Ovarian cysts: symptoms, treatment, and causes

Ovarian cysts: symptoms, treatment, and causes

Cysts can develop anywhere on the body, some may be microscopically small and others very large.

An ovarian cyst is an accumulation of fluid within an ovary that is surrounded by a very thin wall. Ovarian cysts can range widely in size, from as small as a pea to larger than an orange. In rare cases, ovarian cysts can become so large that the woman looks pregnant.

A cyst is a closed sac-like structure - an abnormal pocket of fluid, similar to a blister - that contains either liquid, gaseous, or semi-solid material.

The majority of ovarian cysts are small and harmless and occur most frequently during a female's reproductive years. However, ovarian cysts may affect a woman of any age.

Generally, there are no signs or symptoms, but, in some cases, ovarian cysts can cause pain and bleeding. If the cyst is over 5 centimeters in diameter, it may need to be surgically removed.

  • An ovarian cyst is a buildup of fluid within an ovary surrounded by a thin "shell."
  • A cyst is a closed sac-like structure similar to a blister.
  • Ovarian cysts are usually harmless.
  • There are 2 main types of ovarian cysts: functional ovarian cysts and pathological cysts.
  • In most ovarian cyst cases, they will cause no signs or symptoms.

What is an ovarian cyst?

A cyst can develop anywhere in the body and may vary in size - some are so tiny they can only be observed through a microscope, while others may become so large that they displace normal organs.

There are 2 main types of ovarian cysts:

  • Functional ovarian cysts - the most common type. These harmless cysts form part of the female's normal menstrual cycle and are short-lived.
  • Pathological cysts - these are cysts that grow in the ovaries; they may be harmless or cancerous (malignant).
  • Cysts are divided from surrounding tissue by a membrane. The outer or capsular portion of a cyst is called the cyst wall. If the sac is filled with pus it is not a cyst; it is an abscess.

    Symptoms of ovarian cysts

    Most cysts are symptomless, but, if there are symptoms, they are not very useful for diagnosing ovarian cysts.

    There are several other conditions with similar signs and symptoms, including:

    • endometriosis
    • pelvic inflammatory disease
    • ectopic pregnancy
    • ovarian cancer

    A ruptured ovarian cyst may present similar symptoms to those of appendicitis or diverticulitis.

    Signs and symptoms of an ovarian cyst may include:

    • Irregular menstruation - periods may also become painful, heavier or lighter than normal.
    • Pain in the pelvis - this may be persistent pain or an intermittent dull ache that spreads to the lower back and thighs. Pelvic pain may appear just before menstruation begins or ends.
    • Dyspareunia - pelvic pain during sexual intercourse. Some women might experience pain and discomfort in the abdomen after sex.
    • Bowel issues - including pain when passing a stool, pressure on the bowels, or frequent need to pass a stool.
    • Some pregnancy symptoms - including breast tenderness and nausea.
    • Abdominal issues - bloating, swelling, or heaviness in the abdomen.
    • Urinary issues - problems fully emptying the bladder or feeling the need to urinate frequently.
    • Hormonal abnormalities - in some rare cases, the body produces abnormal amounts of hormones, resulting in changes in the way the breasts and body hair grow.

    Complicated cyst signs and symptoms

    • Torsion - the stem of an ovary can become twisted if the cyst is growing on the stem, blocking the blood supply to the cyst and causing severe pain in the lower abdomen.
    • Bursting - if the ovarian cyst bursts, the patient will experience severe pain in the lower abdomen. If the cyst is infected, pain will be worse. There may also be bleeding.
    • Cancer - in rare cases, an ovarian cyst may be an early form of ovarian cancer.

    What treatments for ovarian cysts are available?

    The main factors are:

    • the patient's age
    • whether the patient is pre-or postmenopausal
    • the appearance of the cyst
    • the size of the cyst
    • whether or not there are any symptoms

    Watchful waiting (observation)

    Sometimes watchful waiting, also known as observation is recommended, especially if the woman is pre-menopausal and has a small functional cyst (2-5 centimeters). An ultrasound scan will be carried out about a month or so later to check it, and to see whether it has gone.

    Birth control pills

    To reduce the risk of new cysts developing in future menstrual cycles, the doctor may recommend birth control pills. Oral contraceptives also reduce the risk of developing ovarian cancer.


    Surgery may be used as a treatment for persistent cysts.

    The doctor may recommend that the patient have it surgically removed if there are symptoms, the cyst is large, does not look like a functional cyst, is growing, or persists through 2-3 menstrual cycles.

    Two types of surgery that may take place are:

    • Laparoscopy (keyhole surgery) - with very small tools, the surgeon can remove the cyst through a small incision. In most cases, the patient can go home the same day. This type of surgery does not usually affect a woman's fertility, and recovery times are fast.
    • Laparotomy - a more serious operation; it may be recommended if the cyst is cancerous. A longer cut is made across the top of the pubic hairline. The cyst is removed and sent to the lab. The patient usually has to remain in the hospital for at least 2 days.

    Cancer treatment

    If the cyst is cancerous, the patient may need to have more organs and tissue removed, such as the ovaries and uterus.

    Causes of ovarian cysts

    As the causes are different for each type of ovarian cyst, we will look at each type in turn.

    Functional ovarian cysts

    There are 2 types of functional ovarian cysts:

    1) Follicular cysts

    Follicular cysts are the most common type of ovarian cyst. A female human has two ovaries. The egg moves 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 does not release an egg. The follicle swells with fluid, becoming a follicular ovarian cyst. Typically, one cyst appears at any single time and normally goes away within a few weeks.

    2) Luteal ovarian cysts

    These are much less common. After the egg has been released, it leaves tissue behind (corpus luteum). Luteal cysts can develop when the corpus luteum fills with blood. In most cases, this type of cyst goes away within a few months. However, it may sometimes split (rupture), causing sudden pain and internal bleeding.

    Pathological cysts

    There are 2 types of pathological cysts:

    1) Dermoid cysts (cystic teratomas)

    A dermoid cyst is usually benign. They are formed from the cells that make eggs. These cysts need to be removed surgically. Dermoid cysts are the most common type of pathological cyst for women under 30 years of age.

    2) Cystadenomas

    Cystadenomas are ovarian cysts that develop from cells that cover the outer part of the ovary. Some are filled with a thick, mucous-like substance, while others contain a watery liquid. Rather than growing inside the ovary itself, cystadenomas are usually attached to the ovary by a stalk. By existing outside the ovary, they have the potential to grow considerably. Although they are rarely cancerous, they need to be removed surgically.

    Cystadenomas are more common among women aged over 40 years.

    How are ovarian cysts diagnosed?

    Ultrasound is a common method of diagnosis of ovarian cyst.

    As most ovarian cysts present no signs or symptoms, they frequently go undiagnosed. Sometimes, even without symptoms, a cyst may be diagnosed during an unrelated pelvic examination or ultrasound scan.

    Diagnosis aims to find:

    • the shape of the cyst
    • the size of the cyst
    • the composition of the cyst - is it filled with solid, fluid, or both?

    The following diagnostic tests may also be ordered:

    • ultrasound scan
    • blood test
    • pregnancy test
    • laparoscopy

    Prevention of ovarian cysts

    There is no definite way of preventing ovarian cyst growth. However, regular pelvic examinations, which allow for early treatment if needed, usually protect the woman from complications.

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    Section Issues On Medicine: Women health