Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Most ovarian cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the belly or pelvis is by far the most common one. The pain can be caused from:
rupture of the cyst,
rapid growth and stretching,
bleeding into the cyst, or
twisting of the cyst around its blood supply (known as torsion).
If the cyst has reached a large size, other symptoms may arise as a result of pressure or distortion of adjacent anatomical structures. These symptoms can include abdominal fullness or bloating, indigestion, feeling full after eating only a small amount (early satiety), feeling an urge to defecate or having difficult bowel movements, or pain with sexual intercourse.
How are ovarian cysts diagnosed?
Sometimes ovarian cysts may be noticed by a health care practitioner during a bimanual examination of the pelvis. If a cyst is suspected based upon the symptoms of physical examination, imaging techniques are used. Most cysts are diagnosed by ultrasound, which is the best imaging technique for detecting ovarian cysts. Ultrasound is an imaging method that uses sound waves to produce an image of structures within the body. Ultrasound imaging is painless and causes no harm.
How can the physician decide if an ovarian cyst is dangerous?
If a woman is in her 40's, or younger, and has regular menstrual periods, most ovarian masses are
"functioning ovarian cysts," which are not really abnormal. Examples include follicular cysts and corpus luteum cysts. These are related to the process of ovulation that happens with the menstrual cycle. They usually disappear on their own during a future menstrual cycle. Therefore, especially in women in their 20's and 30's, these cysts are watched for a few menstrual cycles to verify that they disappear.
Because oral contraceptives work in part by preventing ovulation, physicians will not
generally expect women who are taking oral contraceptives to have common "functioning ovarian cysts." Thus, women who develop ovarian cysts while taking oral contraceptives may be advised against simple observation; rather, they may receive closer monitoring with pelvic ultrasound or, less commonly, surgical exploration of the ovary.
Likewise, functioning ovarian cysts are rare in women after they have reached
menopause.
Other factors are helpful in evaluating ovarian cysts (besides the woman's age, or whether she is taking oral contraceptives). A cyst that looks like it is just one simple sac of fluid on the ultrasound is more likely to be benign than a cyst with solid tissue in it. So the ultrasound appearance also plays a role in determining the level of suspicion regarding a serious ovarian growth.
Ovarian cancer is rare in women younger than age 40. After age 40, an ovarian cyst
has a higher chance of being cancerous than before age 40, although most ovarian
cysts are benign even after age 40. CA-125 blood testing can be used as a marker
of ovarian cancer, but it does not
always represent cancer when it is abnormal.
CA-125 is a protein that is elevated in the bloodstream of approximately 80% of
women with advanced ovarian cancer.
First, many benign conditions in
women of childbearing age can cause the CA-125 level to be elevated, so CA-125
is not a specific test, especially in younger women. Pelvic infections,
uterine
fibroids, pregnancy, benign (hemorrhagic) ovarian cysts, and liver disease are
all conditions that may elevate blood CA-125 levels in the absence of ovarian cancer.
Second,
even if the woman has an ovarian cancer, not all ovarian cancers will cause the
CA-125 level to be elevated. Furthermore, CA-125 levels can be abnormally high
in women with breast,
lung, and
pancreatic cancer.
Ovarian Cysts - Symptoms at Onset of DiseaseQuestion: The symptoms of ovarian cysts can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
There are many types of ovarian cancer, epithelial carcinoma is the most common. Women with a family history of ovarian cancer have an increased risk of developing the disease. Some ovarian cancer symptoms include abdominal pain, nausea, diarrhea, constipation, and abnormal vaginal bleeding, however, they usually do not present until the disease has progressed. Early diagnosis is important for successful treatment.
Endometriosis is the growth of cells similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder. Treatment of endometriosis can be with medication or surgery.
Cysts are saclike structures that can occur throughout the body and usually contain a semisolid, liquid, or gaseous substance. Infections, tumors, genetic conditions, chronic inflammatory conditions, and wear and tear can cause cysts. Though some cysts may be palpable, others may not produce any symptoms. Treatment depends upon the location and cause of the cyst.
Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Sexual dysfunction refers to a problem that arises during any phase of the sexual response cycle, preventing an individual or couple from experiencing sexual satisfaction. Physical, medical, and psychological conditions may affect sexual functioning, resulting in inhibited sexual desire, inability to become aroused, lack of orgasm, and painful intercourse. Treating the underlying physical and psychological problems usually resolves most female sexual problems.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
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