Ovarian cyst: symptoms, diagnosis, types and treatment plan

Ovarian cysts are very common in women of child bearing years. That is because cysts tend to be triggered by the menstrual cycle and the hormonal changes it causes in the body. There are two ovaries present in a woman each about a size and shape of an almond – one on each side of the uterus. The ovaries produce egg (ovulation) and the female hormones oestrogen and progesterone, it also regulates the menstrual cycle and pregnancy.

Ovarian cyst
Ovarian cyst

What is an ovarian cyst

When a fluid filled, or a solid sac like structure develops in or on a woman’s ovary, it is known as an ovarian cyst. They are often asymptomatic and form during ovulation. The cysts are usually harmless and go away on their own without any treatment, but some can be harmful when they do not dissolve on their own or get bigger and become painful. There are chances of ovarian cancer, though rare, in woman who have hit menopause.

Size of ovarian cyst

A normal ovary is 2cm x 3cm (size of an almond). The size of an ovarian cyst is variable ranging from less than 1 cm to 4 cm. A follicular ovarian cyst, if the egg is not released and the fluid starts accumulating, then it can reach to a size of about 10cm. Uncommonly ovarian cysts can form large masses that measure 12 cm or more in diameter. Endometriomas can reach a size of 6cm – 8cm in diameter.

Ovarian cyst is considered large when they are over 5cm and giant when they are over 15 cm. Lets compare the size of ovarian cysts and see what should be there diagnostic approach?

Ovarian Cyst: Diagnostic Approach

Low Risk High Risk
Size Approach Size Approach
Cyst < 3cm No follow up required. Usually dissolves on its own Cyst 5-7cm Yearly follow up required. If the cyst is growing in size, and causing pain, may be removed. Are usually benign.
Cyst 3-5cm Wait and watch. May dissolve on its own. Repeat ultrasound to see the status. Cyst > 7cm Further evaluation with MRI, to look for nature of cyst (simple, complex) and feature of malignancy (solid area in cyst).


Ovarian cyst diagnostic approach
Ovarian cyst diagnostic approach

Symptoms of ovarian cyst

Ovarian cysts are generally asymptomatic, but in some cases, symptoms may be present. Pain in abdomen and pelvis is a common symptom, the other symptoms include-

  • Pain during menstruation or intercourse
  • Abdominal bloating or fullness
  • Nausea
  • Vomiting
  • Unusual bleeding
  • Weight gain
  • Inability to empty the bladder completely
  • Breast pain
  • Pain in the pelvis, lower back or thighs

And the symptoms that need immediate medical attention are as following-

  • Severe abdominal pain that comes suddenly might be a sign of a ruptured cyst or a torsion of cyst.
  • Abdominal pain that is accompanied with vomiting and fever.
  • Fainting
  • Weakness
  • Dizziness
  • Rapid breathing

How does an ovarian cyst form?

An ovarian cyst forms when fluid accumulates within a thin membrane inside the ovary. The size of an ovarian cyst can range from as small as a pea to larger than an orange, they are a result of menstrual cycle (functional cyst). An egg grows in a sac called follicle, this sac is located inside the ovaries, this sac breaks open and releases the egg, when this sac doesn’t break open, the fluid inside the sac or follicle accumulates within a thin membrane inside the ovary and forms a cyst.

Causes of ovarian cyst

  • Some hormones used to treat infertility can cause functional cyst to develop in the ovaries.
  • Some breast cancer medicines can cause ovarian cyst, but they disappear once the treatment is over.
  • During pregnancy ovarian cysts (corpus luteum) forms as there is hormonal changes in the body.
  • Having underactive thyroid can increase the risk of getting ovarian cyst.
  • Endometriosis can cause ovarian cyst.
  • Smokers have a risk of getting functional ovarian cyst.

Types of ovarian cyst

Functional Cyst- Functional cysts are usually harmless, rarely cause any pain and disappear on their own within two or three menstrual cycles.

Functional cysts can be of two types-

  • Follicular Cyst- Around the 14th day of the menstrual cycle (considering 28 days cycle), an egg bursts out of its follicle and travels down the fallopian tube. A follicular cyst forms when the follicle doesn’t rupture and releases the egg but continues to grow.
  • Corpus Luteum Cyst- After the follicle releases the egg, it starts producing oestrogen and progesterone for conception. The follicle now is called a corpus luteum. At times fluid accumulates in the corpus luteum and grows into a cyst.
    • Haemorrhagic Cyst- is an adnexal mass or lump of tissue like structure that forms in the ovaries of a female human body when bleeding occurs into the follicular or corpus luteum. When this happens, the condition is referred to as a haemorrhagic ovarian cyst.

      Types of ovarian cyst
      Types Of Ovarian Cyst

Non- Functional Cysts – There are other types of cysts present that are not related to the normal function of menstrual cycle and can be painful and may need medical emergency, they are as follows-

  • Dermoid Cyst- Also called Teratomas because of its abnormal growth can contain tissue, hair, skin or teeth as they are formed from residual embryonic cells. They can cause ovarian torsion, infection, rupture and in rare cases cancer. A dermoid cyst develops from a totipotential (to grow from a single cell and produce differentiated cells) germ cell that is retained within the egg sac (ovary). Dermoid cyst may occur at any age, but the prime age of detection is the childbearing years. 15% of women can have them in both ovaries. Dermoid cyst can range in size from 1 cm to 45 cm in diameter. The larger the dermoid cyst, the greater the risk of rupture with spillage of the mucinous material which can create problem with adhesion, pain. Majority of these tumours are benign, but some 2% can become cancerous.
  • Cystadenomas- Are a type of benign tumour that develops on the surface of the ovary and are filled with a watery or a mucous material. It tends to be huge in size. They do not affect fertility of a woman in their reproductive years, but they do need to be removed.
  • Classification of a cystadenoma
    • Serous Cystadenoma- They are a type of benign ovarian epithelial tumour accounting for 60% of all serous ovarian tumours. It is found in women within the age range of 40 to 60 years. About 15 -20% cases are bilateral, it may be associated with endometriosis. Most tumours are asymptomatic until they reach a large size. Symptoms include abdominal discomfort, chronic pelvic pain. Some tumours undergo torsion and may cause extreme pain
    • Mucinous Cystadenoma- They are also benign ovarian tumours, they are considered mucinous (mucous) type based on their appearance under a microscope. They generally affect women in the age span of 40 to 50 years. It usually presents as a single mass within the ovary or can occur as multiple masses within a single ovary, it may affect both the ovaries as well. Symptoms include abdominal pain, vaginal bleeding and increased abdominal size. Complete surgical removal of the tumour is suggested.
  • Endometriomas- Also known as Chocolate Cyst are developed as a result of a condition in which uterine endometrial cells grow outside the uterus (endometriosis), some of these tissues attaches itself to the ovary and forms a growth, the area of this endometrial tissue grows and bleeds, as they have no place to shed the tissues and flow out, they form a cyst which is filled with blood and red or brown coloured remnants of the tissues.
  • Polycystic Ovaries- Woman suffering from polycystic ovary syndrome have higher than normal levels of the male hormone called androgen. This excess hormone causes multiple small cysts to form in the ovary, and thus the ovaries swell up. Polycystic ovary syndrome causes hair growth on the face and body, can cause baldness too. It can cause long term health problems like diabetes and heart problem. Women suffering from PCOS have irregular or skipped periods and are insulin resistant.
  • Para-ovarian Cyst- Para means close and ovarium means ovaries, so as the name suggests, it is a cyst near the ovary. They are also called Para-tubal cysts and are epithelium lined fluid filled cysts in the adnexa adjacent to the fallopian tube. Most cysts are small and asymptomatic, sizes range from 1cm-8cm in diameter. These cysts are found during surgery or during any imaging examination. Larger cysts can reach a size of more than 20 cm in diameter and then become symptomatic exerting pressure and pain in the lower abdomen.
Complications that can arise from an ovarian cyst

During a pelvic exam, doctors can find some less common types of cyst. Ovarian cysts that develop after menopause might be cancerous, so it’s important to have regular pelvic examinations. The complications associated with ovarian cysts include-

  • Ovarian torsion- The Cysts that are large can cause the ovary to move out of its original position, increasing the chances of painful twisting of the ovary (ovarian torsion). Symptoms include sudden onset of severe pelvic pain, nausea and vomiting. Ovarian torsion can decrease or stop blood flow to the ovaries and if not treated, it can cause damage or death of the ovarian tissue.
  • Ruptured Cysts- When a cyst ruptures, it causes intense pain and internal bleeding. This increases the risk of an infection and can be life threatening if left untreated.

Diagnosis of ovarian cyst

Most of the ovarian cysts do not have any symptoms and go away on their own. If some women have pain or irregular periods they might visit a doctor.

  • Pelvic Examination- A doctor during a pelvic exam uses an instrument to widen the vagina, and have a look at the vagina, cervix, uterus and other reproductive organs to see any changes or lumps.
  • Ultrasound- If he finds any cyst manually, he will order an ultrasound which helps to understand the size, shape, location and composition (solid or fluid filled) of the cyst.
  • Pregnancy Test- He may also order a pregnancy test, a positive test may suggest, that there is a presence of corpus luteum cyst.
  • CA 125 Blood Test- If the cyst is partially solid and one is at a higher risk of ovarian cancer, a doctor might order a CA 125 blood test. Blood levels of a protein called cancer antigen 125 (CA 125) are often elevated in woman with ovarian cancer. But elevated CA 125 levels are also found in non-cancerous conditions such as endometriosis, uterine fibroids and pelvic inflammatory disease.
  • Other Blood Test- If a woman is under 40, then the doctor might order other blood tests like LDH (lactate dehydrogenase), AFP (alfa- fetoprotein and HCG (human chorionic gonadotropin), these are all tumour markers to check whether the cyst is a type of cancer called the germ cell tumour, though these are very rare.
  • CT Scan- a body imaging device used to create cross-sectional images of internal organs. CT scans do not see small ovarian tumours well, but they can see large tumours and are also able to see if the tumour is growing into nearby structures. It also finds enlarged lymph nodes, can see signs of cancer spread to liver or other organs or signs if an ovarian tumour is affecting a kidney or bladder.
  • MRI- Magnetic resonance imaging, a test that uses magnetic fields to produce in depth images of internal organs. If a doctor finds the cyst as a solid mass, he might recommend a MRI.

Treatment of ovarian cyst

The treatment of an ovarian cyst depends on the age of the patient, the type, size and the symptoms of the cyst. The treatment plan goes as below-

  • Watchful Waiting- As majority of cysts disappear after a few weeks or months a doctor may not immediately recommend a treatment plan. If there is no symptom and an ultrasound report only show, a simple small fluid filled cyst, it is advised to wait and watch and again re-examine if necessary, to see if the cyst has gone on its own.
  • Birth Control Pills- If there is recurrent ovarian cyst the doctor may prescribe oral contraceptive pills to stop ovulation and prevent the formation of new cysts.
  • Laparoscopy is a procedure performed in an operating room, in which a doctor inserts a small device through an incision in the abdomen. The doctor views the reproductive organs and pelvic cavity using this device. If a cyst is seen during this procedure, it will be removed.
  • Laparotomy- If there is a large cyst, size more than 5cm, the doctor will surgically remove the cyst through a large incision in the abdomen. Then they will do a biopsy and if they find the cyst as cancerous, they will do a hysterectomy to remove the ovaries and uterus.


Ovarian cyst prevention

Ovarian cysts cannot be prevented however a routine gynaecological examination can detect ovarian cyst early. Mostly ovarian cysts are benign, but it is important to visit a doctor as symptoms of an ovarian cancer are almost similar, to that of an ovarian cyst, so a correct diagnosis is necessary.

OVARIAN CYST SUCCESS STORY-
Neha (32), name changed on request decided to go the family way after about three years of her marriage.

“After about a year of trying naturally, I didn’t conceive. Each time during my menstrual cycle which was irregular, I had severe pain, at times I had bouts of nausea, diarrhoea and constipation. Initially, I didn’t bother much thinking these symptoms to be associated with my periods. But as I was planning to conceive so thought of consulting a doctor. After going through routine gynaecology tests, I was detected with a large cyst in my left ovary, which was advised to be removed. I could see my dream of becoming a mother being shattered. I had to go through the cyst removal procedure, and my worst fear came true, the cyst was a malignant one! Before starting chemotherapy and radiation I wanted to take an expert opinion from a fertility expert and know my chances of becoming a mother.

I had heard a lot about Medicover Fertility from advertisements as well a friend of mine who had a successful IVF treatment there, so I decided to visit them once. There I spoke to Dr Sweta Gupta, she saw all my reports and told me not to worry. She told Medicover Fertility uses advance fertility treatments and believes in fertility preservation of patients suffering from any kind of serious medical issues. She told, she can retrieve eggs from my unaffected ovary and freeze them. I can still have a baby after my treatment is over. If in any dire consequences, I cannot carry a baby in my womb, I can opt for surrogacy with my own freezed egg and take home my baby.

And yes, thank you Dr Sweta Gupta, I believed in you and today after so many hardships I am a mother to a beautiful daughter. I owe this to Medicover Fertility.”

Doctor’s suggestion – Dr. Sweta Gupta (Clinical Director at Medicover Fertility)

As the signs and symptoms of an Ovarian cancer mimics that of an ovarian cyst. We need to be vigilant and need to visit a Doctor if something is recurrent and bothering us. For young women with ovarian cancer, it is especially important to consider treatment approaches, that incorporate both ovarian cancer treatment and fertility preservation. For these women, because the ovary is the source of fertility and the site of cancer, the challenge we face is to remove the cancer cells as well as preserve the healthy eggs. The fertility preservation options available to a woman detected with ovarian cancer will depend on age, stage, type and location of the cancer, so it is not only a task of an embryologist but a team work of general gynaecologist, gynae-oncologist, operating room staff and reproductive endocrinologists to help the patient preserve the fertility and secure their likelihood of becoming a parent.

Conclusion

The outlook for premenopausal women with ovarian cysts is good. Most cyst disappears within a few months. Recurrent cysts can occur in premenopausal women and in women with hormonal imbalances. If left untreated, some cysts can decrease fertility. This is common with endometriomas and polycystic ovary syndrome. To improve fertility the doctor removes or gives some hormone injections to down regulate the activity of a cyst. Functional cysts, cystadenomas and dermoid cysts do not affect fertility.

Any cyst or growth that develops on the ovaries after menopause should be removed and examined. This is because the risk of developing a cancerous cyst or ovarian cancer increases after menopause. And any cyst that is larger than 5 cm should be removed with a Doctor’s consent.

How can Medicover Fertility help you in dealing with Ovarian Cyst?

Medicover Fertility is a renowned international brand. We have a team of highly skilled and experienced doctors who help couple- dealing with infertility and we have a high success rate. Medicover Fertility has a very high fertility success rate as we use the latest technology in fertility treatments. Here the couples are carefully examined to find out the actual cause of infertility. There are counsellors to take care of the emotional aspect of a patient.

As we know that all ovarian cysts do not cause infertility. Some cysts tend to go on their own. But some like the polycystic ovary syndrome, endometrioma, and some ovarian tumour might cause infertility. Women need to read the signs and symptoms of their body and need to visit a doctor when a symptom is bothering them. Medicover Fertility successfully treats patient suffering from Polycystic ovary syndrome, other types of cysts, tumours that affect fertility by retrieving the healthy eggs and if needed do IVF for those patients.

RELATED QUESTIONS:

Q) Are ovarian cysts painful?

A) Yes, some cysts and tumours cause pain that can be so severe that it starts interfering with daily life, so it is very important to understand your symptoms and consult a doctor when necessary. Pain in the ovaries can be acute or chronic. An ovarian torsion, a ruptured cyst causes immense pain.

Q) How and when ovarian cysts are formed?

A) During a woman’s menstrual cycle, an egg starts growing in a sac called follicle. This sac is located inside the ovaries. Mostly during ovulation, this follicle or sac breaks open and releases an egg. But if the follicle doesn’t break open, the fluid inside the follicle forms a cyst on the ovary.

Q) Are ovarian cysts cancerous?

A) Though relatively rare, some ovarian cysts are cancerous. Symptoms of ovarian cancer are similar to that of ovarian cysts. That’s why it becomes difficult to detect early stage ovarian cancer. So, if there is any pain in the lower abdomen, pelvis, that does not go away, we must at once visit a doctor.

Q) What happens when an ovarian cyst bursts?

A) A cyst that bursts or ruptures may cause no symptoms or only mild symptoms. In some cases, ruptured cysts can cause severe symptoms like pain in the lower abdomen and bleeding. These symptoms need immediate treatment and even hospitalisation. In few cases, ruptured cyst may need an emergency surgery too.

Q) How ovarian cysts are treated?

A) Functional cysts go away on their own. Recurrent ovarian cysts can be treated by giving oral contraceptive pills. A cyst that is more than 5 cm in diameter is removed if it grows and causes pain. Some cysts are removed without removing the ovary (ovarian cystectomy), and in some by removing the affected ovary and leaving the other ovary intact (oophorectomy). If the cystic mass is cancerous, the uterus, ovaries and fallopian tubes (total hysterectomy) are removed.

Q) Can ovarian cyst cause bleeding?

A) Ovarian cysts at times can cause pain and bleeding. Cysts which generally bleed are called haemorrhagic cysts, in certain cases the cysts ruptures and blood may flow into the abdominal cavity. This blood can also pass out as vaginal discharge at times.

Q) Can ovarian cyst cause infertility?

A) Yes, however it depends on the type of cyst. Cyst that become infected and can cause a pelvic infection may cause infertility. Ovarian cysts that contain endometriosis cause infertility. Women suffering from Polycystic ovary syndrome suffer from infertility because they have irregular ovulation so irregular periods because of high levels of androgen.

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