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The ovaries are a pair of small-sized organs that are shaped like almonds and play a central role in the female reproductive system.
Also referred to as the female gonads, these glands are responsible for releasing the ova, or egg, during the menstrual cycle as well as the production of the female sex hormones, namely, progesterone and estrogen.
It is common for women to develop a small blister-like growth filled with fluid or semisolid tissue either inside the ovary or on its surface.
This abnormal sac-like structure is called an ovarian cyst, which is encapsulated within a thin membrane called the cyst wall.
Ovarian cysts are usually small-sized structures that rarely present any symptoms and usually resolve on their own. In fact, most women go about their daily lives without even knowing that they are harboring an ovarian cyst.
Ovarian cysts that are more than 5 cm in width often need to be removed surgically.
Types of Ovarian Cysts
Ovarian cysts are classified into two major categories:
- Functional Cysts
- Pathological Cysts
a. Functional cysts
The most common types of ovarian cysts develop routinely as part of the monthly menstrual cycle and disappear in a matter of 2 – 8 weeks without any treatment.
1. Follicular Cyst
The female egg is formed within a fluid-filled sac present inside the ovary called a follicle.
At the time of ovulation, the ovum is released when the follicle breaks open. It then travels to the womb for potential fertilization. Once the egg moves out of the follicle, it discharges the fluid contained within it and shrinks.
However, if the ovulation fails to materialize, the fluid pools inside the partially mature follicle and acquires the shape of an enlarged follicular cyst.
2. Corpus Luteum Cyst
Sometimes, the follicle may fail to discharge the fluid even after the egg has been released. As a result, the follicle swells up instead of dissolving into the ovary and forms what is known as a corpus luteum cyst.
This kind of cyst is also categorized as a functional cyst, but it is less common than the follicular cyst.
Both these cysts result from a functional rather than a disease process and are usually benign.
b. Pathological Cyst
Unlike functional cysts, the menstrual cycle has no involvement in the formation of pathological cysts. These cysts are the result of excessive growth of ovarian cells and can occur both inside or outside the ovaries.
While most pathological cysts are found to be non-cancerous, the risk of malignancy has been detected in a selected few cases, and therefore cannot be completely ruled out.
Pathological cysts can affect women of all ages, which includes both reproductive as well as post-menopausal women.
1. Dermoid Cysts
Dermoid cysts, also known as cystic teratomas, are the most commonly-occurring pathological cysts in women who are still in the prime of their reproductive age (below 30 years).
A dermoid cyst is made up of those ovarian cells that are used to form the ova or egg. This kind of cyst may also contain traces of hair, dermal tissue, fat, teeth or bone within it.
Despite the threatening appearance, these cysts are usually benign and pose no significant health concern.
Ovarian mucinous cystadenomas differ from dermoid cysts both in terms of their composition and location. Cystadenomas are largely benign tumors that develop from the abnormal growth of those ovarian cells that cover the surface epithelium of the ovaries.
Unlike dermoid cysts which reside within the ovaries, cystadenomas lie outside the ovaries with a small stalk connecting the two.
Cystadenomas are relatively bigger than regular teratomas and can grow large enough to obstruct blood flow to the ovaries. On average, cystadenoma tends to be at least 10 cm wide but can expand to a much greater size.
These cysts tend to have a smooth outer and inner surface and are usually filled with a translucent and runny substance.
Women above the age of 40 are more prone to developing cystadenomas.
Causes of Ovarian Cyst
Ovarian cysts can develop due to a number of causes, but some of the prime culprits include:
- Hormonal Issues: Ovarian cysts can often be traced back to some kind of hormonal dysfunction or imbalance in the female body. Women who face fertility problems and take hormone-based medicines to stimulate ovulation are particularly prone to this type of cyst formation.
- Pregnancy: It is normal for a woman to develop an ovarian cyst soon after conceiving, which serves the purpose of supporting the embryo until the placenta forms. It is also common for childbearing women to retain the ovarian cyst formed during their last phase of ovulation throughout the course of their pregnancy.
- Endometriosis: It refers to a condition characterized by the abnormal growth of endometrial cells that form the uterine lining in places outside the womb. The ovaries are often affected by this kind of endometrial tissue growth, which results in the formation of cyst-like mass that is prone to bleeding.
This brown-colored cyst is known as endometrioma, or chocolate cyst in more general terms. Women with endometriosis are, therefore, at an increased risk of developing ovarian cysts.
- Pelvic Infections: If you have an aggressive form of a pelvic infection, the chances are that it can spread to the ovaries, resulting in the formation of cysts called ovarian abscesses, which are purulent, or pus-filled, cysts.
- Polycystic Ovary Syndrome: PCOS is a common hormonal disorder afflicting a large number of women all over the world. This condition is characterized by the development of multiple tiny cysts in and on the ovaries, and it is the most predominant cause of female infertility.
Signs and Symptoms
Most ovarian cysts are small-sized benign growths that do not exhibit any noticeable symptoms.
However, if the cyst becomes unusually large or ruptures, it may give rise to some degree of discomfort.
Some of the commonly reported symptoms associated with large ovarian cysts include:
- Bloating, swelling, or pressure in the lower abdomen
- Painful bowel movements
- Irregular periods
- Unusually heavy or light menstrual flow with cramps
- Pain in the pelvic area before or during the menstrual cycle, which can range from a dull, heavy ache to a sudden, piercing pain
- Pain that spreads from the pelvis to the lower back or thighs
- Feeling of heaviness even after eating very little
- Frequent need to pass a stool or urinate
- Difficulty in emptying the bladder fully
- Feeling of pressure in the bladder or rectum
- Nausea and vomiting
- Pain during sex
- Rare instances of hormonal fluctuations, which can have a bearing on your breast development and excessive hair growth
- Painful tenderness in the breasts
- Difficulty to conceive, although diminished fertility is reported in only a select few cases of ovarian cysts
If the ovarian cyst bursts, you may experience a sharp pain that comes on suddenly and can be felt only on one side of the abdomen.
The pain associated with a ruptured cyst usually gets aggravated or triggered by any kind of intensive physical activity, such as exercise or sexual intercourse.
Some degree of internal bleeding may be present as well.
However, a lot of women do not feel a thing when their ovarian cyst ruptures, especially if it is small in size.
Diagnosing Ovarian Cyst
Diagnosing an ovarian cyst typically involves a series of tests to help your obstetrician-gynecologist (ob-gyn) get a more detailed picture of what he/she is dealing with. These tests include:
- An ultrasound exam to determine the exact location of the cyst and to see if it is a solid mass or a fluid-containing entity.
- Blood tests to evaluate the level of CA 125, a substance which, if found in higher levels, can signal the risk of cancer, especially in post-menopausal women.
Bear in mind, however, that these test results do not amount to much unless corroborated by the findings of the ultrasound and physical examinations.
- A pregnancy test to check if the cyst is the outcome of early-stage gestation.
- Hormone level tests to identify possible endocrinological factors that may be responsible for the occurrence of ovarian cysts.
- Magnetic resonance imaging (MRI) to analyze ovarian growth in greater detail.
- Biopsy, wherein a sample of the ovarian tissue is tested in a lab for the presence of cancer cells.
Standard Medical Treatment
While it is true that most ovarian cysts tend to clear on their own within a few weeks or months, some may require medical treatment.
In any case, your doctor will ask you to keep a check on your symptoms once you are diagnosed with a functional cyst.
A follow-up ultrasound may be conducted after a given period to see if the cyst has shrunk or dissolved completely.
If the cyst shows no sign of remission or starts growing, the doctor will prescribe the next course of action taking into account the type and size of the cyst, your age, and your overall medical history.
Women who are prone to developing functional ovarian cysts may be prescribed oral contraceptives and other types of hormonal birth control or hormonal therapy to thwart their ovulation cycle.
There isn’t much you can do at home to remove an ovarian cyst, and remedies that claim otherwise are devoid of any scientific support.
Thus, it is always recommended to adhere to the treatment prescribed by your doctor rather than trying out unverified home remedies that may have potentially harmful consequences for your health.
If the problem is major, that is, if the cyst increases in size or starts converting into a cancerous tumor, the following interventions will be performed:
Laparoscopy is one of the less invasive surgical interventions intended for cyst removal, and it is usually recommended if the mass appears small and benign.
This technique involves the use of an instrument called a laparoscope, which resembles a slender telescope. The doctor will make a small incision just above or below your belly button and insert the laparoscope through it. (3)
The tube is equipped with a light source that can help the doctor see your internal organs and reach the cyst that needs to be removed.
The cyst is usually drawn out through small cuts at the pubic hairline, once it is surgically excised.
Laparoscopic surgery is quite popular among young women for the simple reason that it leads to minimal scarring and does not require extensive postoperative care at a hospital facility.
Laparoscopy may not work for removing large cysts or those that may pose a cancer risk, in which case your doctor may perform a laparotomy.
This surgical technique will require your doctor to make relatively bigger incisions to withdraw the large-sized cyst.
The extracted mass will then be tested for the presence of cancer cells. If the test results come out positive, it is highly likely that your doctor will remove the affected ovary and surrounding tissue as well.
If the doctor suspects that cancer has metastasized to the fallopian tubes, the other ovary, or the entire uterus, any and every affected tissue will have to be removed.
It is natural to have a lot of concerns and anxiety about a surgery that is as intensive and invasive as this.
Your doctor can help dispel any doubts that you may have regarding the surgery and can help you prepare for the procedure by telling you just what to expect.
According to one 2015 case study that included 244 cases of ovarian cysts, laparotomy was found to be a preferable treatment strategy over laparoscopy for:
- Patients who were above 35 years of age
- Childbearing women
- Single women
- Patients who had multiple cysts
- Patients who showed signs of abdominal pain (1)
At What Age Does Ovarian Cyst Occur?
In a 2017 study conducted on 1009 girls of different ages, it was observed that the frequency of ovarian cyst formation tends to increase with age once the female child enters into adolescence.
It is at its highest when the girl turns 15. (2)
The children between the ages of 5 and 9 years were most likely to develop small-sized cysts in an infrequent manner.
Whereas, the teenagers with cysts larger than 5 cm in diameter were found to exhibit the most significant cyst-related significant ovarian pathologies.
Difference Between a Tumor and a Cyst
There is a fine line between a cyst and a tumor, which often gets blurred due to certain overlapping characteristics.
Both these growths can occur anywhere in the body, whether in your skin, organs, bones, or soft tissue.
However, you can tell the two apart on the basis of the following characteristics:
- A cyst is essentially a capsule-like structure that is covered by a thin membrane with a cavity inside it that can be filled with air, fluid, tissue, or any other semisolid substance.
A tumor, on the other hand, is a condensed mass of extra tissue that forms due to the abnormal growth of new cells.
- Given that cysts are hollow from within, they tend to budge on pressing, and you can even feel them moving around under the surface of the skin.
Tumors are solid structures that feel firm on touching and are far more rigid.
- Cysts are usually described as noncancerous lumps, barring a few exceptions. Tumors can be benign, premalignant, or cancerous.
- Cysts can be of different types and develop due to a multitude of reasons, ranging from infection, duct blockage, and an underlying medical condition such as PCOS to simply a buildup of dead cells on the surface of the skin.
Tumors form due to excessive growth of tissue that is not in line with the normal tissue surrounding it, resulting in a protruding mass.
This abnormal cell growth is characterized by an unusually rapid and uncontrolled proliferation of new cells that keep on piling up while the older cells fail to die.
- Hormonal changes brought on by menstruation can cause your cyst to act up during that particular time of the month. Tumors are generally not affected by such hormonal fluctuations.
- A cyst may ooze out a white, yellow, or green discharge. Because a tumor is not porous in structure, it is unlikely to exude such fluid contents.
Difference Between PCOS and Ovarian Cyst
It is a general misconception to equate ovarian cysts with PCOS. An ovarian cyst is a broad term that refers to different types of cysts that can develop due to a number of factors.
PCOS is a metabolic disorder that is characterized by an excess of male hormones. It is extremely prevalent among women of childbearing age.
As the name suggests, most women with PCOS usually develop an abnormally large number of cysts in or on their ovaries. However, some patients with PCOS do not.
So, it is wrong to assume that just because you have multiple ovarian cysts, you will inadvertently have PCOS.
Simply put, not everyone with PCOS is bound to have polycystic ovaries, and not everyone with multiple ovarian cysts will necessarily be diagnosed with PCOS.
Does an Ovarian Cyst Affect Pregnancy?
Pregnant women have an increased tendency to developing ovarian cysts, particularly during the early months.
Ovarian cysts such as these are just as benign as those that develop otherwise, but they can complicate matters if they continue to become bigger over the course of the pregnancy.
As the cyst becomes progressively enlarged, it is more likely to burst and twist and can be a challenge during the time of childbirth.
With ovarian cyst or not, every childbearing woman must remain under the constant care of an ob-gyn. This kind of expert supervision just becomes more pertinent when you have a mass growing on your ovaries.
Women with PCOS require special attention as they are generally at a greater risk of certain pregnancy-related complications, such as:
- Gestational diabetes
- Pregnancy-induced hypertension
- Premature delivery
Cancerous (Malignant) Cyst: As in the case of any other tumorous growth, there is always the possibility that the cyst may be malignant or cancerous. However, the chances of that happening are fairly slim considering the present data.
Women who are past the menopausal age are more likely to develop a malignant cyst as opposed to those who are still in the reproductive age.
Ruptured Cyst: Although the development of these fluid-filled sacs in or on your ovary should rarely be a cause of concern, sometimes the cystic ovarian mass can grow to a large size and even rupture, leading to pain, internal bleeding, and other discomforts.
Ovarian Torsion (Adnexal Torsion): Abnormal enlargement of a cyst can cause the ovary to move from its original position and twist itself around its own ligaments.
Though this condition is rare, it is accompanied by pelvic pain. If left untreated, it may also restrict the blood flow to the ovary.
1. Ovarian cysts need to be surgically removed
Majority of ovarian cysts are fairly small, benign, and harmless, and they tend to go away within a few months without any medical or surgical intervention. Surgery is needed only if the cyst:
- Becomes progressively large
- Is accompanied by fever
- Results in unmanageable pain and discomfort in the lower pelvis and abdomen
- Poses a threat of infection or possible malignancy
2. Ovarian cysts cause infertility
A lot of women with ovarian cysts worry that the condition will make it harder for them to conceive a pregnancy, but this is rarely the case.
It is usually when a cyst becomes infected that the risk of diminished infertility may arise.
The infection may spread from the ovarian lesion to the larger pelvic region and may scar the fallopian tubes. You may face some problems in getting pregnant as a result of this fallopian damage.
Ovarian cysts are also more likely to cause fertility-related problems in women who suffer from pre-existing endometriosis.
3. Ovarian cysts only affect older women
Another misconception regarding ovarian cysts is that only women who are past the menopausal age are affected by this condition.
This is entirely untrue, as women of all ages can develop ovarian cysts at any point their life. Some might get them pretty early on before they have even entered puberty.
However, it is worth noting that cysts that form after menopause are more likely to be cancerous than those that occur during the reproductive years.
It is, therefore, mandatory for older women to get their ovarian cysts medically examined to eliminate the risk of ovarian cancer.
4. Ovarian cysts are cancerous
It is easy to get worked up about any abnormal growth in your body due to the fear that it may be cancerous. The same holds true for ovarian cysts, but you can rest easy knowing that most cases are reported to be completely benign.
Thus, the commonly held concern that a cyst on your ovary is the first sign of ovarian cancer may not be completely unfounded, but it is often exaggerated.
By and large, it is fairly uncommon for an ovarian cyst to contain cancer cells.
You can only know if a cyst is malignant or not once your gynecologist has run the necessary tests. Till then, there is no need to worry over nothing as the odds are in your favor.
When to See a Doctor
Ovarian cysts do not qualify as a serious health concern, but you may require medical assistance by an ob-gyn if:
- You start experiencing several symptoms associated with an ovarian cyst.
- You suffer from unmanageable pain in and around the abdomen.
- Your period flow becomes abnormally heavy or light.
It becomes even more crucial to seek medical help if the following symptoms constantly plague you for a minimum period of 2 weeks:
- Feeling of fullness despite eating very little
- Loss of appetite
- Unexplained or unintentional weight loss
Expert Answers (Q&A)
Answered by Dr. Masahide Kanayama, MD (Gynecologist)
Possible consequences of a ruptured ovarian cyst are acute pelvic pain (likely on the side of ruptured ovarian cyst), acute hemorrhage and possible anemia, nausea and vomiting, dizziness, lower back pain, and groin pain.
Ovarian cysts may rupture because they have reached a certain size and cyst walls cannot hold the pressure inside anymore.
Only a very small percentage of ovarian cysts (usually less than 1%) may develop into ovarian cancer.
But the risk of developing into ovarian cancer increase with advanced ages, especially after 60. And with complex cysts, with septations and nodules, the chance of cancer is higher.
It depends on the type of ovarian cysts. If the cyst is endometrioma or chocolate cyst, fertility is significantly compromised by the presence of chocolate cysts.
If it is just a simple follicular cyst, there is no effect on fertility.
It again depends on the type of cyst. If it is a follicular ovulation cyst, it is best to leave it untreated since these cysts disappear over time.
But other pathological cysts like a chocolate cyst, dermoid cyst, and the complex cyst may need to be treated depending on the size, appearance, and symptoms.
Ovarian cysts need to be quickly diagnosed and evaluated. Treatment approaches are entirely different, depending on the type of cyst.
Some cysts like follicular cysts and corpus luteum cysts most likely disappear by themselves.
On the other hand, endometriosis cysts like chocolate cysts cause infertility and pain, and they need to be addressed by specialists.
Any cyst of complex type with nodules and septation raises chances of malignancy, and they need to be monitored and treated accordingly.
About Dr. Masahide Kanayama, MD: Dr. Kanayama is the director of New York Endometriosis Center located in Manhattan, New York USA. He has successfully treated over 6,000 endometriosis laparoscopic excisions in his center, and he has developed his own novel surgical technique to excise deep endometriosis effectively and successfully.
He completed his MD from Medical College of Wisconsin and Internship and Residency in Gynecology and Gynecology surgery, from Mayo Clinic and Mayo Graduate School of Medicine, Rochester, MN.