Ovarian Cysts

What are ovarian cysts?

A cyst is a sac filled with fluid and can be found in several different areas of the body, including the ovaries. A cyst on the ovary is known as an ovarian cyst, which is a complaint that can be very common, though they often do not cause any problems. Conversely, if the cyst is very large or starts to cause problems treatment may be required.

Ovarian cysts can affect females of all ages. In the majority of cases they do not cause symptoms and almost all women will have an ovarian cyst at one point in their lives. Cysts that result in symptoms are less common and it is estimated that only 1 in 25 women will develop a cyst that causes problems. It is rare for ovarian cysts to have negative implications on fertility.

They are classified as either functional or pathological ovarian cysts. Functional cysts, which do not normally result in any symptoms, are formed as part of the menstrual cycle. They are much more common than pathological cysts, which are formed as a consequence of abnormal cell growth.

What causes ovarian cysts?

Functional cysts

Functional ovarian cysts are formed as part of the natural menstrual cycle and are completely harmless. There are two forms of functional ovarian cyst, which are luteal and follicular cysts.

Follicular cysts are the more widespread form of ovarian cyst and are formed when the follicle (a minute structure which holds the egg in the ovary and contains protective fluid) does not fully drain, causing the follicle to increase in size. When the follicle becomes filled with fluid, this is known as a follicular ovarian cyst.

Luteal cysts are caused by the corpus luteum, which is the tissue that remains once an egg is released. In the forming of luteal cyst this becomes filled with blood. In most cases the cysts disappear without treatment but there is a risk of the cyst rupturing.

Pathological cysts

There are two foremost types of pathological cysts. Dermoid cysts are most common in females aged above 40, while cystadenomas are often found in women under the age of 40. Dermoid cysts form from cells that are used to form the egg and can be made from different body tissue, including hair and bone. Dermoid cysts can develop to be quite large and are usually removed.

Cystadenomas come into being from cells on the outer section of the ovary and do not typically become large, but there is a risk of rupture.

Some health conditions, including endometriosis and polycystic ovarian syndrome, can increase the risk of ovarian cysts.

Symptoms of ovarian cysts

In many cases ovarian cysts do not cause symptoms. Generally speaking a cyst will usually only result in apparent symptoms if it is large, ruptures or it is obstructing blood flow to the ovaries. In these cases the following symptoms may develop:

  • Problems emptying the bowel.
  • Needing to urinate on a regular basis.
  • Changes to your normal period.
  • Pain in the pelvis during sexual intercourse.
  • Pelvic pain: this can be sharp (if there is an obstruction) or a dull ache (if the cyst is large).
  • Feeling full or bloated.
  • Indigestion.

If you notice changes to your normal menstrual cycle or you experience pelvic pain on a regular basis, or you have pains that do not go away, you should see your GP. If you experience a very sudden sharp pain, see your GP as quickly as possible or contact your local out of hours service if the surgery is closed.

How is an ovarian cyst diagnosed?

Many people have ovarian cysts but do not know it because they do not develop any symptoms. Sometimes cysts can be diagnosed by chance; for example, during tests or examinations for other conditions. If your GP suspects that you have a cyst which is causing symptoms, they will refer you to a specialist gynaecologist for tests. Such testing may include:

  • Ultrasound scan.
  • Blood tests.

Treating ovarian cysts

In most cases ovarian cysts go away without treatment. If you are diagnosed as having an ovarian cyst, your doctor will decide whether or not to treat it based on how large it is, whether it is causing symptoms and whether or not you have experienced the menopause.

In many cases doctors adopt a policy of watchful waiting, which means that they will keep an eye on the cyst without treating it immediately. Females who have been experienced the menopause are likely to be encouraged to have regular blood tests and scans until the cyst has completely disappeared, as there is a slightly higher risk of ovarian cancer.

Surgery is used to remove cysts that are causing problems and those that are large. Surgery is usually done under general anaesthetic and can be done either through keyhole surgery (laparoscopy) or in the traditional manner (open surgery, known as laparotomy). Laparoscopy is done where possible, as scarring is reduced and the procedure is less invasive; however, it may not be possible for larger cysts. If a laparotomy is performed the cyst and the ovary will be removed and sent to the laboratory to check if the cyst is cancerous. If this is the case the patient will be referred to an oncologist for specialist cancer treatment, which may involve removing the other ovary and the uterus (the womb).

After surgery

Following surgery it is normal to experience mild abdominal pain, but you should seek medical attention if you develop any of the following symptoms (they may be symptomatic of an infection and should be checked out as soon as possible):

  • Severe pain in the abdomen.
  • Severe bloating.
  • Fever (a high temperature).
  • Heavy bleeding.
  • Dark or unpleasant smelling discharge from the vagina.
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