As a woman, chances are you’ve had an ovarian cyst at some point in your life whether you knew it or not. But what causes ovarian cysts and are they cause for concern? Here, DR NG KAI LYN, consultant obstetrician, gynaecologist and urogynaecologist with a specialty in advanced laparoscopic surgery for ovarian cysts, answers all of our questions, from the types of cysts and symptoms to the latest in removal methods.
What causes ovarian cysts?
Ovarian cysts are solid, fluid- or blood-filled sacs that arise in or on an ovary, or both ovaries. They are extremely common, particularly in women of the reproductive age group. In fact, most women will have an ovarian cyst at some point in their lives.
So, what causes ovarian cysts to form? Most develop as a result of a woman’s menstrual cycle. Each month, a woman’s ovaries grow follicles that contain eggs, which are released when she ovulates. If a normal monthly follicle keeps growing, it’s known as a functional cyst. There are two types of functional cysts:
- follicular cysts, which occur when an ovarian follicle grows and does not release its egg; and
- corpus luteal cysts, which form after an egg is released. Once an egg is released, hormones are produced for conception. Sometimes, this causes fluid to accumulate inside of the follicle, turning it into a cyst.
Women of reproductive age are at the highest risk of developing follicular and corpus luteal cysts. That’s because it’s part of the physiological changes that take place during their menstrual cycles.
Other types of ovarian cysts
Cystadenomas are mostly benign tumors that arise on the surface of the ovary. They can sometimes be cancerous, however.
Dermoid cysts are present from birth and occur when ectodermal (skin glands, hair, teeth) elements are trapped during the developmental process.
Endometriotic cysts affect about 10 percent of women. These types of cysts contain old menstrual blood and form as a result of endometriosis, a condition where tissue from the uterine lining is found outside of the uterus.
A woman has higher chances of developing endometriotic cysts if she:
- has a family history of endometriosis;
- experiences short intervals between periods;
- has heavy menstrual bleeding;
- experienced the onset of menstruation at a young age; or
- started menopause late.
Women with endometriosis can be asymptomatic or present with symptoms of ovarian cysts that include painful period cramps, chronic pelvic pain, painful urination, pain during intercourse or infertility.
Another type of ovarian cyst comes from polycystic ovarian syndrome (PCOS) – a hormonal disorder that’s associated with period problems, reduced fertility, weight issues and hair growth. Women with PCOS develop many small, benign, fluid-filled sacs within the ovary.
Are ovarian cysts dangerous?
Most ovarian cysts are not dangerous and usually resolve on their own without the need for treatment. This is especially true for functional cysts. In fact, most women with cysts are not even aware that they have them until they’re found during a routine screening or gynaecological exam.
Further investigation and treatment is recommended if the cysts:
- are of a large size (typically over five centimetres);
- show persistent or rapid signs of enlargement;
- have ultrasound features that may indicate cancer or malignancy; or
- cause symptoms such as abdominal pain.
Ovarian cancer is notorious for not causing symptoms until the late stages, or causing very vague symptoms, if any. These may include abdominal bloatedness, dissension, discomfort, early satiety, and loss of appetite and weight.
If you experience these symptoms or suspect that you may have an ovarian cyst, seek help from your gynaecologist as early as possible.
Regular gynae checks can also ensure early diagnosis of ovarian cysts and allow for prompt treatment, if necessary.
Ovarian cyst complications
Occasionally, women can experience an ovarian cyst accident. This is when the cysts rupture, bleed or undergo torsion – the twisting of the ovary or fallopian tube. This can cause significant abdominal pain, nausea, vomiting, giddiness and fever.
Most ovarian cysts, however, do not rupture. If you do experience symptoms of a ruptured cyst, seek immediate medical treatment.
When do cysts need to be removed – and how?
As functional cysts resolve on their own, no treatment is required. Other types of cysts might need treatment but do not require removal procedures. Ovarian cysts associated with PCOS, for instance, do not need to be removed. Instead, PCOS is typically managed with lifestyle modifications including a healthy diet and regular exercise as mainstays. Depending on a woman’s plans of pregnancy, menstrual regulation can be achieved through hormonal medications such as birth control pills, or ovulation induction and assisted reproductive techniques can be explored for those desiring fertility.
Treatment for endometriotic cysts can also be dependent on a woman’s plans for pregnancy. If a woman doesn’t want to get pregnant anytime soon, small cysts can be managed with hormonal suppression to alleviate symptoms and monitored via pelvic ultrasound scans. However, large endometriotic cysts with bothersome ovarian cyst symptoms or large cysts that interfere with fertility may need to be surgically removed.
Surgery for ovarian cysts
Your doctor might recommend a removal (or excision) procedure in order to determine the exact types of ovarian cysts you’ve got and make sure there are no cancerous cells.
In some cases, surgery for ovarian cysts is the only type of treatment. Dermoid cysts, for instance, arise from birth and do not disappear on their own. They also can’t be treated with medication. Therefore, surgery for ovarian cysts is the only method for treating these types of cysts.
Laparoscopy for ovarian cysts
These days, there are various types of surgery for ovarian cysts that can be performed laparoscopically (via keyhole surgery), particularly for smaller cysts. Laparoscopy for ovarian cysts can be performed by a trained gynae laparoscopist. Done under general anesthesia, laparoscopy for ovarian cysts involves making small cuts in the abdomen to allow for the entry of surgical instruments.
Laparoscopy for ovarian cysts is generally a safe procedure with low rates of complications. It’s minimally invasive and allows for faster recovery periods with less pain.
In some cases, if the cyst is very large or has indicative signs of cancer, an open surgical approach may be necessary instead of laparoscopy.
Can ovarian cysts be prevented?
Taking birth control pills can reduce the incidence of certain physiological cysts, as it suppresses ovulation. However, there is no effective way to prevent most ovarian cyst overall.
In summary, stay abreast of changes in your menstrual cycle and watch for symptoms such has abdominal pain or discomfort. Regular gynae check-ups can help detect early changes in your ovaries, ensuring timely diagnosis of any changes in your ovaries.
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