• SBE ISGE Joint Meeting - Sao Paulo September 2009
• XVIII Annual Congress March 2009 Pattaya,Thailand
• XVII Annual Meeting - Bari Italy
• ISGE Annual Meeting, Japan March 19-23 2007

Ovarian Cysts

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All About Ovarian Cysts

 

 

What Are Ovarian Cysts?

Ovarian cysts start as small fluid-filled sacs that form on the ovaries.  Small cysts (less than a half-inch) are common in women during their reproductive years until menopause.  Some ovarian cysts  are formed as a result of ovulation –  ovary’s monthly release of an egg  in the sac (follicle) to start the menstrual cycle - and  are usually harmless (most ovarian cysts are benign or non-cancerous), often disappearing without treatment. When a follicle fails to rupture and release the egg, fluid remains, accumulates and may enlarge and form an ovarian cyst.  An ovarian cyst may grow from within the ovary and stretch the normal ovarian tissue.     Cysts that are abnormal and may cause problems often occur as a result of an imbalance in the female hormones estrogen and progesterone, which are produced in the ovaries. 

 

What Are the Different Types of Ovarian Cysts?

• Functional cyst, the most common type of ovarian cyst, is produced during ovulation from a “cyst like” structure.  Normally, if this structure does not dissolve, a functional cyst may form, which generally does not cause symptoms or require treatment.   Functional cysts, composed of fluid surrounded by a thin wall, usually stop growing, shrink and disappear within one to three menstrual cycles.  These cysts are common in women who menstruate, but are rare in postmenopausal women, since no eggs are being produced.  Postmenopausal women diagnosed with a cyst will probably have a sonogram performed.  Demoid cyst is an abnormal growth filled with various types of tissue, such as fat, skin, bone, hair and cartilage.  These cysts may become twisted, causing severe abdominal pain.
• Cystadenoma  is a non-cancerous cyst, which develops from cells on the outer surface of the ovary, and is filled with a fatty liquid.
• Endometrioma cyst is formed when tissue similar to the lining of the uterus grows on the ovaries – a condition known as endometriosis.  This cyst is sometimes referred to as an endometrial or chocolate cyst, because of the dark, reddish-brown blood filling the cyst. It affects women during their reproductive years, may obstruct fertility and may cause chronic pelvic pain associated with menstruation. 
• Polycystic ovary is enlarged with small cysts around the outside of the ovary and is associated with infertility, abnormal bleeding, miscarriages and high risk pregnancy.
• Polycystic ovarian syndrome (PCOS) involves metabolic and cardiovascular risks linked to insulin resistance, including increased glucose tolerance, Type 2 diabetes and high blood pressure.  PCOS is associated with an increased risk of endometrial cancer.

What Are the Symptoms of Ovarian Cysts?

Most ovarian cysts do not cause any symptoms.  However, when symptoms do occur, they may appear as bleeding, a dull ache, abdominal pressure or fullness, urinary tract pressure or urine flow problems.  Ovarian cysts may cause pain during intercourse, and severe pain may require hospitalization.  Pain or pressure from a cyst may be caused by a number of factors including

• A bleeding or opened cyst irritating tissue within the abdomen
• A large sized cyst
• Torsion or twisting of the cyst, which blocks blood flow to the cyst
• Delayed, irregular or; unusually painful periods may be a symptom of an ovarian cyst
• Enlarged or swollen lower abdomen

Diagnosing Ovarian Cysts

Ovarian cysts are generally discovered during a woman’s routine pelvic exam. Abdominal or transvaginal sonography helps to determine the presence, type and potential malignancy of an ovarian cyst.  A CA-125 level blood test is generally performed on women with an ovarian cyst, who are at high risk (e.g. family history) for ovarian cancer.  A diagnostic laparoscopy may also be performed (Please refer to Surgical Options below).   It is important for a woman to have regular checkups, especially if she has symptoms or a history of abnormal ovarian cysts and is over 50, when the risk of ovarian cancer is greater. (The vast majority of ovarian cysts are non-cancerous). If ovarian cysts are found before they begin to grow, rupture, become twisted and cause pain, many of the problems associated with them can be prevented.   A physician may perform additional tests if an abnormal ovarian growth is detected during a pelvic exam. 

Treatment Options

Treatment of ovarian cysts will depend on the following factors:

• Cyst’s type and size.  If cyst remains after three menstrual cycles, if it gets larger or if it doesn’t appear to be a functional cyst on the sonogram, surgery may be considered.
• Woman’s age
• Menstruation
• State of health
• Family planning
• Symptoms

 

If a cyst is found early, less extensive treatment may be required.  A small cyst that is not causing any symptoms may be left untreated for two or three menstrual cycles to see if it disappears. Some doctors may prescribe hormones, such as birth control pills, to shrink these cysts.  Since oral contraceptives prevent ovulation, functional cysts are very rare in women taking the pill. Some benign cysts do not respond to oral contraceptives, so surgery may be the option.      However, the pill does offer some protection against malignant or cancerous ovarian cysts and the chances of new cysts forming are decreased. However, there are different types of ovarian cysts in childbearing age women that do require surgery.

Surgical Options

The type of surgery to remove a cyst depends on several factors including:

·        Cyst’s size

·        Cyst’s sonogram appearance

·        Cyst is considered malignant or benign

The following surgical options are available to perform a cystectomy or removal of the cyst:

·        Laparoscopy:  If the cyst is small and looks benign, a doctor may perform a diagnostic and operative laparoscopy.  This minimally invasive procedure involves tiny abdominal incisions just below the navel, through which a thin lit telescope and surgical instruments are inserted.  A doctor is then able to visualize the ovaries on a television monitor and remove the cyst.  This procedure results in minimal or no scarring, less pain and shorter recovery time. 

·        Laparotomy:  If the cyst appears too large or suspicious, the physician will probably perform a laparotomy, which involves a larger abdominal incision to remove the cyst or possibly the entire ovary.  The cyst can be tested for cancer during this procedure.  This surgery results in a greater chance of scarring, pain and greater recovery time. 

Conclusion

Since the vast majority of ovarian cysts are benign, the presence of one is generally no need for alarm.  However, modern laparoscopic procedures do make diagnosing and treating ovarian cysts easier on the patient, so any suspicion of malignancy can be addressed in a timely manner.