What are Ovarian Cysts?
An ovarian cyst is a fluid-filled or semi-solid sac that can grow in one or both of your ovaries. It starts as a benign growth that may not cause symptoms. You may find them growing only after a routine health exam. They commonly develop during pregnancy and will go away if a pregnancy does not occur after ovulation.
Some cysts rarely become malignant (or cancerous), causing health complications that require prompt treatment. They may also put you at risk of complications that can affect your fertility.
Types of Ovarian Cysts
Functional Ovarian Cysts
These are the most common form of ovarian cysts and signal that your ovaries are healthy. They typically shrink after 60 days and disappear without needing treatment. Functional cysts can be further categorised into two different types.
- Follicular cysts: A follicle is a small sac in the ovary which releases an egg each month during the menstrual cycle. If a follicle does not release an egg, it fills up with fluid and becomes a follicular cyst.
- Corpus luteum cysts: Once a follicle releases an egg, it usually shrinks before becoming a hormone-producing structure called the corpus luteum. When conception does not happen, this structure dissolves. However, in some cases, fluid can accumulate and form a cyst.
Non-Functional Ovarian Cysts
Sometimes, ovarian cysts can form and cause complications in the future. Early screenings and follow-up checks help minimise their risk of complications, such as ovarian torsion (which can reduce or cut off blood flow to the ovaries).
- Benign Cyst: Found growing on an ovary’s surface, cystadenomas typically contain watery or mucus-like fluids and can grow very large.
- Dermoid cysts: Also known as teratomas, these cysts have a smooth, rubbery texture and are almost always benign.
- Endometriomas: Sometimes called chocolate cysts due to their dark brown fluid content from degenerated blood products, they form due to endometriosis (tissue similar to the uterine lining grows elsewhere in the body).
- Ovarian cancer: These solid masses are malignant.
What Causes Ovarian Cysts?
Ovulation is the most common cause of ovarian cysts, but the cyclical cysts that form from this natural process are almost always benign and gradually disappear. However, abnormalities and infections can also cause non-functional cysts to appear, carrying a higher risk of health complications. For example, polycystic ovary syndrome (PCOS), a hormonal imbalance disorder, causes multiple smaller cysts to form on the ovaries increasing your risk of infertility.
Symptoms of Ovarian Cysts
Ovarian cysts are typically asymptomatic or only appear much later. Large cysts can cause symptoms such as:
- Intermittent pelvic pain that varies in intensity and duration.
- Bloating in or around your lower belly area.
- Frequent need to use the washroom.
- Infrequent pain in your lower back.
- Pain or discomfort during sexual intercourse.
- Painful or irregular periods.
Cysts may burst or rupture unexpectedly, causing a sudden, severe pain in your lower abdomen that slowly subsides. The larger a cyst the higher is the risk of a rupture.
Diagnosing Ovarian Cysts
A thorough medical examination will help determine the state of your ovarian cysts. Your doctor may order specific diagnostic tests to look for ovarian cysts.
- Pelvic ultrasound: This imaging test uses high-frequency sound waves to create images of your reproductive organs, including the ovaries, and spot ovarian cyst growths. The photos can also determine if the cysts are solid or fluid-filled.
- Laparoscopy: Your doctor will use a laparoscope, an instrument with an attached light and camera, to examine your ovaries for cysts. The laparoscope is inserted into your body through a small incision. This procedure is commonly used during surgeries to remove ovarian cysts.
- CA-125 test: This test looks for the protein CA-125 (cancer antigen 125) in your body. This test is usually ordered as part of an ultrasound for more conclusive results. A high level of CA-125 can mean you have cysts.
A computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan can be performed if the results are inconclusive.
Ovarian Cyst Treatments
Watchful Waiting
For benign ovarian cysts (mainly functional cysts), your doctor will recommend regular monitoring to ensure they remain benign. Follow-up checks will involve ultrasound scans to see if the cysts have started shrinking. If they become larger or cause symptoms, your doctor will advise you accordingly.
Medications for Ovarian Cysts
Your doctor may prescribe medications such as hormonal contraceptives (like birth control pills) to stop ovulation as a preventive measure. It may prevent future cysts formation, but may not help inhibit or treat ovarian cysts already present. Your doctor may recommend other hormonal treatments to treat your condition.
Surgery for Removing Ovarian Cysts
If nonsurgical interventions are not sufficient to remove the cysts safely, surgery will be necessary.
Laparoscopy for Ovarian Cysts
A laparoscopy is a minimally invasive surgical procedure. A laparoscope features an attached camera and light, allowing the surgeon to view the ovaries. The surgeon will use special instruments to remove ovarian cysts found with the laparoscope. As a minimally invasive procedure, you typically have a shorter hospital stay and improved recovery outcomes compared to other surgeries.
Laparotomy for Ovarian Cysts
If the ovarian cysts are larger than expected or if there is a risk that they may be cancerous, your surgeon may perform a laparotomy. It is an open surgery that requires a large incision on your belly (the incision being 5-12cm long, allowing the larger cysts to be removed safely. A laparotomy is a major surgical procedure and will require hospitalisation to facilitate your recovery.
Oophorectomy for Ovarian Cysts
An oophorectomy is another major surgery where one (unilateral) or both (bilateral) of your ovaries are surgically removed. Parts of the fallopian tubes may also be removed (salpingo-oophorectomy). This procedure is performed if the ovarian cysts cannot safely removed with other treatments.
If your ovaries are removed, you will no longer be able to become pregnant. You will also begin to experience menopause, as the ovaries are responsible for producing the reproductive hormones needed for the menstrual cycle. As a result, you may be at higher risk of menopausal symptoms and other complications.
Ovarian Cyst Prevention
Preventing ovarian cysts is not a very straightforward process. Regular health screenings are a great way to stay on top of your reproductive health and detect potential problems early before they worsen. If necessary, oral contraceptives can help stopping ovulation, reducing your risk of ovarian cysts, especially if you are at higher risk or have a history of frequent ovarian cysts.
At O&G The Women’s Specialist
Looking after your health starts with early screenings, and here at O&G The Women’s Medical Specialist, we are ready to support your journey with a full range of fertility care services dedicated to your well-being.
