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OVARIAN CYST: ALL YOU NEED TO KNOW

WHAT IS AN OVARIAN CYST?


An ovarian cyst is a solid or fluid-filled sac that develops on or in an ovary (an organ found in the female reproductive system that produces an egg).

It occurs when fluid accumulates within a thin membrane inside the ovary. They’re very common especially with women who are in their reproductive years but they can appear at any age.

Most of the time they’re painless and harmless and they go away on their own without treatment. There are often no signs or symptoms, but ovarian cysts can sometimes cause pain and bleeding. If the cyst is over 5 centimeters in diameter, it may need to be surgically removed. The size of a cyst can range from as small as a pea to larger than an orange. Cysts are also common during pregnancy.


***A cyst is different from an abscess because it is not filled with pus. A pus-filled sac is an abscess.

Fast facts about Ovarian cyst:

  • An ovarian cyst is a buildup of fluid within an ovary surrounded by a thin shell, or membrane.
  • Ovarian cysts are usually harmless, but a large one may need to be removed.
  • There are two main types of ovarian cysts: functional ovarian cysts and pathological cysts.
  • In most cases, ovarian cysts will cause no signs or symptoms.

TYPES OF OVARIAN CYST

There are two main types of ovarian cysts:

1. Functional ovarian cyst

2. Pathological ovarian cyst

Functional ovarian cyst:

They are the most common type of ovarian cyst. These harmless cysts form part of the female’s normal menstrual cycle and are short-lived.

A functional ovarian cyst is a sac that forms on the surface of a woman’s ovary during or after ovulation. It holds a maturing egg (ova). Usually, the sac goes away after the egg is released. However, if an egg is not released, or if the sac closes up after the egg is released, the sac can swell up with fluid.

Functional ovarian cysts are different from ovarian growths caused by other problems, such as cancer. Most of these cysts are harmless. They do not cause symptoms, and they go away without treatment. But if a cyst becomes large, it can twist, rupture, or bleed and can be very painful.

A functional ovarian cyst forms because of slight changes in the way the ovary makes or releases an egg.

There are two types of functional ovarian cysts. These are:

  • Follicular cyst
  • Luteal cyst

Follicular cysts:

A follicular cyst occurs when a sac on the ovary does not release an egg, and the sac swells up with fluid. A woman has two ovaries. The egg moves from an ovary into the womb, where it can be fertilized by sperm. The egg is formed in the follicle, which contains fluid to protect the growing egg. When the egg is released, the follicle bursts.

In some cases, the follicle either does not shed its fluid and shrink after releasing the egg, or it does not release an egg. The follicle swells with fluid, becoming a follicular ovarian cyst. One cyst normally appears at any single time, and it normally goes away within a few weeks.

Luteal cyst:

These are less common and occurs when the sac releases an egg and then reseals and fills with fluid. After the egg has been released, it leaves tissue behind, known as the corpus luteum. Luteal cysts can develop when the corpus luteum fills with blood. This type of cyst normally goes away within a few months. However, it may sometimes split, or rupture, causing sudden pain and internal bleeding.

Pathological cysts

These are cysts that grow in the ovaries; they may be harmless or cancerous (malignant). The causes are different for each type. We will look at some of them in turn.

Dermoid cysts (cystic teratomas):

A dermoid cyst is usually benign. They are formed from the cells that make eggs (ova) and can develop into any type of cell. These cysts need to be removed surgically. Dermoid cysts are the most common type of pathological cyst for women under 30 years of age. These cysts contain tissue, such as hair, skin, fatty tissue, or teeth, and can grow quite large.


Cystadenomas:

Cystadenomas are ovarian cysts that develop from cells that cover the outer part of the ovary. Some are filled with a thick, mucus-like substance, while others contain a watery liquid. Rather than growing inside the ovary, cystadenomas are usually attached to the ovary by a stalk. By existing outside the ovary, they can grow quite large. They are rarely cancerous, but they need to be removed surgically. Cystadenomas are more common among women aged over 40 years.

Endometriomas

These develop as a result of a condition in which uterine endometrial cells grow outside your uterus (endometriosis). Some of the tissue can attach to your ovary and form growth.

***Both dermoid cysts and cystadenomas can grow exceptionally large in size and cause ovarian torsion, which is a very painful twisting of the ovary caused by the growth blocking the blood supply.

WHAT ARE THE SYMPTOMS OF OVARIAN CYST?

Most ovarian cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the abdomen or pelvis is the most common one. The pain can be caused from:

  • Rupture of the cyst,
  • Rapid growth and stretching,
  • Bleeding into the cyst, or
  • Twisting of the cyst around its blood supply (known as torsion).

If the cyst has reached a large size, other symptoms may arise as a result of pressure or distortion of adjacent anatomical structures.

These other symptoms can include

  • Abdominal fullness, expansion of the abdomen, or bloating,
  • Low back pain,
  • Indigestion,
  • Feeling full after eating only a small amount (early satiety),
  • Urinary urgency,
  • Difficulty with emptying the bladder completely,
  • Feeling an urge to defecate
  • Having difficult bowel movements, or
  • Pain with sexual intercourse


TREATMENT FOR OVARIAN CYST

Treatment depends on age, the type and size of cyst, and symptoms. Suggested treatment methods include:

Watchful waiting:

In many cases, you can wait and be re-examined to see if the cyst goes away within a few months. This is typically an option- regardless of your age- if you have no symptoms and an ultrasound shows you have a simple, small, fluid-filled cyst. A follow-up pelvic ultrasound at intervals to see if the cyst changes in size are recommended.

Medications:

Hormonal contraceptives, such as birth control pills, to keep ovarian cysts from recurring may be recommended. However, birth control pills will not shrink an existing cyst.

Surgery: 

It is recommended that a cyst that is large, growing, does not look like a functional cyst, continues through two or three menstrual cycles, or causes pain should be removed. Some cysts can be removed without removing the ovary (ovarian cystectomy).

In some cases, the affected ovary may be removed and the other ovary is left intact (oophorectomy). If a cystic mass is cancerous, a referral to a gynecologic cancer specialist is recommended.

Sometimes, the womb, ovaries, and fallopian tubes are removed (total hysterectomy) and possibly chemotherapy or radiation. Also, surgery is likely recommended when an ovarian cyst develops after menopause.


FAQs

FAQ on ovarian cyst

Do ovarian cysts always need removal?

Not all ovarian cysts need removal. Functional (follicular) cysts will often resolve spontaneously on their own accord. Surgery may be needed if the cysts are persistent or if there are symptoms (see above). If there is a suspicion of cancer, urgent surgery is necessary to diagnose and provide treatment.

Will I lose my ovary?

Whether the surgery involves removing only the cyst or the entire ovary depends upon your age and what is found during the procedure. If malignancy is suspected, then the ovary should be removed to avoid rupture and spillage of the cyst content. In every other case though, only the cyst will be removed.

How can I prevent recurrent Ovarian cysts?

It may not always be possible to prevent ovarian cysts, but going on the contraceptive pill may prevent cyst formation to a certain degree.

What are the follow-up procedures after removal?

After an ovarian cyst is removed, you will not need further tests if you do not develop any symptoms. However, some types of ovarian cysts, such as endometriomas (chocolate cysts) and functional ovarian cysts, are more likely to recur than others. If you are concerned about recurrent cysts you should undergo yearly pelvic ultrasound scans.


E. Ayala, PharmD in view, member YALI Network, Executive member at Impact Africa Initiative, a member at LEAD (Living Everyday Above Depression), and member Wrighters Community.

REFERENCES

  • https://www.nhs.uk/conditions/ovarian-cyst/
  • https://www.medicalnewstoday.com/articles/179031
  • https://www.webmd.com/women/guide/ovarian-cysts
  • https://www.uofmhealth.org/health
  • https://www.londonwomenscentre.co.uk/conditions/ovarian-cysts
  • https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/diagnosis-treatment/drc-20353411

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