Ovarian Cyst

Types of Ovarian Cysts

There are several different types of ovarian cysts, most of which are functional (related to the menstrual cycle) and typically resolve on their own. Some common types of ovarian cysts include:

1. Functional Ovarian Cysts

These are the most common type of ovarian cyst and are related to the normal function of the ovaries. They usually go away without treatment.

• Follicular cysts:
  A follicular cyst forms when a follicle (the sac that contains the egg) does not release the egg during ovulation. Instead, the follicle continues to grow and fills with fluid. These cysts are usually small and resolve on their own within a few menstrual cycles.
• Corpus luteum cysts:
  After ovulation, the follicle becomes a structure called the corpus luteum, which produces progesterone to support pregnancy. If the corpus luteum fills with fluid instead of breaking down, it forms a cyst. Corpus luteum cysts can sometimes cause pain, especially if they bleed or rupture. These cysts typically resolve within a few weeks to months.

2. Dermoid Cysts (Teratomas)

These cysts can contain various types of tissue, such as hair, fat, or even teeth. They are present from birth but may not be diagnosed until adulthood. Dermoid cysts are typically benign but may need to be surgically removed if they become large or cause symptoms.

3. Cystadenomas

Cystadenomas are non-cancerous cysts that develop from cells on the surface of the ovary. They can grow large and may contain a watery or mucous-like substance. While generally benign, if they grow very large, they can cause pain or pressure on nearby organs and may need to be surgically removed.

4. Endometriomas (Chocolate Cysts)

Endometriomas are cysts caused by endometriosis, a condition where tissue similar to the lining of the uterus grows outside the uterus, often on the ovaries. These cysts are filled with old blood, giving them a dark, “chocolate” appearance. Endometriomas can cause pain, especially during menstruation, and can affect fertility.

5. Polycystic Ovaries (PCOS)

In women with Polycystic Ovary Syndrome (PCOS), multiple small cysts develop on the ovaries. These cysts are typically not harmful on their own but are associated with hormonal imbalances that affect ovulation and menstruation. PCOS can lead to symptoms like irregular periods, excess hair growth, acne, and infertility.

Symptoms of Ovarian Cysts

Most ovarian cysts do not cause noticeable symptoms and are discovered during routine pelvic exams or ultrasounds. However, larger cysts or cysts that rupture may cause more significant symptoms, which include:

• Pelvic pain: A dull ache or sharp pain, typically on one side of the pelvis, that may worsen during menstruation or sexual intercourse.
• Bloating or fullness: Feeling of heaviness or swelling in the abdomen.
• Irregular periods: Changes in menstrual cycle frequency or duration.
• Pain during sex: Discomfort during or after sexual intercourse.
• Nausea or vomiting: Particularly if a cyst ruptures or causes torsion (twisting of the ovary).
• Frequent urination or difficulty emptying the bladder: If the cyst presses on the bladder.
• Lower back pain: Some women with ovarian cysts experience pain in the lower back.

In rare cases, ovarian cysts may cause more severe symptoms, including:

• Sudden, severe pelvic pain: If the cyst ruptures or causes the ovary to twist (ovarian torsion).
• Fainting, dizziness, or rapid breathing: If the cyst ruptures or leads to internal bleeding.

Causes and Risk Factors

Ovarian cysts often form as part of the normal menstrual cycle, but certain factors can increase the likelihood of developing them:

• Hormonal imbalances: Conditions like PCOS or using fertility treatments that stimulate ovulation can increase the risk of developing ovarian cysts.
• Pregnancy: Sometimes a cyst will form if the follicle fails to dissolve after ovulation and the woman becomes pregnant.
• Endometriosis: Women with endometriosis may develop endometriomas, which are cysts filled with old blood.
• Age: Cysts are more common in women of reproductive age, but postmenopausal women can also develop cysts, especially if they are taking hormone replacement therapy (HRT).
• History of ovarian cysts: Women who have had ovarian cysts in the past may be more likely to develop them again.

Diagnosis of Ovarian Cysts

Ovarian cysts are often discovered during routine pelvic exams or imaging tests. If you experience symptoms that suggest the presence of a cyst, your healthcare provider may use the following diagnostic tools:

1. Pelvic Exam:
   The doctor may feel for an ovarian cyst by manually examining the pelvic region. However, not all cysts can be felt this way, especially if they are small.
2. Ultrasound:
   A pelvic ultrasound (either transabdominal or transvaginal) is commonly used to visualize cysts on the ovaries. It can help determine the size, shape, and type of cyst.
3. Blood Tests:
   In some cases, a blood test may be performed to check for signs of pregnancy (if there’s a possibility of an ovarian cyst being related to pregnancy) or elevated levels of CA-125, a protein that can be an indicator of ovarian cancer (though elevated CA-125 can also occur in benign conditions like endometriosis or fibroids).
4. Laparoscopy:
   If a cyst is causing significant symptoms or there is concern about the type of cyst (e.g., cancer), a doctor may recommend a laparoscopic surgery. This minimally invasive procedure allows the doctor to view and sometimes remove the cyst.

Treatment of Ovarian Cysts

In many cases, ovarian cysts do not require treatment and resolve on their own. However, when cysts cause symptoms, complications, or pose a risk of rupture or torsion, treatment options may include:

1. Watchful Waiting:
   If the cyst is small and not causing symptoms, your doctor may recommend monitoring it over time with follow-up ultrasounds to see if it resolves on its own.
2. Pain Management:
   Over-the-counter pain relievers like ibuprofen or acetaminophen can help alleviate mild pelvic discomfort.
3. Birth Control Pills:
   Hormonal contraceptives (birth control pills, patches, or IUDs) may be prescribed to regulate the menstrual cycle and prevent the formation of new cysts, especially in women with recurrent cysts or PCOS.
4. Surgical Treatment:
   • Cystectomy: In cases where a cyst is large, causing significant symptoms, or not resolving on its own, the cyst may need to be surgically removed. This is typically done via laparoscopic surgery, which involves small incisions and a camera to guide the procedure.
   • Oophorectomy: If the cyst is large or cancerous, the entire ovary may need to be removed. This is more common in postmenopausal women or those with a high risk of ovarian cancer.
5. Treatment for Endometriomas:
   If the cyst is associated with endometriosis, treatment may include hormone therapy or surgery to remove the cysts.

When to Seek Medical Help

While most ovarian cysts do not cause significant problems, you should seek medical attention if you experience:

• Severe pelvic or abdominal pain.
• Sudden, sharp pain or pain with nausea/vomiting (possible cyst rupture).
• Unexplained weight gain or bloating.
• Pain during intercourse.
• Irregular or missed periods.
• Difficulty urinating or a feeling of fullness in the abdomen.

Conclusion

Ovarian cysts are generally benign and often resolve without treatment. However, large cysts or those causing symptoms may require medical attention. If you experience symptoms such as persistent pelvic pain, irregular periods, or bloating, it’s important to consult with your healthcare provider for an accurate diagnosis and appropriate treatment. Regular monitoring and follow-up can help ensure that any potential complications are addressed promptly.