Ovarian cysts are fluid-filled sacs which develop in the ovaries. It is very common and occurs during ovulation. Cysts are harmless and may or may not cause any symptoms but once they rupture, they can cause severe symptoms.
Ovaries are part of the reproductive system of a woman and they are located on both sides of the uterus. Females are born with two ovaries which release an egg during ovulation. They also secrete sex hormones which are estrogen and progesterone.
Research has shown that worldwide, about 7% of women have an ovarian cyst at some point in their lives. The American College of Obstetricians and Gynecologists (ACOG) stated that simple cysts found on ultrasound may be safely followed up without intervention, even in postmenopausal women. These cysts are rarely cancerous, neither do they increase the risk of developing cancer.
Types of ovarian cysts
There are several types of cysts that can present in the ovary but the most common ones are the functional cysts.
The two types of functional cysts are:
- Follicular cyst: Every month, the ovaries usually grows cyst-like structures called follicles. These follicles produce the hormones estrogen and progesterone which regulate the females cycle and eventually cause the release of an egg from the ovary when you ovulate. Failure to release this egg as well as continous growth of this follicle will lead to cyst formation
- Corpus luteum cyst: When the follicle finally releases its egg, the follicular sac normally degenerates but if it does not, it begins producing the sex hormones (estrogen and progesterone) for conception. At this point, the follicle is now called the corpus luteum. Fluid can accumulate inside the follicle which can cause the corpus luteum to grow into a cyst.
Other types of ovarian cysts include:
- Dermoid cysts: These are sac-like growths that can present in the ovaries. They are also called teratomas and they can contain hair, fat, and other tissue. They rarely progress to cancer.
- Cystadenomas: They are also noncancerous growths that can develop on the outer surface of the ovaries. They may contain water or mucus.
- Endometriomas: This occurs when tissues that are normally supposed to be in your uterus grow on the outside wall of the uterus or in some cases on the ovaries.
Some women develop a condition called polycystic ovary syndrome. In this condition, the ovaries contain a large number of small cysts and produce an abnormally large amount of androgens (male sex hormones). It can cause the ovaries to enlarge. If left untreated, it can lead to infertility.
Symptoms of an ovarian cyst
Most times, ovarian cysts are small and may cause no symptoms. However, symptoms can develop as the cysts increase in size. Some of the symptoms include:
- Painful bowel movements
- Pelvic pain before or during menstruation
- Lower abdominal pain
- Painful sexual intercourse
- Lower back pain
- Breast tenderness
- Nausea and vomiting
- Bladder fullness (needing to urinate more often)
The pain from ovarian cyst may vary. It may come and go and it could also be sharp or dull
When severe symptoms occur, it may require immediate medical attention, some of these symptoms include:
- Sudden severe, sharp lower abdominal pain
These symptoms can mean the cyst has ruptured or there is an ovarian torsion(twisting of an ovary). Please see your doctor for further evaluation.
Ovarian cysts and fertility
Ovarian cysts does not really stop you from getting pregnant, but it can make it harder to conceive
If surgery is needed to remove the cysts, the surgeon aims at preserving your fertility. This may mean removing just the cyst and leaving the ovaries intact, or only removing 1 ovary.
In a few cases, surgery might be recommended to remove both ovaries, meaning that you no longer produce eggs. Ensure you speak to your doctor extensively as regard your fertility before any surgery is done
Complications of ovarian cysts
Most ovarian cysts are benign and most times they go away on their own without treatment. A few complications of ovarian cysts include:
- It can be cancerous in rare cases.
- Ovarian torsion is another rare complication of ovarian cysts. This is when a large cyst causes an ovary to twist or move from its original position causing the blood supply to the ovary to be cut off. If left untreated, it can cause damage or death to the ovarian tissue. It is not common but when it occurs, it is usually an emergency.
- Cyst can rupture causing severe pain and internal bleeding. This complication can increase your risk of developing an infection and can be life-threatening.
Diagnosing an ovarian cyst
Ovarian cyst can be detected during a routine pelvic examination. Once a swelling is observed, an ultrasound can be done to confirm the presence of a cyst.
Some Imaging studies used to diagnose ovarian cysts include:
- Computerized tomography scan (CT or CAT scan)
- Magnetic resonance imaging (MRI)
- Ultrasound : It is an imaging device used to visualize the ovary. It helps visualize the location, shape and composition of the cyst.
Because most cysts disappear after a few weeks or months, treatment might not commence immediately. Instead, your doctor might suggest you repeat the ultrasound scan in a few weeks or months to monitor its progression.
If no changes is present, your doctor will request additional tests to determine other causes of your symptoms.
These tests include:
- Pregnancy test: If positive, might suggest that you have a corpus luteum cyst.
- Checking for hormone levels to rule out hormone-related issues, such as too much estrogen or progesterone
- CA-125 blood test: Increased blood levels of this protein called cancer antigen 125 (CA 125) is suggestive of ovarian cancer.
Once the doctor discovers your age, the size and type of cyst you have, treatment will commence and the treatment resolves around these factors. The following options might be recommended:
- Watch: A lot of cysts go away on their own. Your doctor may suggest watching and waiting for any changes. If your ultrasound shows you have any type of cyst, your doctor might recommend that you get follow-up pelvic ultrasounds at intervals to see if your cyst changes in size.
- Medication: Your doctor can prescribe pain medications for you. Birth control pills (oral contraceptive) can also be prescribed by your doctor. Although this will not make the the cysts go away, it can prevent formation of new ones.
- Surgery: Some ovarian cysts need surgery. These include large cysts that do not go away, or cause symptoms. Surgery could be also be suggested if you are near menopause, because most cysts are cancerous at this point. Depending on how severe your case is, the surgeon might suggest removal of the cyst or the entire ovary. Some cysts can be removed without removing the ovary (ovarian cystectomy). While in some cases, the affected ovary might be removed leaving the other one intact (oophorectomy).
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