Ovarian Cysts

What Are Ovarian Cysts?

The ovaries produce the eggs in the female reproductive system. Eggs grow, develop, and mature in the ovaries and then are released during ovulation, part of the monthly menstrual cycle that occurs during the childbearing years. Ovarian cysts are fluid-filled sacs that form on the ovaries when the follicles (sacs) on the ovary that contain the egg mature, but do not release the egg into the fallopian tube where it would be fertilized. A woman can develop one cyst or many cysts. Ovarian cysts can vary in size-from as small as a pea to as big as a grapefruit. Most cysts are small and do not cause symptoms. Some cysts might cause a dull ache in the abdomen because they are twisted, bleeding, or have burst; others might cause pain during sexual intercourse. Most cysts are benign (not cancerous). A few cysts, though, may turn out to be malignant (cancerous). For this reason, your doctor should check all cysts. If ovarian cysts are found early, many of the problems they cause can be treated. There are different types of ovarian cysts:

Functional cysts - These cysts are completely normal and form during ovulation. The follicles (sacs) on the ovary that contain the egg often do not mature, and become cysts. These cysts usually disappear during menstruation, before another menstrual cycle begins. If not, they will shrink in about one to three months. Your doctor may want to check in a few months to make sure the cyst has gotten smaller. Only women who are ovulating form functional cysts. If you are in menopause or past menopause and not having periods, you should not have functional cysts.

Endometriomas - These cysts develop in women who have endometriosis, a condition in which tissue from the lining of the uterus (endometrium) grows in other areas, such as on the fallopian tubes, the ovaries, and on other organs outside of the uterus in the stomach. These may be filled with a thick, brown blood and so also are called "chocolate cysts." Because uterine tissue is sensitive to hormones, it bleeds monthly, which may cause it to form a growing cyst on the ovary. These cysts can be painful during sexual intercourse and during menstruation.

Benign cystic tumors (cystadenomas) - These tumors are non-cancerous and are often filled with a fatty liquid. They develop from cells on the outer surface of the ovary. Some of these tumors, called dermoid cysts, are lined with structures such as hair, or pieces of bone. They are often small and may not cause symptoms. They can, however, become large and uncomfortable.

Multiple Cysts - Women who do not ovulate regularly can develop multiple cysts. This is a disorder in which the ovaries are enlarged and contain many small cysts. This can be caused by a condition called polycystic ovary syndrome (PCOS). Symptoms of PCOS include irregular menstrual periods, infertility, and increased body hair.

What Are Ovarian Cysts Symptoms?

Many women may have functional cysts or benign cystic tumors without having any symptoms. Sometimes, though, a cyst will swell large enough to cause pressure or pain in the abdomen. The cysts also may put pressure on the urinary tract and cause problems with urine flow. Some women may have pain during sexual intercourse. Although it is rare, it is possible for a very large cyst to become twisted, stopping its own supply of blood. This can cause nausea, fever, and severe abdominal pain. In women with endometriosis, ovarian cysts can cause the commonly felt symptoms of pelvic pain, painful menstrual periods, abnormal bleeding and painful sexual intercourse.

When Are Women The Most Likely To Develop Ovarian Cysts?

Ovarian cysts are very common during the childbearing years. Most often, cysts in women of this age group are not cancerous. Women who are past menopause (ages 50-70), however, and have ovarian cysts, have a higher risk of having ovarian cancer. If you are over 50 and have an ovarian cyst, your doctor will probably want to do surgery to remove it. However, if you think you might have a cyst, at any age, you should tell your health care provider.

How Can Ovarian Cysts Be Diagnosed and Treated?

Ovarian cysts usually are found during routine pelvic examinations. During this examination, your doctor is able to feel the swelling of the cyst on your ovary. Once a cyst is found, the doctor may perform an ultrasound, or a screening to see if the cyst is hollow or solid, determine its size and exact location, and see if it contains fluid or abnormal structures that help show its type. The doctor may decide to "wait and see" if the cyst will shrink on its own in a few months. If you frequently develop cysts, your doctor may prescribe birth control pills to prevent you from ovulating. This will prevent follicles from developing and new cysts from forming. Your doctor might talk with you about birth control pills, and if they are right for you.

If the cyst does not go away after several menstrual periods, if it has gotten larger or more painful, or it does not appear to be a functional cyst, your doctor may want to perform other tests or procedures to look at and remove the cyst. To detect your risk for ovarian cancer, your doctor may want to do a blood test to measure a substance in the blood called CA-125. The amount of this protein is increased in the blood of women with ovarian cancer. However, some ovarian cancers do not produce enough CA-125 to be detected by the test, and there are other non-cancerous diseases that also increase the levels of CA-125. For these reasons, the CA-125 test is recommended mostly for women who are at high risk for the disease.

If the cyst is small and looks benign on the ultrasound, your doctor may perform a laparoscopy. This procedure is done under general anesthesia on an outpatient basis and allows the doctor to closely examine all of your reproductive organs. A very small incision is made above or below the navel, and a small instrument that acts like a telescope is inserted into the abdomen. If the cyst is small and looks benign, it can be removed after the doctor makes very small incisions in the pubic hairline.

If the cyst is too large to remove this way, the doctor may perform a procedure called a laparotomy. This procedure involves making bigger incisions in the stomach to remove the cyst. While you are under general anesthesia, the doctor is able to have the cyst tested to find out if the tissue is cancerous. If it is cancerous, the doctor will then be able to remove other tissue that could be affected, like the ovary, fallopian tubes, uterus, or lymph nodes. Before any surgery, your doctor will talk to you about what will happen during the surgery, the risks, and how long it will take you to recover. It is important to remember that most cysts are not cancerous and relatively harmless if treated properly.

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