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Ovarian Cyst

What is an Ovarian Cyst? Ovarian cysts are the sacs or pockets filled with fluid found either inside or on the surface of the ovaries. We all know that women have two ovaries (one on each side of the uterus) each having a shape and size about that of an almond. Eggs, as we know, develop, and mature in the ovaries till they are released every month in their monthly (menstrual) cycles during their childbearing years. At times, fluid filled sacs (cysts) can be found growing in/on either one or both of the ovaries. Many women have ovarian cysts at some point in their lives as these are normal to be found considering the fact that they develop as normal parts of the reproductive/menstrual cycles. Most of these ovarian cysts present either little or no discomfort of any kind and may disappear within a few months without even any kind of treatment. However, there may be times when these ovarian cysts tend to be problematic as they can cause serious symptoms- particularly those that rupture. A great majority of these ovarian cysts are benign (non-cancerous) and hence, are not really matters of stress. There are, however, times of concern when these ovarian cysts can be cancerous(malignant) or may become cancerous and hence, becoming matters of concern. Hence, to protect the health, one should have regular pelvic exams and be aware of the symptoms that can indicate a potentially serious or alarming problem.

Ovarian Cysts Causes:

There are a lot of potential causes that can be responsible for the development of cysts in/on your ovaries. These ovarian cyst causes may include one or more of the following:

  1. Pregnancy: An ovarian cyst in pregnancy is something very common. Often ovarian cysts develop in the early pregnancy phase aimed towards helping/supporting the pregnancy until the placenta is formed. At times, these cysts can stay on the ovaries even after the pregnancy and hence, may need to be removed.
  2. Hormonal imbalance: Hormonal imbalance can also lead to a fairly high chance of ovarian cysts formation. Such hormonal imbalance can be triggered in case of people undergoing fertility treatments or due to any other causes.
  3. Endometriosis: Endometriosis is a very common cause of ovarian cysts. Women who have endometriosis may develop a kind of ovarian cyst called endometrioma in which the endometriotic (abnormal endometrial growth) tissue may get attached to the ovary and form a growth. Such cysts can cause pain during intercourse (sex) or during one’s menstrual periods.
  4. Pelvic infections: If one is having infections in the pelvic region, the infection may reach their ovaries and fallopian tubes and hence, cysts can be formed at those regions.
  5. Previous history of Ovarian Cysts: There are high chances of ovarian cysts being found in case of people who have experienced ovarian cysts in the past i.e., have had earlier occurrences of ovarian cysts. If one has experienced ovarian cysts in the past, she should be aware of the associated symptoms, keep a check on them, and tell their doctors if they notice anything abnormal.

Ovarian Cyst Types:

Ovarian cysts can have a varied range of sizes as they can range from being smaller than the size of a pea to being larger than the size of a watermelon.  The two main types of ovarian cyst include:

1) Functional Cysts: These are the most common types of ovarian cysts that develop as parts of the menstrual cycles and hence, are harmless. These can develop usually in case of women receiving any kind of infertility treatments.

The functional cysts can further be divided into following two types:

  • Follicle Cysts: During the menstrual cycle of a woman, the egg grows in a sac which is known as a follicle which is found inside the ovaries. During ovulation, this follicle ruptures to release the egg. If this follicle doesn’t break for any reason, a cyst can be formed on the ovary because of the internal fluid.
  • Corpus Luteum Cysts: Usually, the follicle sacs get dissolved after the egg is released but, if for any reason, the egg does not dissolve, and the follicle gets sealed, extra fluid can develop in the sac and this accumulation of fluid leads to the formation of a corpus luteum cyst.

 

2) Pathological Cysts: These cysts are the least common ovarian cysts as these are formed because of abnormal cell growth. Not every cyst is a functional one as sometimes, cysts can also be developed due to some underlying conditions that one may have. These cysts are found more in case of women who have been through the menopause.

These cysts include the following types:

  • Dermatoid Cysts: These ovarian cysts are mostly seen in younger women. These cysts develop from the cells which are responsible for making the eggs in the ovaries and hence, ovarian cyst size can get really large in such cases. These usually contain peculiar/odd things in them like hair, parts of teeth/bone, fatty tissue, etc. These cells can also make different kinds of tissues just like the egg as they are made from the same cells as the egg. Dermatoid cysts can run in families.
  • Cystadenomas: These cysts develop from the cells covering the outer part of the ovary. These are usually filled with water-like fluid and can sometimes grow large in size. These cysts are of different types. For instance, a serous cystadenomas filled with a thin fluid whereas the mucinous cystadenoma is filled with thick mucus-like substance. Such cysts are attached by a stalk to the ovary rather than growing inside the ovary itself.
  • Endometriomas: As the name suggests, these ovarian cysts are generally caused by endometriosis i.e., tissues which are normally found to be growing inside the uterus (womb) grow outside of the uterus/ uterine cavity and hence, resulting in cyst formation. Sometimes, these cysts can be filled with blood. The old blood found inside these cysts appear like chocolate and therefore, these cysts are also known as chocolate cysts.

Risk Factors:

The chances of one having ovarian cysts gets increased to great heights if she has any of the following conditions:

  1. Pregnancy: If someone is pregnant, there are high chances of functional ovarian cysts being formed in their bodies as it is pretty common for such cysts to develop during the pregnancy. These are mostly harmless though.
  2. Endometriosis: As we have already discussed, endometriosis refers to the condition which causes endometrial cells to grow at places outside the uterus. These abnormal cells can attach to the ovary and hence, lead to the growth of a cyst.
  3. Hormonal Problems: If there are problems like hormonal imbalance, for example in case of people who take infertility treatment.
  4. Any Pelvic Infection: In case of someone having infections, there are really high chances of the infection being spread to the ovaries and the fallopian tubes which may lead to cyst formation.
  5. A history of Ovarian Cyst: If someone has a prior history of ovarian cyst, the chances of them having recurrences of ovarian cysts are likely high.

Complications:

It is very important to have regular pelvic examinations by a competent doctor as some women may develop unusual complications with ovarian cysts. These complications may include:

  1. Ovarian Torsion: If by any chance, the cysts grow larger they can even make the ovary move and also twist the stalk to itself which is really painful. This twisting can stop the flowing blood to the cyst and as the blood supply is cut off, it can lead to either damage or death of the ovarian tissue This can lead to sever pain in the lower abdomen.
  2. Rupture: Sometimes, the cysts can break open and hence, can cause severe pain and even internal bleeding. This can be caused due to vigorous activities like vaginal intercourse. Most of the times, these ovarian cyst bursts can heal on their own but there are also times when such ruptures become emergency medical conditions as this complication may also increase your risks of infection and hence, can be proven fatal if not treated timely.
  3. Infection in the ovarian cyst: There may be times when the ovarian cyst form an abscess in response to pelvic infections. If such abscess gets burst, dangerous infections like bacteria can be spread throughout the body.

Ovarian Cyst Symptoms:

Most of the times, ovarian cysts do not cause symptoms as these cysts are mostly small in size. The symptoms may start appearing as the cyst advances or grows larger in size. These symptoms can be one or more of the following:

  1. Abdominal swelling
  2. Painful bowel movements
  3. Pain before or during the menstrual cycles.
  4. Irregular menstrual cycles
  5. Pain during intercourse
  6. Facing struggle in emptying the bowels i.e., constipation
  7. Feeling full even after not eating much
  8. Pain in the lower backs or thighs
  9. Breast tenderness
  10. Nausea and vomiting- seen mostly in cases where the ovary gets twisted
  11. Unexplained weight gain
  12. Urge to urinate more often

There are also a few symptoms indicating need for urgent medical attention like:

  • Sharp pelvic pain
  • Feeling dizziness
  • Rapid breathing

These symptoms may hint towards ovarian cyst complications like ruptured cyst or an ovarian torsion.

Ovarian Cysts Diagnosis:

Ovarian cysts can be diagnosed during a regular pelvic examination. Swelling can be noticed on one of the ovaries which is then followed by an ultrasound test (safe and painless imaging test in which high frequency sound waves are used to produce an image of the internal organs) in order to confirm the presence of an ovarian cyst. An ultrasound test can be used as it tells us about the size, place, shape of the ovarian cyst along with the composition (whether it is solid, or liquid filled).

Other imaging tools/techniques that can be used to diagnose ovarian cysts are:

    • MRI (Magnetic Resonance Imaging): In this test, magnetic fields are used to produce thorough images of the internal organs.
    • CT (Computerised tomography) Scan: This is another body imaging device that creates cross-sectional images of the internal organs.
    • Laparoscopy: If the results of the above tests are not conclusive then a laparoscopy is done in which, a thin probe (with a camera and light) is inserted into the belly through a small incision. This helps the doctor in seeing the internal organs more clearly and she/he can reach to a conclusion.

Your doctor may not recommend a treatment plan as soon as the cyst is confirmed because most of these cysts disappear just after a few weeks or months. However, if there are not any positive changes in your condition or in case the cyst increases in the size, your doctor may request you to go for the additional tests that are effective in finding other causes of the experienced symptoms. These tests are:

  1. Pregnancy Test: This test is done in order to rule out pregnancy as if someone is pregnant then it may just be a corpus luteum cyst which is absolutely normal.
  2. Hormone level Test: It is done in order to check for any issues/problems related to hormone, for example, abnormally higher levels of estrogen or progesterone.
  3. Blood Test: This includes the CA-125 blood test which is usually recommended to people having a partially solid cyst. This is done to test the bloods for the levels of a protein called CA-125 (Cancer Antigen 125) which is found to be higher in women having ovarian cancer and in women having other illnesses/conditions like uterine fibroids, endometriosis, etc.

Ovarian Cyst Treatment:

There are a lot of things on which the treatment for ovarian cyst depends. There are a lot of factors like the age of the woman, whether she is having her menstrual periods or not, symptoms, location of the cyst, etc. As we have already discussed, almost all of the functional cysts get shrunken down in a few months. Still, if you keep getting such cysts regularly, or in case such cysts grow larger in size then your doctor may recommend one of the following treatment methods to you:

1) Birth Control Pills: If someone is having recurrences of ovarian cysts one after the other, their doctor can prescribe oral contraceptive pills in order to stop the ovulation and hence, reducing the chances of the occurrence of any ovarian cysts further. These contraceptives can also significantly decrease the risk of one getting ovarian cancer.

In case the above-mentioned treatment plan does not work for you then there are other surgical procedures that can be done in order to get rid of the ovarian cysts.

You can know if you need surgical help by the following pointers:

  • If the cyst remains even after several menstrual cycles
  • If the cyst gets larger in size
  • If the cyst looks abnormal/unusual in the sonogram
  • If the cyst causes continuous/unbearable pain

 

2) Laparoscopy: This refers to the procedure in which a doctor makes a small incision in your lower abdomen to insert a thin device along with a camera and light to observe and then eliminate the cysts. This surgical treatment is used in cases where the cyst is small

3) Laparotomy: In case of woman with larger cysts (where the cysts can be suspicious), the doctor can also remove the cyst by making a large incision in the abdomen. An immediate biopsy of the cyst is done afterwards to see if the cysts is cancerous or not. If the cyst is cancerous then this may be followed by a hysterectomy in which your ovaries and uterus are removed to prevent any further occurrences of ovarian cysts.

Conclusion:

Most of the ovarian cysts disappear on their own within a span of three to four months and hence, are not matters of stress. However, for the few cases where these cysts are recurrent, there are many matters of concern/stress as such cysts can be problematic and can even lead to a fatal problem. If such cysts are not treated timely or are left untreated, these can also have drastic effects on your fertility. Hence, you really need to have a competent doctor by your side because, in the end, it all comes down to the expertise of the doctor and trust of the patient.

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