Before we delve into ovarian cysts, let's take a quick look at the amazing organs themselves - the ovaries. The ovaries typically exist in pairs. They are positioned in the lower abdomen on either side of the uterus. Their primary functions include the production and release of eggs (ovulation) and the secretion of hormones such as estrogen and progesterone. These hormones play a vital role in regulating menstrual cycles, pregnancy, and maintaining the overall balance of the female reproductive system.
Ovarian cysts are fluid-filled or semi-solid sacs that form on or within the ovaries. Pelvic masses, often ovarian cysts, are quite common, affecting approximately 20% of women during their lifetime. In most cases, these cysts are harmless. They usually disappear on their own within a few months. A cyst becomes problematic if it persists, increases in size, induces bleeding, or begins to cause pain. The vast majority of ovarian cysts are non-cancerous (benign), although a small number are cancerous (malignant).
Functional ovarian cysts form as part of the menstrual cycle. These cysts arise from follicles, small structures that produce hormones and break open to release an egg each month. Two types include:
Follicular cyst: Forms when a follicle fails to release its egg and continues to grow.
Corpus luteum cyst: Develops after ovulation, if a blockage occurs at the opening where the egg exited, followed by fluid buildup in the follicle (now corpus luteum), forming a cyst.
Pathological cysts include:
Dermoid cyst: Develops from germ cells (reproductive cells that make eggs in the ovary ) and can contain hair, skin, or teeth
Cystadenoma: Benign tumors on the ovary surface, filled with fluid or mucus, and can grow very large.
Endometrioma: Endometriosis tissue (tissue lining the uterus) forms a cyst on the ovary.
Very small ovarian cysts usually won't cause noticeable symptoms. Functional cysts may cause continuous dull lower abdominal pain, especially at the time of the menstrual cycle. Some patients may experience excessive bleeding or irregular periods. Severe pain during menstruation (dysmenorrhea) and in between menstrual cycles warrants immediate medical attention. Larger ovarian cysts can result in acute abdominal pain, especially if they twist (torsion), accompanied by sudden vomiting, fever, and difficulty in walking. This acute pain is localized to the loin area, typically on the right or left side where the cyst is located. Immediate medical attention is crucial if torsion pain occurs.
Dr. M. Vanitha, MD, DGO, Associate Professor, Government Medical College, Thoothukudi, and Consultant Obstetrician-Gynaecologist, Royal Hospitals, Tirunelveli, Tamil Nadu, India
Ovarian cysts are more common in those who haven't undergone menopause. They are more prone to develop and persist during pregnancy. A history of ovarian cysts increases the likelihood of experiencing them again in the future. Furthermore, certain medical conditions can elevate the risk, including endometriosis and hormone imbalances, as well as the use of medications to stimulate ovulation.
A self-diagnosis is possible only when that cyst becomes very large. The ovary, being a pelvic organ, is not clinically palpable even by a doctor, unless it gets enlarged more than two times. Only when the cyst enlarges and the ovary comes across the pelvic bone, patients can feel heaviness or stretching pain in the lower abdomen. So, self-diagnosis is somewhat difficult.
Dr. M. Vanitha, MD, DGO, Associate Professor, Government Medical College, Thoothukudi, and Consultant Obstetrician-Gynaecologist, Royal Hospitals, Tirunelveli, Tamil Nadu, India
Ovarian cysts can be diagnosed through a routine pelvic exam. Imaging tests like ultrasonography assess the size, shape, type, and location of cysts. Sometimes, a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan is also utilized. In case of a partially solid ovarian cyst, the doctor may recommend blood tests to measure levels of CA 125 (cancer antigen 125). Elevated levels are commonly associated with ovarian cancer, uterine fibroids, and endometriosis.
Treatment will vary according to the situation. Functional cysts often resolve over a period of two to three months. If the size of the cyst is less than 5 to 6 cm and the patient is asymptomatic, periodic monitoring with ultrasound is needed. If the size is not decreasing, they go for hormonal therapy for 3 to 6 months. Most of the time, 90% of the cysts will resolve.
Dr. M. Vanitha, MD, DGO, Associate Professor, Government Medical College, Thoothukudi, and Consultant Obstetrician-Gynaecologist, Royal Hospitals, Tirunelveli, Tamil Nadu, India
Benign cysts don't respond to any hormonal treatment and they need some sort of surgical management if they are not resolving in size. Nowadays, we are following the laparoscopic surgical procedure for a benign cyst, and for a cancerous growth, the treatment has to be done with a surgical oncologist. Particularly, when there is a family history of not only ovarian but also breast cancer, and uterine (endometrial) cancer, close monitoring is needed. Periodically, they should undergo transvaginal ultrasound, breast self-examinations, and mammograms to rule out cancer.
Dr. M. Vanitha, MD, DGO, Associate Professor, Government Medical College, Thoothukudi, and Consultant Obstetrician-Gynaecologist, Royal Hospitals, Tirunelveli, Tamil Nadu, India
Most ovarian cysts cannot be prevented. However, regular pelvic exams aid in the early detection of any changes in the ovary. Paying attention to variations in your menstrual cycle and taking note of any unusual symptoms that persist for more than a few cycles is crucial. It should then be discussed with your gynecologist to prevent complications.
References:
1. https://www.mayoclinic.org/diseases-conditions/ovarian-cysts/symptoms-causes/syc-20353405
2. Mobeen S, Apostol R. Ovarian Cyst. 2023 Jun 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32809376.
3. https://health.clevelandclinic.org/signs-you-have-an-ovarian-cyst-and-what-to-do-about-it
4. https://www.nhs.uk/conditions/ovarian-cyst/
5. Mustafin C, Vesnin S, Turnbull A, Dixon M, Goltsov A, Goryanin I. Diagnostics of Ovarian Tumors in Postmenopausal Patients. Diagnostics (Basel). 2022 Oct 28;12(11):2619. doi: 10.3390/diagnostics12112619. PMID: 36359464; PMCID: PMC9689025.
