What is an Ovarian Cyst?
An ovarian cyst is a fluid-filled sac that grows in the ovary during ovulation. They usually occur within or on the surface of the ovaries, part of the female reproductive system which produces hormones oestrogen and progesterone, as well as egg cells (ova) needed for reproduction. Ovarian cysts are common and affect women of all ages, even after menopause. Most ovarian cysts that form are benign and will shrink on their own after some time.
Benign cysts do not cause any pain or discomfort, but some cysts may be at risk of rupturing. Ruptured cysts can lead to a host of complications that require immediate medical attention. An ovarian cyst could also be a risk factor for ovarian cancer.
Types and Causes of Ovarian Cysts
Functional cysts, the most commonly diagnosed type of ovarian cyst, occur as a result of the normal function of the menstrual cycle. They usually start from a follicle, a cyst-like structure that produces egg cells. Normally, a mature follicle, or sac, breaks open to release an egg. After the egg is released, the follicle dissolves and becomes a corpus luteum, which produces oestrogen and progesterone. An ovarian cyst forms when the follicle, or corpus luteum, has a defect that causes it to accumulate liquid and thus form a cyst.
There are two types of functional cysts. Follicle cysts, the first type, happen when the follicle does not break open to release an egg and causes a build-up of liquid, forming a cyst. Corpus luteum cysts, the other type, occur after the follicle has become a corpus luteum, but a build-up of liquid causes it to form a cyst. Functional cysts are the most common, but are usually harmless and cause no symptoms. These will often shrink and disappear after two or three menstrual cycles. Functional cysts also do not occur in menopausal women since their ovaries no longer produce eggs.
There are also other types of uncommon ovarian cysts that are not related to the menstrual cycle. These cysts mainly form due to abnormal cell growth.
- Dermoid cysts: These cysts contain tissue (hair, skin, fatty tissue, etc.), as they are formed from embryonic cells. They are also known as teratomas. These benign cysts generally grow to rather large sizes, and must be surgically removed.
- Cystadenomas: These are formed from cells lining the exterior of the ovaries, growing outside while attached to the ovaries by a stalk-like structure. They may contain a watery or mucous-like material, and can also grow to a rather large size.
- Endometriomas: These cysts are caused by endometriosis, a medical condition where uterine endometrial tissue – tissue similar to the lining of the uterus – grows outside of the womb. These are referred to as “chocolate cysts” due to the colour of blood found within the cysts.
Both dermoid cysts and cystadenomas may be harmless, but exceptionally large ones can move the ovary out of position and cause ovarian torsion. This is when an ovary twists around the ligaments holding it in place. Ovarian torsion is very dangerous, as it cuts off blood supply to the ovary and the fallopian tube (the structure that carries ova from the ovary to the uterus).
Risk Factors of Ovarian Cysts
A person can be at risk of having an ovarian cyst if they have any of the following risk factors:
- Hormonal imbalance, or other hormonal issues
- Pregnancy (a cyst that persists on the ovary even after ovulation)
- Having endometriosis (where uterine endometrial cells grow outside the uterus)
- Having polycystic ovary syndrome (PCOS)
- Severe pelvic infection
- Smoking
- Hypothyroidism (low thyroid hormones in the body)
- A previous ovarian cyst
Note that having any of these risk factors does not mean that you will develop an ovarian cyst.
Benign ovarian cysts do not cause any adverse symptoms until they rupture, are of a large size, and/or block blood supply to the ovaries. If any of the above occurs, symptoms that can present themselves may include (but are not limited to):
- Abdominal and/or pelvic pain or discomfort (with varying severity, mainly on the side where the cyst is located)
- Painful vaginal intercourse
- Abdominal distension, or swelling
- Difficulty urinating, or a frequent need to urinate
- Abnormal (internal) bleeding
- Irregular/inconsistent periods
- Nausea or vomiting
- Bloating
- Fullness even after eating small portions
- Difficulty falling pregnant
If you or your loved one suffers sudden, severe pain, it could be a sign that the cyst has either ruptured or ovarian torsion has occurred. A ruptured cyst can lead to internal bleeding, which will require immediate medical attention.
Ovarian Cysts in Postmenopausal Women
While functional cysts rarely occur in postmenopausal women, they are still at risk from other types of ovarian cysts. Even though the ovaries are no longer actively producing eggs or hormones, they are still active and thus, at risk of developing cysts. A study estimates that by age 65, approximately 4% of women will be hospitalised for ovarian cysts.
The symptoms and risk factors of ovarian cysts in postmenopausal women are similar to those that occur in premenopausal women. However, the risk of ovarian cancer is high in postmenopausal women. As such, the doctor may order a specific test to look out for cancer markers (refer to the Diagnosing Ovarian Cysts below) in order to determine if the cyst is malignant or otherwise. An ultrasound imaging test may also be performed. Treating the cyst may differ depending on the nature of the cyst.
Ovarian Cysts VS Polycystic Ovary Syndrome (PCOS)
Having prolonged symptoms listed above could be a sign of polycystic ovary syndrome, or PCOS. PCOS is a medical disorder where the ovaries’ functions are impaired and cause hormonal imbalance. The three main features of PCOS are:
- Irregular and/or prolonged periods (or none at all) which disrupt the ovulation process;
- Abnormal levels of male sex hormones (androgens) which cause physical changes such as excess facial or body hair;
- Polycystic ovaries, where the ovaries contain an abnormal number of fluid-filled follicles.
Having two of the three criteria may mean you have PCOS.
Despite the name of the disorder, women with PCOS do not actually produce cysts, but rather refer to follicles that are unable to release an egg. This is a sign that ovulation does not happen. PCOS may be caused due to abnormal hormone levels within the body, thus disrupting reproductive functions.
The main reason why ovarian cysts are confused with PCOS is because they share symptoms, namely the abnormal changes to periods, pelvic pain and nausea. They also refer to cysts being the central issue that causes complications. However, PCOS is actually a disruption of hormonal balance that causes significant changes to a woman’s reproductive functions. Ovarian cysts, on the other hand, form as a result of the menstrual cycle, and do not disrupt reproductive functions. Ovarian cysts can cause major physical complications such as ovarian torsion, while PCOS causes physical changes due to the ongoing hormonal imbalance.
In some cases, those with PCOS may not develop any ovarian cysts at all.Diagnosing Ovarian Cysts
As most ovarian cysts are harmless, they often go undiagnosed and eventually disappear after some time. In some instances, women being examined for other medical reasons may incidentally discover the presence of an asymptomatic ovarian cyst. If you or your loved one are having any of its symptoms, though, this may indicate the presence of a large or malignant cyst.
A routine pelvic examination by a doctor is the first step to making a diagnosis. For this examination, the doctor will examine you or your loved one’s reproductive organs and make sure that nothing is out of the ordinary. They will usually try to detect any abnormal lumps or changes that they can feel.
Your doctor may order a pelvic ultrasound for further examination. This is much like a pregnancy ultrasound test, but for checking you or your loved one’s reproductive system. The ultrasound scan will be performed to confirm if there really is a cyst, where it is located, how large its size is and whether it is solid, filled with fluid, or a mix of both.
Other diagnosis methods may include:
- Laparoscopy: The doctor makes a small incision on the abdomen and inserts a slim instrument with a small light and camera (a laparoscope) to examine the ovaries. As this is a surgical method, you or your loved one will be under anaesthesia. If a cyst is detected, the doctor may also remove it during this procedure.
- CT/MRI scan: If the ultrasound is unable to yield results, a CT or MRI scan may be done instead. An MRI scan uses magnetic waves to produce detailed images of your internal organs, while a CT scan uses body imaging to create a cross-section of your internal organs.
- CA125 blood test: This test looks for a specific protein called cancer antigen 125, or CA125, in your bloodstream. The presence of this protein in your blood can be an early marker for ovarian cancer but is not necessarily accurate. Further tests may need to be done to confirm if it is cancer or otherwise.Treatment of Ovarian Cysts
The general rule of thumb is that the earlier an ovarian cyst is detected, the less invasive the treatment that is required. Most functional cysts generally go away on their own after some time and do not need any medical intervention to treat it. Frequent follow up checks via ultrasound will help to check if the cysts have indeed disappeared, or if there have been any changes to it. In some cases, the treatment of ovarian cysts may have your doctor prescribing hormonal contraceptives to stop ovulation and prevent ovarian cysts from forming again in the future.
In more serious cases, surgery is the best option to remove an ovarian cyst. The choice of surgery can vary depending on a number of factors, including age, the size of the cyst, you or your loved one’s plans to have children, and whether the cyst is cancerous or otherwise.
For smaller cysts, a laparoscopy will be conducted. As described above, this is a minimally invasive procedure where the doctor makes a small incision in you or your loved one’s abdomen, and then inserts a laparoscope to examine the ovaries. Once the cyst is found, the doctor may then have it removed. A larger cyst may require a laparotomy, which surgically removes the cyst via a large incision in your abdomen.
If the cyst can be removed without removing the ovary, it is known as an ovarian cystectomy. However, if the cyst has affected the ovary, or if there may be potential concerns of ovarian cancer, the ovary may need to be surgically removed as well. This is known as an oophorectomy. If the cyst is cancerous, a total hysterectomy may be required. A total hysterectomy involves the surgical removal of your uterus, ovaries and fallopian tubes, followed by chemotherapy or radiotherapy to follow up as additional cancer treatment. This may be done to remove cancerous cells and prevent them from spreading to the rest of the body.
Prevention of Ovarian Cysts
There is no effective means of preventing ovarian cysts from occurring. After an ovarian cyst has disappeared, with or without medical treatment, follow up checks will be done to make sure there is no recurrence. Regular checks can be very important in catching potential recurrence early, which can help in quickly remediating the matter and with little to no surgery required (if it is not malignant). Some doctors do recommend low dose hormonal contraceptives as a way to prevent a recurrence, despite there being little to no evidence of its actual efficacy.
Be sure to notify the doctor if you or your loved one experiences any changes, such as changes to the menstrual cycle, the presence of any pelvic pain or discomfort, or the recurrence of any other symptoms of an ovarian cyst. Lifestyle changes may or may not help in preventing recurrences; this includes quitting smoking, having healthier meals, and regular exercise.