Why Ovarian Cysts Are a Cause for Concern

What are ovarian cysts?

Your ovaries contain your eggs and usually one egg is released every month during your menstrual cycle in a process called ovulation. The egg travels into your uterus via the fallopian tube. Your ovaries are also responsible for producing the hormones oestrogen and progesterone.

Sometimes, a fluid- or blood-filled sac called a cyst can grow on your ovaries and in most cases, this is painless and causes no symptoms. The cyst may disappear without you ever knowing you had it.

Are there different types of ovarian cysts?

Yes, there are several types ranging from fluid-filled cysts to cancerous growths. Some types may affect fertility.

Follicular cyst

During your monthly cycle, when you ovulate, the follicle 'breaks' as it releases the egg. If the follicle does not break open, the fluid inside can build up, forming a cyst on the ovary.

Corpus luteum cyst

When a follicle successfully releases an egg, the follicular sac should dissolve. This cyst is a group of cells within the ovary that forms during the second half of the menstrual cycle. It releases progesterone, which is a hormone that prepares the uterus for a pregnancy. A corpus luteum cyst usually resolves once you have your period!

Dermoid cyst

These can contain materials such as hair, skin, sweat glands, fat, bone, nails, teeth and cartilage. Most dermoid cysts are benign but still pose risks to a woman's health as it can sometimes lead to an infection. A large dermoid cyst can cause abdominal pain, abnormal bleeding and painful intercourse. A cyst that is pushing on the bladder can also cause difficulty with urination.

Cystadenomas

These are non-cancerous growths that can develop on the outer surface of the ovaries.

Endometriomas

Endometrial tissue is tissue that grows in the lining of the uterus. When this lining backflows and accumulates onto the ovary, it can lead to an endometrioma.

Polycystic ovary syndrome

This condition causes many small follicles to develop in the ovary, causing it to become enlarged. This may be a cause of subfertility or irregular menstrual cycles.

Can ovarian cysts be prevented?

Unfortunately, there is nothing you can do to prevent cysts from forming. In certain cases, hormonal medication can be given to suppress certain types of cysts. However, by going for regular routine gynaecological examinations, any cyst you have can be diagnosed and treated in its early stages, whether it is benign or cancerous.

What are the symptoms of ovarian cysts?

Ovarian cysts are common in women. It is sometimes only discovered on an ultrasound. There may be no symptoms at all. However, if the cyst grows, you may begin to experience the following symptoms:

• abdominal pain
• abdominal bloating ordistension
• pelvic pain before or during the menstrual cycle
• pain in the lower back or thighs
• painful bowel movements
• painful intercourse

What ovarian cyst complications could result?

If you experience the above symptoms and then develop severe or sharp pelvic pain, fever, sudden nausea and vomiting. Seek urgent medical attention as you may have a ruptured cyst or an ovarian torsion. Both need to be treated quickly to avoid further complications.

Ruptured cyst

This is uncommon but when it happens, it will cause severe pain and internal bleeding. It can be life threatening if you do not seek treatment soon enough. Sometimes the bleeding is mild and self-limiting. In other cases, the bleeding can be substantial. 

Ovarian torsion

This is also uncommon and happens when a large ovarian cyst causes the ovary to twist so that the blood supply to the ovary is cut off. This is an emergency and if not treated, the ovarian tissue can be compromised and you could lose that ovary.

Cancerous cystic ovarian mass

Symptoms of ovarian cancer can mimic symptoms of an ovarian cyst. So, it is important to visit your doctor for an accurate diagnosis if you notice symptoms such as:

• changes in your menstrual cycle
• ongoing pelvic pain
• loss of appetite
• unexplained weight loss
• abdominal fullness and bloatedness
• change in bowel habits

How are ovarian cysts diagnosed?

Pelvic examinations

Often cysts are diagnosed during pelvic examinations. A pelvic exam usually lasts only a few minutes.

Ultrasound

If your doctor suspects a cyst, they will order an ultrasound to confirm the diagnosis and determine the size, location of the cyst and to see whether it is fluid-filled or solid.

Most benign cysts resolve on their own so your doctor will probably monitor your condition for a few weeks or months. If it doesn't resolve on its own, your doctor may recommend treatment.

What is the treatment for an ovarian cyst?

Birth control pills

As ovarian cysts are connected to ovulation, your doctor may recommend taking the contraceptive pill, which stops ovulation, thereby preventing the development of new cysts. Taking the Pill also reduces your risk of ovarian and uterine (endometrial) cancer.

Surgery

Your doctor may recommend surgery if you develop the following symptoms:

• You have pain or problems conceiving
• You have growths in both ovaries
• Size of the cyst: larger cysts (approximately >5cm)
• Ultrasound features: large cysts, solid areas with multiple septations
• Persistent cyst: despite being on treatment or growing after the menopause
• Ovarian cancer: Your doctor suspects ovarian cancer. In this case, you will be referred to a gynaecologic oncologist.

What are the common surgery approaches to treat ovarian cysts?

Laparoscopy

This surgery involves the surgeon removing the cyst through 3 – 4 tiny incisions, one near your belly button and two either on the side or near the centre, using an instrument with a camera so they can see inside your body while performing the operation. The surgeon will stitch or glue the incision so you are left with only a very small scar. It may be a day surgery carried out under general anaesthesia so you will be able to go home soon after you wake up. You should be able to get back to normal activities within 1 – 2 weeks.

Laparotomy

If your cyst is large, or there is a chance it is cancerous, your surgeon will need to make a larger incision in your abdomen. This gives your surgeon better access to the cyst and prevent dissemination of the cancer. The whole cyst and ovary may be removed, with some samples taken for laboratory testing to determine whether it is cancerous. This is considered an open surgery.

Can ovarian cysts come back after surgery?

While surgery can successfully remove ovarian cysts, they can sometimes come back in the same place or in the other ovary, especially endometriomas. Hormonal medication may be given to suppress the cysts. You will need to discuss this with your doctor to determine if you are a suitable candidate for an oophorectomy (removal of the ovary) or whether cyst removal is a better option.