanied by a dull ache in the lower back and thighs.
• Abnormal vaginal bleeding, spotting, or discharge.
• Pressure, bloating, or fullness in the abdomen.
• Difficulty emptying the bladder or bowel.
• Nausea or vomiting.
• Dizziness or lightheadedness.
• Sudden weight gain or swelling of the abdomen.

Other less common symptoms include:

• Pelvic or lower back and thigh pain
• Trouble emptying the bladder completely
• Pain during sexual intercourse
• Weight gain
• Abnormal vaginal bleeding
• Breast tenderness
• Urinary urgency

Causes Of Ovarian Cysts

Various factors, including hormonal imbalances, ovulation, and pelvic infections, can cause ovarian cysts.

Types of Ovarian Cysts

There are several types of ovarian cysts, which can be classified based on their cause and structure. Simple or functional cysts are the most common type of ovarian cyst formed during the menstrual cycle.

Functional cysts are usually benign. The two most common types of benign cysts include:

• Follicular Cysts: The follicle is the sac where an egg grows and matures. Upon maturation, the follicle breaks and releases an egg every month. Follicle cysts form when the follicle does not break open to release the egg.
• Corpus Luteum Cysts: When the follicle sac does not dissolve after the egg is released, additional fluids accumulate inside the sac. This results in the formation of corpus luteum cysts.

Some women develop polycystic ovary syndrome, in which the ovaries don’t ovulate properly and contain multiple tiny cysts. This condition is discussed separately as it is a different issue.

Other types of ovarian cysts include:

• Endometriotic Cysts form when tissue similar to the lining of the uterus (endometrium) grows outside of the uterus and attaches to the ovary. They are also called chocolate cysts because they can contain dark, old blood.
• Dermoid Cysts are present at birth and consist of a mixture of tissues, including hair, skin, and teeth.
• Cystadenomas These cysts are formed from cells on the surface of the ovary and can be filled with clear, brown, or blood-tinged fluid.
• Cancerous Cysts Ovarian cancer can also present as cyst formation. These types of cysts are typically large and solid.

Risk Factors

Several factors may increase the risk of developing ovarian cysts, including:

• Age: Ovarian cysts are most common in women of reproductive age.
• Hormonal imbalances: Ovarian cysts are more likely to occur in women with conditions that affect the levels of hormones, such as polycystic ovary syndrome (PCOS) or endometriosis.
• Family history: Women with a family history of ovarian cysts may be at an increased risk of developing them.
• Previous ovarian cysts: Women who have previously had ovarian cysts are at a higher risk of developing new ones.
• Lifestyle factors: Some lifestyle factors, such as obesity, a sedentary lifestyle, and a diet high in processed foods, may also increase the risk of developing ovarian cysts.

Diagnosis of Ovarian Cysts

A vaginal ultrasound is often the first investigation to elicit the characteristics of the ovarian cyst.

A repeat ultrasound is often required six weeks after the first scan to see if the cyst has resolved itself with time. Sometimes additional tests include blood tests of tumour markers (blood substances produced by certain ovarian tumours), CT or MRI scans.

Treatments of Ovarian Cysts

Some cysts will disappear by themselves, and some large cysts will require treatment.

Treatment options include non-surgical and surgical treatment. The non-surgical treatment includes:

• Oral contractives pills help to decrease the formation of new cysts and prevent the formation of eggs that will become cysts.
• Non-steroidal anti-inflammatory drugs such as ibuprofen help to relieve pain.

Surgical Treatment of Ovarian Cysts

Surgery will be recommended to remove the cyst or ovary for cysts 5 to 10 cm in diameter, causing pain and discomfort, or if they are highly suspicious to be cancerous.

Most smaller cysts can be treated using a surgical treatment for ovarian cysts called a laparoscopy (keyhole surgery) to remove the cysts.

Some larger or more complicated ovarian cysts may require an open surgery approach. This involves a larger incision on the abdomen and will require one to two days of an overnight stay in the hospital after the operation. 

Laparoscopy for Ovarian Cysts

This is minimally invasive endoscopic surgery where:

• Three to five small incisions are made on the abdomen, 
• a camera is inserted through one of the incisions,
• instruments for excision of the cysts are inserted through the other incisions,
• carbon dioxide gas is then introduced into the abdominal cavity to create space for surgical excision of the cyst. 
• Laparoscopies are performed under general anaesthesia.

The aim of either surgical approach when treating ovarian cysts is only to remove the cyst, leaving the ovaries intact. However, at times part or all of the ovary may need to be removed.