Ovarian cyst - What is an ovarian cyst?

Article by Dr Christopher Ng

Ovarian cyst - What is an ovarian cyst?

Dr Christopher Ng

Obstetrician & Gynaecologist
Imperial College, London, United Kingdom
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An ovarian cyst is a fluid filled sac arising from the ovary. They can vary in size and number. Ovarian cysts may occur in women of all ages at any point in their lives. Most cysts are harmless, asymptomatic and may resolve on their own.

Who are prone to Ovarian Cyst?

Women of all age groups can develop cysts depending on the nature of the cyst. Cancerous cysts tend to occur in older women most often after menopause, though it can occur at any age. The risk factors for cancerous cyst include an inherited gene mutation (small percentage), a positive family history, never been pregnant before and a previous history of cancer of the breast and colon.

Most benign cysts are functional cyst (follicular and corpus luteum) in that they appear and disappear at various times during the menstrual cycle so they occur in younger women of reproductive age.  A follicular cyst develops when the follicle does not rupture and release the egg (anovulation). The follicle grows instead to form a cyst. A corpus luteum cyst develops when the egg is released followed by bleeding into the follicle creating a cyst. These functional cysts are harmless, asymptomatic and spontaneously resolve within 2 to 3 cycles.

Endometriotic cysts, dermoid cysts and cystadenomas are benign cysts that are not related to the menstrual cycle. Endometriosis is a condition where the tissues that line the inside of the womb (endometrium) are found outside the womb and implant into the ovaries forming endometriotic cysts. These endometrial tissues continue to bleed with each menstrual cycle. Endometriotic cyst may enlarge and rupture causing acute severe pelvic pain. Dermoid cysts may contain tissue such as hair, skin or teeth because they form from cells that produce human eggs. They are rarely cancerous. Both endometriotic and dermoid cysts tend to occur in younger women. Cystadenomas develop from ovarian tissue and sometimes may become cancerous with time and age. Dermoid cysts and cystadenomas can become large, causing painful twisting of the ovary, called ovarian torsion.

Can it be prevented? How?

There is no definite way to prevent the occurrence of ovarian cysts but OCPs may reduce the development of functional cysts and concurrently reduce the risk of ovarian cancer.\

How does ovarian cyst affect fertility?

Functional cysts do not affect fertility. Ovarian cysts will usually affect fertility if they are part of a syndrome called polycystic ovary syndrome (PCOS) whereby women have many cysts (usually at least 10) around the periphery of the ovary. This condition is associated with an inability to ovulate and irregular menses. Some (endometriotic) cysts can damage ovarian and tubal function. Surgical complications during a cystectomy may also damage the ovary increasing the risk of infertility in the future. Oophorectomy in which the cyst and ovary are removed together will reduce the chances of conception.

Is it possible for the cyst to come back again after treatment? What do the patients have to take note of?

There is always the possibility of cyst recurrence after surgery either in the same ovary or development of new cysts in the previously unaffected ovary. Patients should see their gynaecologists for regular checkups and ultrasound scans routinely or when they develop changes in their menstrual cycle, pelvic pain or abdominal distension. 

What are some of the common symptoms?

 

Most cysts are asymptomatic so the majority of women with ovarian cyst are unaware of their presence when the cysts are small. If symptoms occur, women may experience one or more of the following symptoms which may mimic other medical conditions:

- Fullness or abdominal distension

- Pelvic pain shortly before the period begins or just before it ends
Constant or intermittent pelvic pain unrelated to menses that may radiate to the back

- Deep pain during intercourse

- Discomfort or pressure during bowel movements

- Irregular or heavy menses

- Desire to urinate more frequently resulting from bladder compression

Women should see a gynaecologist immediately if the painful symptoms are severe or sudden onset.

What are the available treatments for ovarian cyst?

The treatment depends on the age of the patient, size and nature of the cyst along with the severity of the symptoms. Conservative management with repeat ultrasound scans a few months later is appropriate if the cyst is small, asymptomatic, appears to be benign on ultrasound scan and the ovarian cancer markers are not significantly raised.

Oral analgesia can be used to reduce the pain but they do not have any effect on the ovarian cyst. Hormonal treatment in the form the oral contraceptive pills (OCPs) prevent ovulation and therefore the chance of new cysts developing in future menstrual cycles. This treatment will not make cysts you already have go away. But it will prevent new functional cysts from forming. OCPs reduce the risk of ovarian cancer and this risk persists for more than 30 years after stopping them.

Surgery is recommended if the symptoms are severe or getting worse, if the cyst is large and not deemed to be functional and if there is a suspicion of it being cancerous. The cyst can be removed without removing the ovary (cystectomy) especially if the cyst is benign and fertility is to be preserved. On the other hand, the cyst and ovary can be removed (oophorectomy) together if it is cancerous or if the patient is nearing menopause or already menopause as the risk of cancer increases in these older women. Both operations can be performed via laparoscopy (key-hole surgery) which requires more surgical skills but is more beneficial to the patient in terms of faster recovery, less discomfort and not to mention aesthetically more pleasing. Laparotomy (open surgery) is recommended if the cyst is cancerous or is too big or too adherent to be safely removed laparoscopically.

 

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