Ovarian Cysts

Ovarian cysts are thin-walled fluid-filled sacs in the ovary.  They are primary classified as either functional or pathologic.

Functional Cysts form in the ovary as part of the development or cyclical changes that occur during the regular menstrual cycle.  Functional cysts spontaneously disappear or resolve in days or months.  These types of cysts are common among women, particularly during childbearing years.

Pathologic or Non-Functional Cysts are abnormal growths not related to the menstrual cycle.  Though most are harmless or benign, some may be malignant or degenerate and become cancerous.  Common types of non-functional cysts are:

Dermoid Cysts (Teratomas)-  May contain tissues found in the other parts of the body, such as the fatty tissues, hair, skin or teeth.  They may resolve spontaneously in months.

Polycystic Ovaries- Multiple benign cysts are found in the ovaries.  As part of Polycystic Ovarian Syndrome, this is one of the causes of infertility.

Endometriomas- The endometrium is the tissue which lines the inside portion of the uterus.  Some endometrial tissues abnormally grow on areas other than the inner lining of the uterine cavity (referred to as endometrial implants) in a condition known as endometriosis.  These endometrial implants may form a cyst which may bleed.  The bleeding may lead to the aggregation of old clotted blood, giving it a chocolate appearance.  Thus, this type of ovarian cyst is sometimes referred to as “chocolate cyst.”

Cystadenomas-  May abnormally develop from the tissue covering the ovaries. They are usually attached to the ovary through a projection or stalk and grow outside of the ovary.  These types of cysts are generally benign, but some have the potential to be cancerous.

Symptoms of Ovarian Cysts

Most of the cysts are small and benign and cause no symptoms; this is why most women are unaware that they have ovarian cysts. However, in some instances, the following signs and symptoms may manifest.

  • Lower abdominal or pelvic pain, usually on one side, may occur when the cyst twists or ruptures. 
  • Bleeding within the cyst may stretch the cyst capsule and may cause pain.  Ischemic pain may be noted when the blood supply to the ovary is impeded by the growing cyst.
  • In cases of serious torsion, twisting, rupture or bleeding, the pain may be severe and associated with nausea, vomiting and even signs of shock.
  • Pain during sexual intercourse
  • Dysmenorrhea and abnormal bleeding

Larger cysts may present with the following symptoms.

  • Abdominal bloating or heaviness
  • Sensation of pressure in the bladder, causing frequent voiding
  • Pressure sensation in the rectum, resulting to frequent passing of stools

Diagnosis

For small to medium sized cysts, the discovery is usually incidental during a pelvic examination conducted for routine purposes or following the complaint of other gynecological problems. Pelvic or trans-vaginal ultrasound or laparoscopy findings confirm the presence of ovarian cysts.  More sophisticated imaging tests may also be conducted, such as MRI, Doppler studies or CT scan. The following laboratory work-up would further support the findings.

  • Complete blood count
  • Determination of Hormone levels (LH, FSH, estradiol and testosterone)
  • Pregnancy test
  • Ca-125 test to determine malignancy

Associative Conditions

Certain conditions may be associated with ovarian cysts, namely:

Torsion, denoted by twisting of the cyst may impede the blood supply to the ovary and lead to severe pain in the abdomen.

Rupture, associated with bigger cysts may also be associated with bleeding and may produce pronounced symptoms.  If an infection sets in, a more serious condition may be the consequence.

Ovarian Cancer may be the result of the degeneration of a benign ovarian cyst that turns malignant.

Treatment and Outcome

Majority of ovarian cysts spontaneously disappear or resolve without treatment within 8 to 12 weeks. In cases wherein surgical intervention is necessary, exploratory laparotomy or pelvic laparoscopy may be performed.  The following factors are considered when entertaining a surgical intervention approach.

  • Size of the cyst – greater than 5 or 10 cms
  • Occurrence and severity of symptoms
  • Whether the individual is in the pre-menopausal or menopausal phase of life.

Ovarian cysts which occur during the childbearing age are basically benign and resolve spontaneously.  If the cyst appears or persists during the menopausal period, there is a higher risk for malignancy or cancer and a more aggressive approach should be undertaken.

It is important to recognize that medications and medical procedures are associated with benefits and risks that should be discussed with your physician. It is important to recognize that all information contained on this website cannot be considered to be specific medical diagnosis, medical treatment, or medical advice. As always, you should consult with a physician regarding any medical condition. Your Health Access disclaims any liability for the decisions you make based on this information.