1.1 About ovarian cyst
Ovarian cysts are a common gynecological issue, particularly among women of reproductive age. An ovarian cyst refers to the presence of one or multiple fluid-filled sacs (cysts) inside or on the surface of the ovary. Most ovarian cysts do not cause any symptoms and can be managed through observation. However, a small percentage of cases may result in clinical discomfort or complications.
Structurally, the ovaries are located on either side of the uterus and are responsible for producing eggs and female hormones. Ovarian cysts can occur singly or simultaneously on either one or both ovaries. When multiple cysts (typically at least 10) develop on one ovary, it is referred to as polycystic ovarian syndrome (PCOS).
1.2 Types of ovarian cyst
Ovarian cysts can be further classified into various types. Functional cysts are formed during a woman’s menstrual cycle, while other types of cysts do not form during the menstrual cycle. They are caused by abnormal cell growth in the ovaries and can be categorized as ovarian tumors.
Ovarian tumors result from uncontrolled cell growth. The majority of ovarian tumors are benign, meaning they do not invade other tissues or spread. However, these tumors can occasionally transform into malignant tumors and even metastasize to other parts of the body.
Functional cysts
Functional cysts, including follicular cysts and luteal cysts, are a type of cyst that forms during the menstrual cycle in women. During the menstrual cycle, the egg develops within the ovarian follicle. Each month, there is a follicle that grows larger until it ruptures and releases the egg. Functional ovarian cysts are formed from these developing follicles.
- Follicular cyst: It is formed from a follicle that does not rupture.
- Luteal cyst: If the follicle releases the egg but does not rupture, it can form a luteal cyst filled with fluid or blood.
Functional cysts usually resolve on their own.
Cystadenoma
Cystadenoma is formed from cells covering the outer surface of the ovaries. It is classified into serous cystadenoma (filled with watery fluid) and mucinous cystadenoma (filled with thick mucus-like fluid) based on the fluid content inside the cyst.
Dermoid cyst
Dermoid cyst is formed from cells responsible for producing eggs in the ovaries. The cyst may contain various types of tissues, most commonly hair, teeth, and other tissues.
Endometriotic cyst
Endometriotic cyst, also known as an endometrioma, is associated with endometriosis. When endometrial tissue appears in the ovaries, it can form a cyst called an endometriotic cyst.
1.3 Cause of ovarian cyst
Some women’s ovarian cysts appear for reasons that have yet to be determined. Certain fertility treatment drugs may trigger follicular cysts.
1.4 Symptoms of ovarian cyst
Most ovarian cysts do not cause noticeable symptoms, and they are often discovered incidentally during physical examinations or ultrasound scans.
However, a small number of patients may experience the following symptoms:
- Lower abdominal pain: Ovarian cysts rarely cause lower abdominal pain, but some patients may feel bloating or pain during sexual intercourse.
- Lower abdominal discomfort: If the cysts continue to grow in size, it can lead to discomfort in the lower abdomen.
- Frequent urination: Large ovarian cysts can sometimes exert pressure on the bladder or urethra, causing frequent urination.
- Changes in menstrual cycle: The duration of the menstrual period may lengthen or the flow may increase. Sometimes the menstrual cycle may shorten.
Occasionally, ovarian cysts can lead to acute complications such as torsion or rupture, causing severe abdominal pain, nausea, or vomiting. In such cases, immediate medical attention is required, and hospitalization may be necessary for prompt management.
1.5 Diagnosis of ovarian cyst
If you’re concerned about having ovarian cysts, it’s important to consult a doctor. The doctor will begin by taking a detailed medical history, including information about your symptoms, medical background, family history, and other relevant factors. Then, they will conduct a thorough gynecological examination, including palpation, to check for any masses or clinical findings in your lower abdomen and pelvic region.
To further investigate the presence of ovarian cysts, the doctor may recommend the following tests:
Pelvic Ultrasound Scan
A pelvic ultrasound scan, either transabdominal (abdominal ultrasound) or transvaginal (vaginal ultrasound), is a non-invasive imaging test. During the scan, the doctor will use ultrasound to examine the organs in the pelvic region, including the uterus, ovaries, and fallopian tubes, to look for any suspicious masses, cysts, or fluid-filled sacs.
Pelvic Computed Tomography (CT) Scan
If more detailed imaging information is required, the doctor may arrange for a pelvic CT scan. This scan provides clear cross-sectional images of the pelvic region and has higher accuracy and sensitivity compared to a pelvic ultrasound scan. If there is a suspicion of ovarian cysts, particularly concerning the possibility of malignant cysts, the doctor may recommend a pelvic CT scan for a more detailed evaluation.
Blood Tests
CA 125 is a tumor marker commonly used for diagnosing and monitoring ovarian cancer cases. The doctor may combine the results of imaging scans and CA 125 levels to assess the possibility of malignancy in ovarian cysts.
It’s important to consult with a healthcare professional who can provide a proper evaluation and guide you through the necessary diagnostic procedures based on your specific situation.
1.6 Treatment of ovarian cyst
Clinical Monitoring
If the ovarian cyst is small in size (less than five centimeters in diameter) and there are no other suspicious findings in clinical assessment, the doctor may recommend regular monitoring of the ovarian cyst. In most cases, these ovarian cysts will resolve on their own within one to two menstrual cycles without causing any complications.
Additionally, for individuals with functional ovarian cysts or those prone to developing functional ovarian cysts, the doctor may suggest taking hormonal contraceptive medications, which can help prevent the occurrence of functional ovarian cysts.
Surgical Treatment
Surgery may be recommended if the ovarian cyst is larger in size, there is suspicion of malignancy, malignancy cannot be completely ruled out, or if the ovarian cyst is causing clinical symptoms such as pain or discomfort.
The surgical approach will depend on several factors, including the size, location, and type of cyst, the patient’s age and overall health, and whether they have plans for future fertility.
Ovarian Cystectomy
In most cases, ovarian cysts can be treated by removing only the cyst while preserving the ovary. If the cyst is small in size and the likelihood of malignancy is low, the doctor may suggest a laparoscopic cystectomy (minimally invasive surgery). The advantages of this type of surgery are faster recovery and smaller incisions. However, for larger cysts or when there is a suspicion of cancer, the doctor may recommend an open abdominal surgery (laparotomy).
Oophorectomy or Total Hysterectomy with Bilateral Salpingo-Oophorectomy
If the ovarian cyst is deemed too large, there is suspicion of cancer, or the patient has already undergone menopause or does not plan to conceive, the doctor may recommend an oophorectomy (removal of the ovary) or a total hysterectomy with bilateral salpingo-oophorectomy (removal of the uterus, fallopian tubes, and both ovaries).