Ovarian Cysts

Overview

Ovarian cysts refer to fluid-filled sacs that can grow inside or on the surface of the ovaries. Every female has two ovaries, each on both sides of the uterus. These ovaries are quite small and resemble the shape of an almond. They then accommodate the growth of eggs, which later develop, mature, and exit the body through monthly menstrual cycles.

These cysts are common in women who haven't undergone menopause or are pregnant. Ovarian cysts can be further segmented into various types, most of which are harmless and painless. With that being said, ovarian cysts are generally harmless. There is a chance that one can get one cyst every month, and it is just painlessly ejected from the body during the menstrual cycle. Often, a woman can't even feel the presence of the cyst, other than a feeling of fullness and bloating around the pelvis.

However, the real problem occurs when the cyst isn't eliminated during the menstrual cycle or grows in size. The process will get quite painful then. Additionally, a large ovarian cyst might also serve as a stepping stone for cancer.

For instance, if the cyst grows larger than 2.5 cm, a woman will experience symptoms such as irregular periods, sudden weight loss, pain during sex, vomiting, nausea and bowel movement pain. Now that the cyst is huge in size, one might not be able to pass it. This might take surgery to get rid of.

Also, if the cyst isn't treated on time, it might even impact ovulation, paving the way for PCOD (ovaries have minute cysts on the surface). This will make conceiving difficult. Furthermore, some other risks associated with ovarian cysts are ovarian rupture and ovarian torsions.

Types of Ovarian Cysts:

Functional cysts are not associated with any disease process; they form during ovulation and frequently resolve without treatment. Some other types of cysts are:

1. Corpus luteum cysts
The corpus luteum is formed when your ovary releases an egg. The corpus luteum is a collection of cells that produce hormones during ovulation. When it fills with fluid, it forms a cyst on the ovary.

2. Follicular Cysts
During ovulation, your ovary's follicle releases an egg. When you do not release an egg during the month, the follicle may fill with fluid, forming a cyst on your ovaries.

3. Endometriomas
Endometriomas are cysts that form from endometrial tissue, the uterine lining that sheds during menstruation. Endometriosis is a common cause of these cysts.

4. Dermoid cysts
Dermoid cysts, or teratomas, comprise various tissues in your body. These cysts form on your ovary and contain hair, teeth, and skin tissues. They form from the reproductive cells in your ovary.

Symptoms:

If a woman is experiencing the symptoms of ovarian cysts, she must get it checked by a doctor as soon as possible. To give a better idea, here are a few symptoms of ovarian cysts one must look out for.

1. Nausea

2. Fever 

3. Vomiting

4. Swelling around ovaries

5. Pelvic pain in waves of varying intensity

6. Sharp pain below the belly button (usually towards one side)

7. Constant feeling of fullness in the belly, bloating

8. Irregular periods, pain during sex

9. Sudden weight loss

10. Not getting pregnant

11. Increase in urgency to urinate, 

12. Increase in urination frequency

13. Painful bowel movements

Causes:

Ovarian cysts are fluid-filled sacs that can form on or inside an ovary. The causes of ovarian cysts include:

Hormonal Imbalance: This can occur naturally or as a result of taking fertility drugs.
Pregnancy: Cysts can develop from the corpus luteum, which is the area of the ovary that releases an egg and produces hormones until the placenta forms.
Endometriosis: This condition causes endometrial cells to grow outside the uterus, sometimes on the ovaries, leading to cyst formation.
Pelvic Infections: Infections that spread to the ovaries can cause cysts.
Previous Ovarian Cysts: Having had an ovarian cyst in the past increases the likelihood of developing more cysts.
Most ovarian cysts are benign and often resolve on their own without treatment. However, regular pelvic exams are important for early detection and management. If you’re experiencing symptoms or have concerns about ovarian cysts, it’s best to consult with a healthcare provider.
 

Risk factors:

Ovarian cysts are fluid-filled sacs that can form in or on the ovaries. The risk factors for developing ovarian cysts include:

Hormonal imbalance: This can occur naturally or be influenced by fertility drugs.
Pregnancy: Cysts can develop from the corpus luteum, which is the tissue left after an egg has been released.
Endometriosis: Growth of endometrial cells outside the uterus, including on the ovaries.
Pelvic infections: These can spread to the ovaries and contribute to cyst formation.
Previous ovarian cysts: Having had cysts before can increase the risk of developing new ones.
Cigarette smoking: Especially when combined with a lower body mass index (BMI).
Tubal ligation: Some studies suggest an association between tubal ligation and functional cysts.
Family history: A family history of ovarian cysts can increase risk.
Obesity: Higher body weight has been linked to an increased risk of cysts.
Ovarian hyperstimulation syndrome: This can occur with hormone supplements.
Genetic mutations: Certain genetic mutations may increase the risk.
It’s important to have regular pelvic examinations for early detection and to note any changes in menstrual cycles or symptoms. If you’re experiencing new, severe, or persistent symptoms, contacting a healthcare provider is crucial.

Possible Complications:

Here are certain complications of leaving a severe ovarian cyst untreated:

• Ovarian torsion

This is when the cyst becomes so large that it might cause the ovary to move. As a result, the ovary might undergo painful twisting, resulting in nausea, vomiting, and severe pelvic pain. This condition might also restrict blood flow to the ovaries.

• Cyst rupture

This is when the said ovarian cyst bursts open, resulting in bleeding inside the pelvis and intense pain. As the size of the cyst increases, the chances of it rupturing will also increase. Furthermore, activities that lay too much pressure on the pelvis (e.g., vaginal sex) can also lead to the rupture of this cyst.

• Rapid growth of the cyst

If an ovarian cyst is left untreated, it will keep growing in size. If not treated on time, this cyst can grow as much as 40-42 cm. This will lead to abnormal ovary functioning, sharp pain, compromised fertility, and abnormal functioning of the reproductive organs.

Prevention:

Preventing ovarian cysts can be challenging since many develop as a result of the normal menstrual cycle. However, there are steps you can take to reduce your risk of developing problematic cysts:

Stop Smoking: Smoking has been linked to an increased risk of developing ovarian cysts. If you smoke, consider seeking help to quit.
Maintain a Healthy Weight: Being overweight can contribute to conditions like polycystic ovary syndrome (PCOS), which increases the risk of developing cysts. Aim for a healthy weight through a balanced diet and regular exercise.
Consider Birth Control: Hormonal contraceptives, such as birth control pills, patches, rings, injections, and implants, can prevent the formation of new cysts by suppressing ovarian function and preventing ovulation.
Manage Underlying Conditions: Conditions like PCOS and endometriosis increase the risk of cysts, so proper management and treatment of these conditions are important.
Regular pelvic examinations are crucial for early detection. It’s also important to note any changes in your menstrual cycle or symptoms and discuss them with your healthcare provider. If you have hormone issues, your healthcare provider may advise taking birth control pills, which may help prevent ovarian cysts. Taking antibiotics for a pelvic infection may also prevent a cyst from forming.

Remember, if you’re experiencing new, severe, or persistent symptoms, you must contact a healthcare provider.
 

When to Consult a Doctor?

Here are some of the top signs that suggest an ovarian cyst is growing out of proportion and can cause irreparable damage

• Inability to get pregnant

If a woman has been trying to conceive a child for more than a year without any luck, there is a chance that she might have an ovarian cyst or PCOD. The presence of these cysts impacts ovulation, making it difficult, or in some cases, impossible to conceive a child. So, if a woman faces this issue, she should visit a gynaecologist as soon as possible. This is because reproduction and pregnancy are matters that no woman can think beyond a certain age. Not taking timely precautions can lead to permanently compromised fertility.

• Regular pelvic examinations

Generally, every woman approaching puberty must visit a gynaecologist for regular body checkups at least once a year. This will allow her to catch any looming gynaecological emergency in its early stages, paving the way for a swift prognosis and treatment.

As mentioned earlier, most of these cysts are asymptomatic, making them very difficult to detect. Hence, regular pelvic exams are necessary to ensure that the ovarian cyst doesn't grow or show signs of growing out of control.
An early diagnosis will help a woman to catch these ovarian issues on time, avoiding the need for risky complications down the line.

Diagnosis:

To diagnose the presence of ovarian cysts, one needs to visit a licensed gynaecologist. The doctor will look for symptoms and perform a comprehensive physical examination to check for swelling in the area around the ovaries. The doctor will also perform routine pelvic exams.

Once the doctor grasps a basic understanding of the condition, he or she will prescribe a set of imaging and lab tests to confirm the cyst’s exact size, location, composition, and nature. Once both the physical examination and testing are done, the doctor will pool the results and choose the appropriate treatment method for cyst removal.

To give better detail about the various tests that entail ovarian cyst detection, here are some diagnostic tests that are used:

Diagnostic tests:

• Lab Tests

One of the primary ways to check for the presence of ovarian cancer is via a blood sample. The protein known as cancer antigen is found in excess when the person suffers from ovarian cancer. If a woman has a cyst that has already solidified, she is exposed to a considerable risk of ovarian cancer.

The doctor might then order a cancer antigen 125 test (CA 125 Test) and other important blood tests. But remember that the CA 125 levels will also be elevated for certain non-cancerous conditions such as pelvic inflammatory disease, endometriosis, etc.

• Imaging Tests

Imaging tests are compulsions during the diagnosis of an ovarian cyst. Firstly, the doctor will ask the patient to get a pelvic ultrasound. This test leverages sound waves to create images of the internal organs. It will confirm the presence or absence of an ovarian cyst.

Next up, the doctor will ask the patient to get a couple of other imaging tests, including an MRI, CT scan, or sonography. An MRI is a machine that employs magnetic fields to develop in-depth images of the internal organs.

On the other hand, a CT scan creates a cross-sectional image of the internal organs. All these imaging tests will help the doctor understand the exact nature of the cyst, i.e., whether it is solid or filled with fluid.

• Advanced Tests

Laparoscopy falls under this category of the most advanced pelvic tests to detect the presence of ovarian cysts. Essentially, the test uses a specialised medical instrument, the laparoscope, inserted into the abdomen through a minute incision. This instrument will allow the doctor to view the ovaries very clearly, and hence, they can check for the growth of cysts in or on the ovary surface.

This is possible because the laparoscope has a small camera attached at the insertion end, allowing doctors to see inside the body through the incision. By doing so, the doctor can gauge the accurate location and size of the cyst, leading to a much more precise diagnosis.

Treatment:

The treatment method one adopts for dealing with ovarian cysts will vary based on age, underlying symptoms, and other factors. Here are some of the top treatment options one can take to get rid of ovarian cysts:

• Home Care

There is a chance that an ovarian cyst might go away without treatment. If the cyst is functional, the doctor might ask the patient to adopt a wait-and-see approach. In the meanwhile, one can relieve pain using a warm compress, painkillers, and home remedies. However, remember that sharp pain will suggest an ovarian rupture, and one should consult a doctor immediately.

• Medication

Treatment for ovarian cysts often depends on the type, size, and symptoms of the cysts. Some may not require treatment and can disappear on their own, while others might need medical intervention. Here are some medications commonly used to manage ovarian cysts:

Hormonal contraceptives: Birth control pills, patches, rings, injections, and implants can help prevent new cysts from forming in future menstrual cycles by suppressing ovulation. Examples include:
Ethinyl estradiol/norgestimate
Ethinyl estradiol/levonorgestrel 
Metformin: This medication is used to increase insulin sensitivity, especially in cases related to polycystic ovary syndrome (PCOS).
In some cases, if medical treatment fails and the patient presents with danger signs, surgical options such as cyst drainage or removal of the affected ovary may be considered.

It’s important to consult with a healthcare provider to determine the most appropriate treatment based on individual circumstances. They can provide guidance on the risks and benefits of each treatment option. Remember, this information is not a substitute for professional medical advice.

• Surgical Treatment

Doctors suggest surgical treatment if the cyst is too large to be passed. Certain cysts can be removed without having to remove the ovary (cystectomy), and certain surgical operations can also help remove the ovary (oophorectomy).