Ovarian Cysts

Symptoms

• Most ovarian cysts, especially functional ones, cause no symptoms and are found incidentally during other examinations.
• Dull ache or sharp pain in the lower abdomen on the side of the cyst (pelvic pain).
• Bloating or swelling in the abdomen.
• Feeling of fullness or pressure in the pelvis.
• Pain during intercourse (dyspareunia).
• Painful bowel movements.
• Urinary frequency or difficulty emptying the bladder due to pressure.
• Menstrual irregularities (heavier, lighter, or irregular periods).
• Lower back or thigh pain.
• Sudden, severe abdominal or pelvic pain (emergency symptom).
• Pain accompanied by fever or vomiting (emergency symptom).
• Signs of shock, such as cold, clammy skin; rapid breathing; lightheadedness or weakness (emergency symptom).

Causes & Risk Factors

• Menstrual Cycle (Functional Cysts): Follicular cysts occur when a follicle fails to rupture and release an egg, continuing to grow. Corpus luteum cysts form when the follicle sac, after releasing an egg, seals off and accumulates fluid.
• Abnormal Cell Growth (Pathological Cysts): Dermoid cysts (teratomas) form from embryonic cells and can contain various tissues. Cystadenomas develop on the surface of an ovary and may be filled with watery or mucous material. Endometriomas develop as a result of endometriosis, where endometrial-like tissue grows outside the uterus.
• Hormonal issues, such as taking fertility drugs that cause ovulation (e.g., clomiphene).
• Pregnancy, as cysts can form in early pregnancy to help support the pregnancy until the placenta forms.
• Endometriosis, which can lead to the formation of endometriomas ('chocolate cysts').
• A history of previous ovarian cysts, increasing the likelihood of developing more.
• Pelvic infection, where severe infections spreading to the ovaries can cause cysts.
• Polycystic Ovary Syndrome (PCOS), though the 'cysts' in PCOS are small, undeveloped follicles, and the direct link to larger, true ovarian cysts is complex.
• Tamoxifen use for breast cancer, which has been associated with an increased risk of developing benign ovarian cysts.
• Smoking, with some studies suggesting a link, particularly for functional cysts, but evidence is not definitive.
• Age (more common in premenopausal women).
• Genetic predisposition (e.g., BRCA1/BRCA2 mutations increase risk of ovarian cancer, which can present as a cystic mass).
• Use of combined oral contraceptives, which can reduce the risk of developing functional ovarian cysts by suppressing ovulation.
• Full-term pregnancy, which may have a protective effect.
• Breastfeeding, which may have a protective effect.

Diagnosis

• Medical history, including menstrual history, pain characteristics, associated symptoms, obstetric and gynecologic history, and family history of ovarian or breast cancer.
• Physical examination, including abdominal examination for tenderness or masses, and bimanual pelvic examination to assess the uterus and ovaries.
• Pregnancy test (hCG) to rule out ectopic pregnancy.
• CA-125 (Cancer Antigen 125) blood test, recommended for postmenopausal women with an ovarian cyst or for premenopausal women if ultrasound findings are suspicious for malignancy. It is not a routine test for premenopausal women with simple cysts as it can be elevated by many benign conditions.
• Complete Blood Count (CBC) to check for signs of infection or hemorrhage.
• Other tumor markers (e.g., HE4, AFP, LDH) may be considered by specialists if malignancy is suspected.
• Pelvic Ultrasound, the primary imaging method, often transvaginal, to characterize the cyst's size, shape, and internal features (simple vs. complex).
• MRI or CT scan, used less frequently if ultrasound results are inconclusive or if malignancy is highly suspected.
• Simple Cyst: Appears as a smooth, thin-walled, fluid-filled structure without solid components or septations on ultrasound, overwhelmingly likely to be benign.
• Complex Cyst: Has features such as thick walls, internal divisions (septations), solid components, or internal debris, requiring more careful evaluation due to a slightly higher (but still low overall) risk of malignancy.

Treatment Options

• Watchful Waiting (Expectant Management): The most common approach for premenopausal women with simple, asymptomatic cysts under a certain size, as functional cysts typically resolve on their own within 1-3 menstrual cycles. Follow-up imaging may be recommended.
• Hormonal Contraceptives (e.g., birth control pills): Do not make existing cysts go away faster but can prevent the formation of new functional cysts by suppressing ovulation.
• Pain Medication: Over-the-counter analgesics like NSAIDs (ibuprofen) or acetaminophen can manage mild pain.
• Ovarian Cystectomy: Surgical removal of the cyst while preserving the ovary, often performed laparoscopically (minimally invasive).
• Oophorectomy: Surgical removal of the entire ovary, which may be necessary if the cyst is very large, has destroyed ovarian tissue, or if malignancy is strongly suspected.
• Emergency Surgery for Ovarian Torsion: Immediate laparoscopy to untwist the ovary and attempt to save it. If tissue is necrotic, oophorectomy may be required.
• Emergency Surgery for Ruptured Cyst with Hemorrhage: Required if there is significant internal bleeding causing hemodynamic instability, to control the bleeding.

Frequently Asked Questions