Ovarian Cysts

Introduction

What is an ovarian cyst?

Each woman has two ovaries, a left and a right one. The ovaries are the main reproductive organs as they contain the eggs, the female reproductive cells. The ovaries also produce the female hormones oestrogen and progesterone.

When tumours grow in the body they can be solid, meaning they contain flesh, and are then called lumps or nodules, or they can be cysts which are round structures mainly containing fluid, contained by a fine membrane or capsule.

Most ovarian tumours tend to be cystic because of the nature of the ovary.

Every month, the ovary prepares an egg to be released at ovulation. The egg matures inside a small ovarian cyst called a follicle. Follicles are “normal” ovarian cysts that can grow up to 3 cm in diameter. They form every month and then break at the time of ovulation.

Ovarian cysts are common and can be thin-walled and only contain fluid (known as simple cysts) or they may be more complex, containing thick fluid or blood, having membranes that divide them into more than one cystic area (septations) or have solid areas in addition to the fluid.

Tumours in general, grow in the body because one cell manages to multiply itself more than it normally should, causing a mass of cells where there shouldn’t be one.

Because the ovary has several different types of cells, it can grow many different types of tumours. Ovarian cysts can therefore be very different depending on which cell they originate from.

It is also important to know that ovarian cysts can be benign, or malignant (cancerous).

Most cysts that occur before menopause are benign (non-cancerous).

Cancer of the ovary before the menopause is rare, but not impossible. Complex ovarian cysts in young women need to be thoroughly investigated.

Types of Ovarian Cysts

There are several different types of cysts that can occur. Some of the most common ones are:

• Simple cyst: (the most common) a large follicle that continues to grow after the egg has been released – they tend to disappear within a few months.

• Cystadenoma: they look very much like a simple follicular cyst, but are bigger and don’t go away.

• Endometrioma: an ovarian cyst of endometriotic cells from the lining of the womb (see endometriosis for more detail).

• Dermoid cyst: formed from cells that make the eggs in the ovary, often contain substances such as fat and hair.

Ovarian Cyst Symptoms

Most women will be unaware that they have a cyst as they often cause no symptoms and disappear spontaneously with time.

They can also occur in pregnancy.

Other cysts may be diagnosed by chance, for example during a routine examination or ultrasound for another reason.

Symptoms from ovarian cysts can be non-specific and confounded with other conditions.

Possible ovarian cyst symptoms include:

• Lower abdominal pain or pelvic pain

• Painful periods or a change in the pattern of your periods

• Pain during sex

• Pain related to bowels

• A feeling like you want to pass urine urgently or more frequently

• A change in appetite or feeling full quickly

• A distended or swollen abdomen

• Difficulty in falling pregnant which may also be sign of endometriosis

  Complications from Ovarian Cysts

• Cyst rupture

  With ruptured ovarian cysts, sometimes the cyst wall breaks, releasing fluid inside the abdomen.

  This can be very painful, and in many cases, urgent care is needed.

• Ovarian torsion

  Sometimes the weight of the cyst may cause the ovary to twist.

  This may compress the artery that brings the blood supply to the ovary.

  This situation can also cause intense pain and require urgent attention.

  In rare cases, the ovary starved from the blood supply may experience necrosis requiring ovary removal.

Ovarian Cyst Diagnosis

Large ovarian cysts may be detected by abdominal or internal examination.

The best test to detect cysts however is the ultrasound - either abdominally or internally through the vagina.

If the cyst looks complex, if malignancy is suspected, if it is too big or if it happens in post-menopausal women other tests may be required and these include Magnetic Resonance Imaging (MRI) and blood tests.