Ovarian Cyst's Symptoms, Diagnosis and Treatment

The ovary is a female reproductive gland that produces eggs (ova) and reproductive hormones. Ovaries are paired, with one located on each side of the uterus. An ovary is about the size of an olive and weighs less than 5 grams, but it plays an extremely important role in the female reproductive system. Ovarian cysts are very common, especially among women of childbearing age. These mostly benign fluid-filled sacs can be found either inside or on the surface of the ovary. Types of ovarian cyst are as follow:

Functional cysts

Functional cysts occur during a woman’s menstrual cycle and are the most common types of ovarian cyst. They are formed by the accumulation of excessive fluid in the follicle or corpus luteum.

• Follicular cysts: During a normal menstrual cycle, the follicle will grow bigger until it ruptures and releases an egg. If the follicle fails to burst, fluid will continue to accumulate inside, causing it to grow larger than normal.
• Luteal cysts: During a normal menstrual cycle, a follicle will form into a corpus luteum after ovulation. Sometimes, fluid accumulates inside the follicle, causing the corpus luteum to grow into a cyst.

Functional cysts are usually harmless and do not require treatment. They often disappear on their own within two or three menstrual cycles.

Ovarian cystadenomas

These types of cyst are formed from cells that cover the outer surface of the ovary. Serous cystadenomas are formed when filled with watery liquid while mucinous cystadenomas are formed when filled with mucus material.

Endometriomas

Endometriomas are also known as chocolate cysts. They develop as a result of endometriosis, a condition in which uterine endometrial cells (cells that form the inner lining of the uterus) grow in the ovary instead of the uterus. With multiple episodes of bleeding, which is equivalent to menses within the ovary, blood accumulates and turns into this chocolate-like fluid. Chocolate cysts will grow over time and can cause compression symptoms. Surgery may be required.

Polycystic ovary syndrome (PCOS)

PCOS is a syndrome caused by hormonal disorders. It is characterized by the numerous follicles inside the ovary that can be seen clearly on ultrasound. The etiology of this disease is still unknown.

Dermoid cysts

Also known as teratomas. They are formed from embryonic cells and contain not only fluid but also tissues, such as hair, skin or teeth. Dermoid cysts will not disappear on their own; instead, they may grow bigger in time and result in a higher chance of ovarian torsion, so it is best to remove them by surgery. Luckily, dermoid cysts are rarely cancerous.

Most cysts cause no symptoms and disappear on their own. However, ovarian cysts that are too large in size, ruptured or twisted can cause the following symptoms:

Pelvic compression syndrome: Characterized by a dull or sharp ache or a feeling of fullness or heaviness in the abdomen.

Ovarian torsion: Oversized ovarian cysts can cause the ovary to twist, thus blocking the blood supply to the ovary and resulting in necrosis eventually. Emergency surgery may be required.

Infertility: Most ovarian cysts do not cause infertility. However, it is quite common for infertile women to have polycystic cysts and chocolate cysts (endometriosis).

Menstrual disorders: Common in patients with PCOS.

An ovary, under normal circumstances, is about 2-4cm and very soft in texture, hence cannot be felt by palpating the abdomen. However, if cysts are developed, the ovary may grow bigger and become palpable on a pelvic examination. The doctor may also suggest patients undergoing other diagnostic examinations to find out the type of the cysts and whether treatment is needed. Possible examinations include:

Pregnancy test: A positive test result may suggest corpus luteum cysts or atopic pregnancy.

Pelvic ultrasound: Ultrasound is the most common tool to identify the location and type (solid, filled with fluid or mixed) of the cysts.

CA 125 blood test: Women with ovarian cancer often have an elevated level of a protein called cancer antigen 125 (CA 125) in their blood. Usually, CA 125 blood test are performed only if the cysts suggest a high risk of cancer, i.e. being partially solid.

Treatment of ovarian cysts depends on patients’ age, the type and size of the cysts, and symptoms.

Surveillance

If no symptoms are shown and an ultrasound identify a simple, small (less than 8cm), fluid-filled cyst, patients can wait and be re-examined to see whether the cyst goes away in a few months.

Medication

The doctor may recommend hormonal contraceptives, such as birth control pills, to keep ovarian cysts from growing or recurring. However, birth control pills will not shrink existing cysts.

Surgical Treatment

If a cyst appears on ultrasound to be malignant or have the potential to become malignant, continues to grow in size and is accompanied by sharp pain, surgical removal may be required. Ovarian cysts can be removed by simple laparoscopy. Some can be removed without removing the ovary (ovarian cystectomy); however, if the cysts are too big, the affected ovary may have to be removed as well while leaving the other intact (oophorectomy). Fertility can be preserved after a unilateral oophorectomy.