Definition
Ovarian cyst is an abnormal fluid-filled pocket that develops on the inside of a girl’s ovaries. The ovaries are the female reproductive organ and are found in the lower abdomen. The ovaries release an egg during the ovulation phase of each menstrual cycle (period). Cysts in the ovaries are relatively common and can affect girls and women of all ages.
An ovarian cyst can occur in one or both ovaries. The cysts can occur as single sacs or in clusters and are sometimes filled with other substances like blood in addition to fluid. They can be many different sizes and occur in different locations within the ovary. Most ovarian cysts in children and young women are benign (non-cancerous) but can develop into cancer in rare cases. In severe cases where the cyst is very large and heavy, its unbalanced weight can cause the ovary to twist in an abnormal way. The twisting cuts off blood flow to the ovary and can damage the organ. This rare complication is called ovarian torsion.
Epidemiology
Estimates of the prevalence of ovarian cysts vary widely, with most authors reporting between 8% and 18% of both premenopausal and postmenopausal women having ovarian cysts. Most post-menopausal cysts persist for years.
In the United States, approximately 5% to 10% of women undergo surgical exploration for ovarian cysts in their lifetime though only 13% to 21% of these cysts are malignant. Presurgical evaluation of ovarian cysts is critical to prevent unnecessary surgical intervention while still detecting potential malignancy.
For the vast majority of women, ovarian cysts are not precancerous lesions and do not increase the risk of developing ovarian cancer later in life. Removal of benign cysts does not decrease future mortality from ovarian cancer.
Types of Ovarian Cyst
There are several different types of ovarian cysts:1
Functional Cysts: These cysts will often shrink and disappear within two or three menstrual cycles. Because this type of cyst is formed during ovulation, it rarely occurs in menopausal women as eggs are no longer being produced.
Dermoid Cysts: These cysts are filled with various types of tissues, including hair and skin.
Endometrioma Cysts: These cysts are also known as the “chocolate cysts” of endometriosis, and they form when tissue similar to the lining of the uterus attaches to the ovaries.
Cystadenoma Cysts: These cysts develop from cells on the outer surface of the ovaries.
Polycystic Ovarian Disease: This disease, also commonly known as Polycystic Ovary Syndrome (PCOS), refers to cysts that form from a buildup of follicles. They cause the ovaries to enlarge and create a thick outer covering, which may prevent ovulation from occurring. They are often the cause of fertility problems.
Ovarian Cyst risk factors
The following are potential risk factors for developing ovarian cysts:
- History of previous ovarian cysts
- Irregular menstrual cycles
- Infertility
- Polycystic ovarian syndrome
- Endometriosis
- Obesity
- Early menstruation (11 years or younger)
- Hyperthyroidism
- Tamoxifen therapy for breast cancer
Causes of Ovarian Cyst
The most common causes of ovarian cysts include:
Hormonal problems: Functional cysts usually go away on their own without treatment. They may be caused by hormonal problems or by drugs used to help you ovulate.
Endometriosis: Women with endometriosis can develop a type of ovarian cyst called an endometrioma. The endometriosis tissue may attach to the ovary and form a growth. These cysts can be painful during sex and during your period.
Pregnancy: An ovarian cyst normally develops in early pregnancy to help support the pregnancy until the placenta forms. Sometimes, the cyst stays on the ovary until later in the pregnancy and may need to be removed.
Severe pelvic infections: Infections can spread to the ovaries and fallopian tubes and cause cysts to form.
Symptoms
Ovarian cysts often cause no symptoms.
An ovarian cyst is more likely to cause pain if it:
- Becomes large
- Bleeds
- Breaks open
- Interferes with the blood supply to the ovary
- Is twisted or causes twisting (torsion) of the ovary
Symptoms of ovarian cysts can also include:
- Bloating or swelling in the abdomen
- Pain during bowel movements
- Pain in the pelvis shortly before or after beginning a menstrual period
- Pain with intercourse or pelvic pain during movement
- Pelvic pain constant, dull aching
- Sudden and severe pelvic pain, often with nausea and vomiting (may be a sign of torsion or twisting of the ovary on its blood supply, or rupture of a cyst with internal bleeding)
Changes in menstrual periods are not common with follicular cysts. These are more common with corpus luteum cysts. Spotting or bleeding may occur with some cysts.
Complications
An ovarian cyst often causes no problems, but sometimes it can lead to complications.
- Torsion is when the stem of an ovary becomes twisted, which can happen if a cyst is growing on it. It can block the blood supply to the cyst and cause severe pain in the lower abdomen.
- A ruptured ovarian cyst is a burst cyst. Symptoms include severe pain in the lower abdomen and possibly bleeding.
- Some cysts are cancerous or later develop into ovarian cancer.
A person should seek immediate medical help if they experience:
- Pain with fever
- Nausea and vomiting
- Faintness, weakness, or dizziness
- Sudden, severe, abdominal pain
- Rapid breathing
- Unexpected and heavy bleeding
Diagnosis and test
While most ovarian cysts are benign, it’s important we check them to rule out cancer. It is especially important for postmenopausal women to be examined because they are at increased risk for ovarian cancer.
The doctor may first detect an ovarian cyst during a routine pelvic exam. We can then use several tests to determine the cyst’s type, size, and composition (what it’s filled with). Cysts that are filled with fluid are less likely to be cancerous. Those that are solid or filled with fluid and solids may indicate cancer.
Tests and procedures we may use to diagnose ovarian cysts include:
- CA-125 blood test: This blood test looks for a protein called cancer antigen 125. Women with ovarian cancer tend to have higher levels of this protein.
- Laparoscopy: In this surgical procedure, a doctor inserts a laparoscope (a thin, lighted instrument) into the abdomen through a small incision to see your ovaries, remove the cyst, or take a small piece of tissue to test for cancer.
- Pregnancy test: A corpus luteum cyst can cause a false positive on a pregnancy test.
- Ultrasound: This imaging test uses high-frequency sound waves to create an image of your uterus and ovaries.
If the diagnosis is ovarian cancer, consult a gynecologic oncologist for treatment options.
Treatment and medications
Treatment depends on the size of the cyst, the type of cyst, and whether the cyst is causing pain or other problems.
The most common treatment strategies include:
Monitoring: If your cyst isn’t causing any uncomfortable symptoms, your doctor may suggest rechecking it via ultrasound in a few months. Most ovarian cysts go away without treatment, so if you’re not in pain, monitoring may be a good option.
Birth control pills: Oral contraceptives will not get rid of an existing cyst but can prevent the development of more cysts.
Surgery: If a cyst is causing discomfort or has persisted and is growing, surgery may be used to remove the cyst from the ovary. In most cases, doctors can remove ovarian cysts through tiny incisions in the abdomen and preserve the ovary. If the cyst is large or suspected of being cancerous, your doctor may remove one or both ovaries.
In the case of cancerous cysts, a specialized surgeon is preferred to remove the cysts, but it may require the entire reproductive system to be removed (Fallopian tubes, uterus, and ovaries).
Prevention of Ovarian Cyst
Ovarian cysts cannot be prevented, but there are steps you can take to monitor your health. Ovarian cancer symptoms often mimic ovarian cyst symptoms, so it is essential to visit your doctor if you are at all concerned. If you notice any of the following symptoms, talk to your healthcare provider for further testing:
- Changes in your menstrual cycle
- Chronic pelvic pain
- Unexplained weight loss
- Loss of appetite
- The feeling of abdominal fullness
Most ovarian cysts are not cancerous and go away on their own. Regular check-ups with your gynecologist will help detect any changes to your health.