Ovarian Cysts

Understanding ovarian cysts

Cysts are described as a collection of fluid surrounded by a thin membrane, which is as opposed to other types of growths like solid lumps or nodules.

The production of ovarian cysts in the ovaries is generally part of normal function, and sometimes happens during the process of ovulation. In the most common form of ovarian cysts, the egg will mature inside of the follicle, which is also known as a follicle, which then bursts to release the fluid and egg. Sometimes the follicle wall doesn’t break, but instead continues to expand to fit the fluid that it contains. This can occur in multiple follicles over multiple cycles, with the natural resolution of a benign ovarian cyst being for it to retract or burst. A burst ovarian cyst can be very painful for a few days, and multiple cysts on the ovary can prevent successful ovulation.

Ovarian cyst, however, is also a term used to describe several different types of growths that include benign tumours, physiological follicles and malignant or cancerous tumours. Most ovarian cysts are asymptomatic and get picked up when an ultrasound is performed.

Symptoms of ovarian cysts

Ovarian cysts do not always present symptoms, but may present symptoms as they grow bigger, largely due to pressure on other surrounding tissue. The symptoms are not specific but can include:

  • A dull ache, heaviness or pressure in the pelvis or abdomen
  • Abdominal bloating or swelling
  • Painful bowel movements
  • Painful intercourse
  • Tenderness of the breasts
  • Pain in the thighs or lower back
  • Pelvic pain before or during ovulation or menstruation

The different types of ovarian cysts

There are several

ovarian cysts, these include:

  • Follicle cysts
  • Corpus luteum cysts
  • Dermoid cysts
  • Cystadenomas
  • Endometriomas

Follicle cysts

Eggs grow in small sacs in the ovaries, called follicles, during a woman’s menstrual cycle. Most of the time, the sac or follicle breaks open and releases an egg, or for unsuccessful follicles, retracts back into the ovary. If the follicle doesn’t open or retract, the fluid inside forms a cyst on the ovary. These cysts are considered completely normal for fertile-age women, and will come and go during a lifetime. Often these cysts are discovered during routine examinations for other reasons and are not cause for alarm. Observation and no treatment is typically the preferred way forward at first.

Corpus luteum cysts

After releasing an egg, the follicle sac – known as the corpus luteum – typically dissolves, however, if the sac doesn’t dissolve and the opening of the corpus luteum seals shut, additional fluid can develop inside and cause a cyst.

Dermoid cysts

A sac-like growth on the ovaries that contains fat, hair and other tissue. This is not a fertilised egg and is not a foetus, but an abnormal growth.

Cystadenomas

A non-cancerous growth that can develop on the outer surface of the ovaries.

Endometriomas

Tissue that normally grows inside of the uterus (endometrium) can also develop outside of the uterus and attach to the ovaries and cause a cyst. Endometriosis is the underlying condition that causes endometriomas.

Note on polycystic ovaries (PCO) and polycystic ovarian syndrome (PCOS): PCOS is different to having polycystic ovaries (PCO). If you have been diagnosed with polycystic ovaries, it means your doctor has found more than one cyst on one or both of your ovaries. Polycystic ovarian syndrome, however, is a hormonal condition – actually not a cystic condition at all, and needs a new name!

What causes ovarian cysts?

There are many possible causes of ovarian cysts, and the most common of these include:

  • Hormonal problems – functional cysts normally go away on their own but may be caused by a hormonal problem or by drugs that help you ovulate.
  • Endometriosis – those with endometriosis develop tissue that may attach to the ovaries and form cysts, which can be painful during your period and sex.
  • Pregnancy – ovarian cysts tend to develop during early pregnancy to help support the pregnancy until the placenta forms, but the cysts may stay on the ovaries until later in pregnancy and need to be removed.
  • Severe pelvic infections – infections that spread to the ovaries and fallopian tubes can cause cysts to form.

How we diagnose ovarian cysts

If you have any symptoms of ovarian cysts, you should consult your doctor, who may feel it is necessary to perform a pelvic exam to feel for swelling or lumps. If a cyst is, found your doctor may think it best to wait to see if the cyst goes away by itself, or they may order tests to start planning treatment. These tests can include:

  • Ultrasound – this test can help the doctor see the size, shape, location and mass of a cyst
  • Pregnancy test – to help rule out pregnancy as a cause
  • Hormone level test – to see if any cysts could be related to hormone problems
  • Blood tests – if you are postmenopausal your doctor may test for cancer antigens in your blood, and if you are premenopausal, your doctor may test for other illnesses or diseases that can cause cysts

How we treat ovarian cysts

Most cysts don’t need any treatment and will go away on their own. If a cyst is large enough or causes problems, your doctor may keep an eye on it and check it again later. If your doctor decides that something needs to be done, they may prescribe you medication such as birth control. The birth control hormones will not make the cysts go away, but can prevent new cysts from forming.

Some large ovarian cysts can cause other symptoms or do not go away, and may need surgery. Cysts that form in women near menopause may need surgery, as they are more likely to be cancerous. There are several different surgeries to remove cysts, including:

  • Laparoscopy – a non-invasive surgery that is used for the removal of smaller cysts or the ovaries
  • Laparotomy – is a more invasive surgery that is used for cysts that may be cancerous

What can go wrong with ovarian cysts?

Sometimes ovarian cysts can become an emergency. You should seek medical attention for any of the following symptoms:

  • Sudden and severe abdominal pain
  • Rapid breathing
  • Faintness, weakness or dizziness
  • Pain with fever and vomiting

These symptoms may mean your cyst has ruptured or may be causing other serious complications in your abdomen, like a twisted fallopian tube or ovary. Larger cysts can cause heavy bleeding if they rupture.

Can I prevent ovarian cysts?

There is no way to prevent functional ovarian cysts if you are ovulating. If you are prone to ovarian cysts, your doctor may be able to prescribe medication to help stop you from ovulating and reduce the risk of developing new cysts. Your doctor will have further specific advice for you regarding your individual concerns and can refer you on as necessary.