Ovarian cyst – Risk, diagnosis and treatment

An ovarian cyst is a small round sac on the surface or within the ovary.

It is usually a benign condition and is considered to be functional, that is a part of the normal physiologic process and not due to a disease. The cyst most often contains fluid, but can also be solid or part fluid, part solid.

Causes of ovarian cysts

There are different types of ovarian cysts and they have different causes:

  • Functional ovarian cyst – This is commonly seen in young women of child bearing age who are either smokers or are being treated for infertility with a drug called clomiphene citrate. A functional cyst occurs during a menstrual cycle when the follicle containing the egg does not rupture and instead forms a cyst.
  • Follicular cyst – the sac does not release the egg but gets filled with fluid.
  • Corpus luteum cyst – the sac releases the egg from the ovary and then gets filled with fluid which may lead to a pregnancy and the follicle is then called corpus luteum.
  • Dermoid cyst – this type of cyst is seen on sites other than the ovary, like on the back. It may contain skin, teeth or hair as it is formed from the cells which form the skin, teeth and hair.
  • Endometrioid cysts – these occur due to a condition called endometriosis in which the tissue lining the inner wall of the uterus called endometrium is seen outside the uterus. These cysts may contain blood.
  • Hemorrhagic cyst – it is a type of functional cyst in which bleeding occurs as a part of polycystic ovarian syndrome, which may have multiple cysts, irregular periods and infertility.

Risk factors of ovarian cysts

  • Hypothyroidism
  • Infertility or women who are on treatment for infertility
  • Those taking tamoxifen, a drug to combatbreast cancer
  • Irregular periods
  • Early periods (before 11 years)
  • Previous history of ovarian cysts.
  • A drug called clomiphene may lead to formation of corpus luteum cyst.

Symptoms and signs of ovarian cysts

  • A majority of ovarian cysts do not show any symptoms and disappear on their own, after a few weeks or months.
  • Pelvic pain may be a feature on the side the cyst is located. There may also be pain in the lower back or thighs.
  • If the cyst is large it may cause a dull pain in the abdomen.
  • A large cyst may compress the urinary bladder leading to increased frequency of emptying the bladder, because of the pressure from the cyst.
  • Most cysts contain fluid, some may have blood and some may be solid, the latter is usually cancerous.
  • Infertility – endometrioid cysts are seen in endometriosis and women with this condition may be infertile.
  • There may be vaginal bleeding at a time other than your menstrual period.
  • Pain during sex or pain associated with nausea and vomiting may occur when the cyst gets twisted; this is known as ovarian torsion.
  • Menstrual period may be delayed.

Diagnosis of ovarian cyst

Your doctor will gather a detailed history of the symptoms as well as details of your menstrual period. Also, if there is pain during sex, the location and severity of the pain are important clues to the diagnosis. A pelvic examination by the gynaecologist may reveal a cyst. While the investigations below are helpful, pelvic ultrasound clinches the diagnosis.

Investigations for ovarian cyst

A pelvic ultrasound is the investigation of choice. A cyst appears like a bubble and the location, size and contents can be noted.

  • Blood tests for hormonal levels of estrogen, testosterone and others may be required in some cases. Blood levels of a protein called CA 125 are elevated in cases of ovarian cancer.
  • Endovaginal ultrasound is done in some clinics. Here, the ultrasound probe is inserted into the vagina to obtain more information on the ovarian cyst.
  • A pregnancy test that is positive may indicate the cyst to be a corpus luteum cyst.

Treatment of ovarian cyst

Most doctors adopt a wait and watch approach to check if the cyst is growing or showing any symptoms. You will be required to go for periodic check-ups to assess the condition. If there are symptoms of bleeding, rupture, pressure on bladder or a chance of malignancy, swift action needs to be taken.

  • Drug therapy – using oral contraceptives decreases the risk of new cyst formation while on medication. They also reduce the risk of developing ovarian cancer.
  • Laparascopic surgery is best if the cyst needs to be removed. The surgeon makes a small incision near the belly button to insert the laparascope; the cyst is visually ‘captured’ and removed or a small piece is removed and sent for biopsy. Removal of the cyst is called cystectomy.
  • Emergency surgery is necessary for an ovarian cyst that is twisted; this is called ovarian torsion.
  • Laparatomy is performed to remove a big cyst. Here, a bigger incision is made on the abdominal muscles and then the cyst is reached and removed.

Prevention of ovarian cyst

Not smoking is extremely important to prevent the formation of ovarian cysts.

It is important to detect any major changes in menstrual cycles. You should report this and all/any of the above mentioned symptoms to your doctor immediately.

 

Photograph by sxc.hu

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