30.MAY.2019 5 MIN READ | 5 MIN READ

While most ovarian cysts are benign and resolve on their own, it is important to recognise when they may cause problems that could lead to infertility or chronic pain if untreated.

What are ovarian cysts?

Your ovaries contain your eggs and one egg is released every month during your menstrual cycle in a process called ovulation. The egg travels into your uterus via the fallopian tube. Your ovaries are also responsible for producing the hormones estrogen and progesterone.

Sometimes, a fluid- or blood-filled sac called a cyst can grow on your ovaries and in most cases, this is painless and causes no symptoms. The cyst may disappear without you ever knowing you had it.

Are there different types of ovarian cysts?

Polycystic ovary syndrome
Yes, there are several types ranging from fluid-based cysts to solid non-cancerous cysts to cancerous growths. Some types may affect fertility.

Follicular cyst – During your monthly cycle, when you ovulate, the follicle ‘breaks’ as it releases the egg. If the follicle does not break open, the fluid inside can build up, forming a cyst on the ovary.

Corpus luteum cyst – When a follicle successfully releases an egg, the follicular sac should dissolve. If it doesn’t and the opening reseals, additional fluid can develop inside the sac and cause a corpus luteum cyst.

Dermoid cyst – These are sac-like growths that can contain hair, fat and other tissue.

Cystadenomas – These are non-cancerous growths that can develop on the outer surface of the ovaries.

Endometriomas – Endometrial tissue is tissue that grows in the lining of the uterus. When this lining backflows and accumulates onto the ovary, it can lead to an endometrioma.

Polycystic ovary syndrome – This condition causes many small cysts to grow in the ovary, causing it to become enlarged. This may be a cause of subfertility.

Can ovarian cysts be prevented?

Unfortunately, there is nothing you can do to prevent cysts from forming. In certain cases, hormonal medication can be given to suppress certain types of cysts. However, by going for regular routine gynaecological examinations, any cyst you have can be diagnosed and treated in its early stages, whether it is benign or cancerous.

How can I tell if I have an ovarian cyst?

Symptoms of ovarian cyst
Lots of ladies have cysts. It is sometimes only discovered on an ultrasound. There may be no symptoms at all. However, if it grows, you may begin to experience the following symptoms:

  • abdominal bloating or swelling
  • pelvic pain before or during the menstrual cycle
  • pain in the lower back or thighs
  • painful bowel movements
  • painful intercourse
  • nausea and vomiting

What ovarian cyst complications could result?

If you experience the above symptoms and then develop severe or sharp pelvic pain, fever, sudden nausea and vomiting. Seek urgent medical attention as you may have a ruptured cyst or an ovarian torsion. Both need to be treated quickly to avoid further complications.

Ruptured cyst – This is uncommon but when it happens, it will cause severe pain and internal bleeding. It can be life threatening if you do not seek treatment soon enough.

Ovarian torsion – This is also uncommon and happens when a large ovarian cyst causes the ovary to twist so that the blood supply to the ovary is cut off. This is an emergency and if not treated, the ovarian tissue can die and you could lose that ovary.

Cancerous cystic ovarian mass – Symptoms of ovarian cancer can mimic symptoms of an ovarian cyst. So, it is important to visit your doctor for an accurate diagnosis if you notice symptoms such as:

  • changes in your menstrual cycle
  • ongoing pelvic pain
  • loss of appetite
  • unexplained weight loss
  • abdominal fullness and bloatedness
  • change in bowel habits

How are ovarian cysts diagnosed?

How ovarian cyst is diagnosed
Often cysts are diagnosed during pelvic examinations. If your doctor suspects a cyst, they will order an ultrasound to confirm the diagnosis and determine the size, location of the cyst and to see whether it is fluid-filled or solid. Most benign cysts resolve on their own so your doctor will probably monitor your condition for a few weeks or months. If it doesn’t resolve on its own, your doctor may recommend treatment.

What is the treatment for an ovarian cyst?

Birth control pills – As ovarian cysts are connected to ovulation, your doctor may recommend taking the contraceptive pill, which stops ovulation, thereby preventing the development of new cysts. Taking the Pill also reduces your risk of ovarian and uterine (endometrial) cancer.

Your doctor may recommend surgery in the following situations:

  • You have pain or problems conceiving
  • You have growths in both ovaries.
  • Size of the cyst: larger cysts (approximately >5cm)
  • Ultrasound features: endometria, cancerous changes
  • Persistent cyst: despite being on hormones or after the menopause
  • You have a cyst and you:
    • Have never had a menstrual period
    • Have been through menopause
    • Use birth control pills
  • Your doctor suspects ovarian cancer. In this case, you will be referred to a gynaecologic oncologist.

What are the common surgery options?

Surgery options for ovarian cyst
Laparoscopy – This surgery involves the surgeon removing the cyst through 3 – 4 tiny incisions, one near your belly button and two either on the side or near the centre, using an instrument with a camera so they can see inside your body while performing the operation. The surgeon will stitch or glue the incision so you are left with only a very small scar. It may be a day surgery carried out under general anaesthesia so you will be able to go home soon after you wake up. You should be able to get back to normal activities within 1 – 2 weeks.

Laparotomy – If your cyst is large, or there is a chance it is cancerous, your surgeon will need to make a larger incision in your abdomen. This is considered open surgery. If the cyst is determined to be cancerous, your surgeon may perform a total hysterectomy to remove your ovaries and uterus. You will be under general anaesthesia for this surgery and will be warded to monitor your recovery. Depending on the extent of your operation and your speed of recovery, you may stay in the hospital for 3 – 5 days. It may be 4 – 8 weeks before you can resume normal activities.

Whichever surgery you have, it is important to get up and about as soon as you can after the surgery. Avoid lifting heavy weights until you have fully recovered.

Can ovarian cysts come back after surgery?

While surgery can successfully remove ovarian cysts, they can sometimes come back in the same place or in the other ovary, especially endometriomas. Hormonal medication may be given to suppress the cysts. You will need to discuss this with your doctor to determine if you are a suitable candidate for an oophorectomy (removal of the ovary) or whether cyst removal is a better option.

 

Article reviewed by Dr Natalie Chua, obstetrician and gynaecologist at Parkway East Hospital

References

Ovarian cysts. 17 July 2017. Retrieved 29 March 2019 from https://www.healthline.com/health/ovarian-cysts

Surgery for ovarian cysts. (n.d.) Retrieved 29 March 2019 from https://www.uofmhealth.org/health-library/hw178611

Treatment Ovarian Cyst. (n.d.) Retrieved 10 April 2019 from https://www.nhs.uk/conditions/ovarian-cyst/treatment/

Surgery for ovarian cysts. (n.d.) Retrieved 10 April 2019 from https://www.healthlinkbc.ca/health-topics/hw178611

30.MAY.2019
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Chua Weilyn Natalie
Obstetrician and Gynaecologist
Parkway East Hospital

Dr Natalie Chua is a female obstetrician-gynaecologist (Obgyn) who is practicing in Parkway East Hospital, Singapore. She attained her specialist traineeship at KK Women and Children Hospital Singapore, before obtaining her Membership of the Royal College of Obstetricians & Gynaecologists (MRCOG London) in 2009.