An ovarian cyst is a sac or pouch that develops in or on the ovary. The cysts may contain liquid, or solid material or a combination of both. Ovarian cysts are very common, particularly in women between the ages of 30 and 60. They may be single or multiple, and can occur in one or both ovaries. Most are benign (non-cancerous), but approximately 15 percent are malignant (cancerous).
During ovulation (the process during which the egg ripens and is released from the ovary) the ovary produces a hormone to make the follicles (sacs containing immature eggs and fluid) grow and the eggs within it mature. Once the egg is ready, the follicle ruptures and the egg is released. Once the egg is released, the follicle changes into a smaller sac called the corpus luteum. Ovarian cysts occur as a result of the follicle not rupturing, the follicle not changing into its smaller size, or doing the rupturing itself. There are five (5) common types of ovarian cysts: functional cysts, polycystic ovaries, endometrial cysts, cystadenomas and dermoid cysts. Functional Cysts There are two types of functional cysts - follicle cyst and corpus luteum cyst. Both of these types of cysts develop as part of the natural function of the ovary.
- Follicle Cyst. This cyst occurs during ovulation when an egg is released into the fallopian tube or when a developing follicle fails to rupture. These cysts grow from 1Â½ inches to 2 inches in diameter, and will usually dissolve within one to three months.
- Corpus Luteum Cyst. This cyst is caused by a malfunction of the corpus luteum. Unless a woman is pregnant, the corpus luteum disintegrates. But in the formation of a corpus luteum cyst, it fills with fluid and remains in the ovary.
Polycystic ovaries (also known as polycystic ovarian syndrome or disease) is a condition in which the follicles never erupt from the ovaries. Under normal circumstances, follicles grow, mature, and rise to the surface of the ovary, where they burst and release an egg to the Fallopian tube, a process controlled by pituitary hormones. The remnants of the burst follicle then begin to produce progesterone, which stimulates the lining of the uterus (endometrium) to grow thicker in case it needs to support a fertilized egg. The effect on the pituitary of an increase in progesterone production is to signal it to stop stimulating the development of eggs. In polycystic ovaries, the follicles grow just under the ovaries' surface, and are produced again and again because the pituitary has not been signaled to shut off. Both ovaries become filled with tiny cysts and can become enlarged.
Endometrial cysts (also known as endometriomas or "chocolate cysts" (filled with dark blood)) form as a result of endometriosis. Endometriosis is a disease in which the endometrial tissue normally found in the uterus grows in other areas. After successive menstrual cycles, this misplaced endometrial tissue bleed, gradually forming endometrial cysts. Over time the cysts grow and can become as large as a grapefruit.
Cystadenomas are known as neoplasms (new growths). Ovarian neoplasms are new and abnormal formations that develop from the ovarian tissue. There are two (2) types of cystadenomas - serous and mucinous.
- erous cystadenom
- ucinous cystadenom
Dermoid cysts are also known as ovarian neoplasms and consist of skin or related tissue such as hair, teeth or bone instead of fluid like the cystadenomas. Dermoid cysts develop from the ovary's germ cells (cells that produce the egg and the beginnings of all human tissues). Dermoid cysts may be present at birth but are not noticed until adulthood. They generally measure between 2 inches to 4 inches in diameter.
Cysts may grow quietly and go unnoticed until they are found on routine examination. However, if they are ruptured (by sexual intercourse, injury or childbirth) and/or become large enough, the following symptoms may occur:
- Intense abdominal pain (symptom in all types of cysts)
- Menstrual changes such as late periods, bleeding between periods or irregular periods (symptom occurring in corpus luteum cysts and polycystic ovaries)
- Heavy menstrual flow (symptom occurring in polycystic ovaries)
- Infertility (symptom occurring in polycystic ovaries and endometrial cysts)
- Internal bleeding (symptom occurring in endometrial cysts)
- Severe menstrual cramps (symptom occurring in endometrial cysts)
- Pain with sexual intercourse (symptom occurring in endometrial cysts)
- Pain during a bowel movement (symptom occurring in endometrial cysts)
- Weight gain (symptom occurring in polycystic ovaries and endometrial cysts)
If a cyst becomes twisted, the woman may experience spasmodic pain. Sudden or sharp pain may mean a cyst has ruptured. The twisting or rupture of a cyst may increase the likelihood of an infection. If the woman is experiencing abdominal pain, fever, vomiting and symptoms of shock such as cold, clammy skin and rapid breathing, get help immediately.
The doctor will take a thorough medical history, perform a physical examination, and conduct laboratory and diagnostic tests. During the physical examination the doctor will do a pelvic exam. During a pelvic exam the doctor will put an instrument called a speculum into the vagina. This instrument opens the vagina so the doctor can see the vaginal walls and the cervix, and can get samples of vaginal discharge (called a Pap smear). The doctor will gently clean the cervix with a cotton swab and then collect a sample of cells from the cervix with a small brush, a tiny spatula, or a cotton swab. This sample is "smeared" on a glass slide and sent to a laboratory for examination under a microscope by an expert. Once the speculum is removed, the doctor will do a bimanual exam. This involves inserting two fingers into the vagina and with the other hand pressing on the abdomen. This exam allows the doctor to feel the size and shape of the uterus and ovaries. If an ovarian cyst is present, the ovaries feel larger than normal and the exam itself causes the woman discomfort. If the doctor suspects cysts he will recommend additional laboratory and diagnostic tests. Laboratory tests include a complete blood count (CBC) to detect infection and internal bleeding, and a pregnancy test to detect uterine pregnancy or ectopic (tubal) pregnancy. Diagnostic tests include an ultrasound, and if needed, an x-ray and laparoscopy. Ultrasound uses sound echoes to provide a picture of the tissues and organs inside the body. Using this technology the doctor can see where, how big, how many and what the cysts are made of. If the cyst is composed of solid materials or a combination of fluid and solid materials, the doctor may recommend an x-ray of the area where the cyst resides. This x-ray can reveal whether the cyst is a benign dermoid cyst or a malignant tumor. Doctors will recommend an additional diagnostic test called a laparoscopy if endometriosis is suspected, if the cyst is very large, if the cyst is not fluid-filled, or if the woman is over the age of 40 when the risk of cancer begins to increase. Laparoscopy involves the insertion of narrow tube with a fiberoptic light at one end (called a laparoscope) into the lower abdomen through a small incision just below the navel to view the ovaries, and if necessary drain the fluid from the cyst or remove the cyst entirely.
Treatment depends on many factors, including the type of cyst, its size, its location, the type of material it contains and the woman's age. For functional cysts a "watch and wait" approach is taken. Functional cysts tend to dissolve over time and treatment is not needed. The doctors do, however, require the woman to return after two menstrual cycles to get a pelvic exam and/or ultrasound again. If the cyst is still present and growing (over 2 inches) the doctor may recommend a laparoscopy to remove the cyst. If the cyst comes and goes, the doctor may prescribe birth control pills. These pills reduce the hormones that promote growth of cysts and prevent formation of large cysts. For polycystic ovaries the treatment varies. A major symptom of polycystic ovaries is infertility, and whether the woman is trying to conceive or not determines the treatment. If the woman is trying to conceive and having fertility problems, the doctor will prescribe Clomid which helps stimulate ovulation. If the woman is not trying to conceive and is having infrequent or no periods, the doctor will prescribe Provera. Provera restores normal menstrual flows. For endometrial cysts, cystadenomas and dermoid cysts the treatment is to surgically remove the cyst. If the cyst is small enough the doctor can remove it via laparoscopy. If the cyst is over 2 ½ inches in diameter the available procedures are:
- Ovarian cystectomy - removal of cyst
- Partial oophorectomy - removal of the cyst and a portion of the ovary
- Salpingo-oophorectomy - removal of the cyst, ovary and fallopian tube. This procedure is done dependent upon the size of the cyst and complications encountered such as bleeding, rupturing and twisting of the cyst.
- Total abdominal hysterectomy with bilateral salpingo-oophorectomy - removal of the cyst, both ovaries, fallopian tubes and uterus. This procedure is rarely used unless the cyst is cancerous.