Dr Tariq Jagnarine
Fam Medicine, Endocrinology/Diabetes
The ovaries are part of the female reproductive system. They are located in the lower abdomen on both sides of the uterus. Women have two ovaries that produce eggs as well as the hormones oestrogen and progesterone. Sometimes a fluid-filled sac, called a cyst, will develop on one of the ovaries. Many women will develop at least one cyst during their lifetime. In most cases, cysts are painless and cause no symptoms.
An ovarian cyst is a sac filled with fluid that forms on or inside an ovary. It is called a functional cyst. These are not the same as cysts caused by cancer or other diseases. The formation of these cysts is a perfectly normal event, and is a sign that the ovaries are working well. Typically, ovarian cysts are functional (not disease-related) and usually disappear on their own within 60 days. Oral contraceptives may be prescribed to help establish normal cycles.
CAUSES
Each month during the menstrual cycle, a follicle (cyst) grows from the ovary. The follicle is where an egg is developing.
* The follicle makes the estrogen hormone. This hormone causes normal changes of the uterine lining as the uterus prepares for pregnancy.
* When the egg matures, it is released from the follicle. This is called ovulation.
* If the follicle fails to break open and release an egg, the fluid stays in the follicle and forms a cyst. This is called a follicular cyst.
Another type of cyst occurs after an egg has been released from a follicle. This is called a corpus luteum cyst. This type of cyst may contain a small amount of blood. This cyst releases progesterone and estrogen hormones. Ovarian cysts are more common in the childbearing years between puberty and menopause. The condition is less common after menopause.
Taking fertility drugs often causes the development of multiple follicles (cysts) in the ovaries. These cysts most often go away after a woman’s period, or after a pregnancy. Functional ovarian cysts are not the same as ovarian tumours or cysts due to hormone-related conditions such as polycystic ovary syndrome.
SYMPTOMS
Ovarian cysts often cause no symptoms.
An ovarian cyst is more likely to cause pain if it:
* Becomes large
* Bleeds
* Breaks open
* Interferes with the blood supply to the ovary
* Is twisted or causes twisting (torsion) of the ovary
Symptoms of ovarian cysts can also include:
* Bloating or swelling in the abdomen
* Pain during bowel movements
* Pain in the pelvis shortly before or after beginning a menstrual period
* Pain with intercourse or pelvic pain during movement
* Pelvic pain – constant, dull aching
* Sudden and severe pelvic pain, often with nausea and vomiting (may be a sign of torsion or twisting of the ovary on its blood supply, or rupture of a cyst with internal bleeding)
Changes in menstrual periods are not common with follicular cysts. These are more common with corpus luteum cysts. Spotting or bleeding may occur with some cysts.
EXAMS AND TESTS
A cyst may be found during a pelvic exam, or when an ultrasound test is done for another reason.
Ultrasound may be done to detect a cyst, which can be repeated in 6 to 8 weeks to make sure it is gone.
Other imaging tests that may be done when needed include:
* CT scan
* Doppler flow studies
* MRI
The following blood tests may be done:
* CA-125 test, to look for possible cancer if an abnormal ultrasound is found or experiencing menopause
* Hormone levels (such as luteinizing hormone, follicle stimulating hormone, estradiol, and testosterone)
* Pregnancy test
TREATMENT
Functional ovarian cysts often do not need treatment. They often go away on their own within 8 to 12 weeks. If the ovarian cysts are frequent, birth control pills (oral contraceptives) may be prescribed. These pills may reduce the risk of developing new cysts; however, birth control pills do not decrease the size of current cysts.
Surgery is an option to remove the cyst or ovary to make sure that it is not ovarian cancer.
Surgery is more likely to be needed for:
* Complex ovarian cysts that do not go away
* Cysts that are causing symptoms and do not go away
* Cysts that are increasing in size
* Simple ovarian cysts that are larger than 10 centimetres
* Women who are near menopause or past menopause
Types of surgery for ovarian cysts include:
* Exploratory laparotomy
* Pelvic laparoscopy
Other treatments may be needed if there are other underlying issues such as having polycystic ovary syndrome or another disorder that can cause cysts.
OUTLOOK (PROGNOSIS)
Cysts in women who are still having periods are more likely to go away. A complex cyst in a woman who is past menopause has a higher risk of being cancer. Cancer is very unlikely with a simple cyst.
POSSIBLE COMPLICATIONS
Complications have to do with the condition causing the cysts. Complications can occur with cysts that:
* Bleed.
* Break open.
* Show signs of changes that could be cancer.
* Twist, depending on size of the cyst. Bigger cysts carry a higher risk.
Medical attention is needed if
* Persons experience severe symptoms of an ovarian cyst
* Severe pain
* Bleeding that is not normal
* Getting full quickly when eating
* Loss of appetite
* Losing weight without trying
These symptoms may indicate ovarian cancer. Studies which encourage women to seek care for possible ovarian cancer symptoms have not shown any benefit. Unfortunately, there are no proven means of screening for ovarian cancer.
PREVENTION
In women who are not trying to get pregnant and often get functional cysts, they can be prevented by taking birth control pills. These pills prevent follicles from growing. The outlook for premenopausal women with ovarian cysts is good. Most cysts disappear within a few months. However, recurrent ovarian cysts can occur in premenopausal women and women with hormone imbalances. If left untreated, some cysts can decrease fertility. This is common with endometriomas and polycystic ovary syndrome. To improve fertility, doctors can remove or shrink the cyst. Functional cysts, cystadenomas, and dermoid cysts do not affect fertility. Although some doctors take a “wait and see” approach with ovarian cysts, some doctors may recommend surgery to remove and examine any cyst or growth that develops on the ovaries after menopause. This is because the risk of developing a cancerous cyst or ovarian cancer increases after menopause. However, ovarian cysts do not increase the risk of ovarian cancer. Some doctors will remove a cyst if it is larger than 5 centimetres in diameter.
As common as ovarian cysts can be, there are still ways women can prevent them from developing.
* Maintain a healthy weight
A woman’s overall health plays a big role in whether or not she will develop ovarian cysts, which is especially true when it comes to weight. Maintaining a healthy weight based on age and body mass index is important for all women. When a woman is overweight, she is at a higher risk for developing conditions like polycystic ovarian syndrome (PCOS), which can subsequently increase the risk of ovarian cyst development.
* Rule out fertility medication
Similar to weight gain, there are other underlying issues that can contribute to a woman developing ovarian cysts. If a woman is experiencing infertility and is taking fertility medication to increase her chances of becoming more fertile, she may get cysts over time. There are certain fertility medications, like clomiphene, that cause a woman’s body to ovulate more and often create this unwanted result.
* Steer clear of smoking cigarettes
Smoking is never advised, especially for those who wish to live a long, healthy life. Since the nicotine in cigarettes promotes conditions such as cancer and emphysema, it also increases a woman’s risk of developing ovarian cysts.
* Think about birth control
Birth control can help with a myriad of issues, from acne to period regulation. Fortunately, birth control can also help prevent ovarian cysts and can even help to reduce the risk of ovarian cancer.
Staying fit and healthy not only helps with specific illnesses, but also generally improves health and longevity
