Ovarian Cysts: What You Need to Know

An ovarian cyst is a buildup of fluid within an ovary surrounded by a thin shell, or membrane. 

You have two, small, grape-shaped organs called ovaries inside of your abdomen (belly) on either side of your uterus. One amazing fact that most women do not usually know is that when you are born, your ovaries are already filled with millions of eggs.

When you reach puberty, chemicals from the pituitary gland in your brain signal your ovaries to ripen an egg. The ovaries produce eggs, as well as the hormones estrogen and progesterone.

During a woman’s monthly cycle of ovulation, the ovaries form cysts which contain these eggs.

Usually, once a month an egg is released from a fluid-filled sac in the ovary, so it can travel through the fallopian tube to the uterus. This is called ovulation, which, as you know, is an obligatory part of your monthly cycle.

That “fluid-filled” (or sometimes, solid) sac in or on your ovary is called an ovarian cyst. An ovarian cyst is a buildup of fluid within an ovary surrounded by a thin shell, or membrane.

It develops in the ovary and usually resolves with the monthly ovulation, in which the egg is released: the cyst fluid is also released and the cyst then resolves. This is a very small amount of fluid that is absorbed by the body.

Usually benign

Ovarian cysts may affect both ovaries at the same time, or they may only affect one. Ovarian cysts may be up to 4 centimeters or 1.5 inches in size. Occasionally, these cysts remain and grow up to two to three inches. But these, too, usually resolve naturally in your body within a month or two.

Most of the time, ovarian cysts are painless and harmless. You might get one every month as part of your cycle and never know it. Cysts are also common when you are pregnant.

Most women will have an ovarian cyst sometime during their life. In most cases, it will go away on their own. However, if you have persistent symptoms or you are getting older, an ovarian cyst warrants follow-up.

A cyst becomes a problem when it doesn’t go away or gets bigger. It can become painful. There is also the possibility of cancer, but in fact, it is rare. The chances go up as you get older.

The good news, though, is that the majority of ovarian cysts have nothing to do with cancer, gynecologists report. More often than not, ovarian cysts are benign. These cysts are painless and cause no symptoms.

When to worry

Oftentimes, ovarian cysts do not cause any problems. However, symptoms can appear as the cyst grows.

An ovarian cyst usually only causes symptoms if it splits (ruptures), is very large, or blocks the blood supply to the ovaries. In these cases, a woman may have the following:

  • pelvic pain – this can range from a dull, heavy sensation to a sudden, severe and sharp pain
  • pain during sex
  • difficulty emptying her bowels
  • a frequent need to urinate
  • heavy periods, irregular periods or lighter periods than normal
  • bloating and a swollen tummy
  • feeling very full after only eating a little
  • difficulty getting pregnant – although fertility is unaffected in most women with ovarian cysts (see ovarian cysts and fertility)

If a cyst ruptures, it can cause sudden, severe pain.

If a cyst causes twisting of an ovary, you may have pain along with nausea and vomiting.

Severe symptoms of an ovarian cyst that require immediate medical attention include severe or sharp pelvic pain, fever, faintness or dizziness, and rapid breathing.

These symptoms can indicate a ruptured cyst or an ovarian torsion. Both complications can have serious consequences if not treated early.

What kind of help you can seek

There is no way to prevent ovarian cyst growth.

However, regular pelvic examinations will allow for early treatment if needed. This can often prevent complications.

To protect your health, see your doctor if you have persistent symptoms of an ovarian cyst. Your doctor may do a pelvic exam to feel for swelling of a cyst on your ovary.

If a cyst is found, your doctor will either watch and wait, or order tests to help plan treatment. Tests include:

  • Ultrasound. This test uses sound waves to create images of the body. With ultrasound, your doctor can see the cyst's shape, size, location, mass (whether it is fluid-filled, solid, or mixed)
  • Pregnancy test to rule out pregnancy
  • Hormone level tests to see if there are hormone-related problems
  • Blood test. If you are post-menopause, your doctor may give you a test to measure the amount of cancer-antigen 125 (CA-125) in your blood. The amount of CA-125 is higher with ovarian cancer. In premenopausal women, many other illnesses or diseases besides cancer can cause higher levels of CA-125.

The National Institutes of Health estimates that 5% to 10% of women have surgery to remove an ovarian cyst. Women health specialists note that only 13% to 21% of these cysts are cancerous.

Your cyst may require surgery if you are post-menopause, or in the case if your cyst:

  • Does not go away after several menstrual cycles
  • Gets larger
  • Looks unusual on the ultrasound
  • Causes pain

If your cyst does not require surgery, your doctor may talk to you about pain medicine. Your doctor may recommend over-the-counter medicine or prescribe stronger medicine for pain relief.

If you have cysts often, your doctor may prescribe hormonal birth control. Hormonal birth control – such as the pill, vaginal ring, shot, or patch – help prevent ovulation. This may lower your chances of getting more cysts.

Types of surgery

Some ovarian cysts will need surgery. That includes cysts that are large, do not go away, or cause symptoms. Cysts in women near menopause may need surgery. That’s because they may be cancerous. The surgeon may take just the cyst, or the ovary. It depends on your cyst.
Surgery in case of ovarian cysts may be recommended in the following cases:

  • the cyst is large or appears to be growing
  • the cyst does not look like a functional cyst
  • the cyst persists through 2 to 3 menstrual cycles.

Two types of surgery are:

  • Laparoscopy, or keyhole surgery: The surgeon uses very small tools, to remove the cyst through a small incision. In most cases, the patient can go home the same day. This type of surgery does not usually affect fertility, and recovery times are fast.
  • Laparotomy: This may be recommended if the cyst is cancerous. A longer cut is made across the top of the pubic hairline. The cyst is removed and sent to the lab for testing. The patient usually stays in the hospital for at least 2 days.

Ovarian cysts and fertility

Ovarian cysts don't usually prevent you from getting pregnant, although they can sometimes make it harder to conceive.

If you need an operation to remove your cysts, your surgeon will aim to preserve your fertility whenever possible. This may mean removing just the cyst and leaving the ovaries intact, or only removing one ovary.

In some cases, surgery to remove both your ovaries may be necessary, in which case you'll no longer produce any eggs. Make sure you talk to your surgeon about the potential effects on your fertility before your operation. 

 

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