Ovarian Cyst Symptoms and Signs
Cysts can arise through a variety of processes in the body, including:
- Pain during intercourse
- Unusual bleeding
- Abdominal fullness
- Breast pain
- Aching in the pelvic region
The ovary is one of a pair of reproductive glands in women that are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of a walnut. The ovaries produce eggs (ova) and the female hormones estrogen and progesterone. The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. They also regulate the menstrual cycle and pregnancy.
Ovarian cysts are closed, sac-like structures within an ovary that contain a liquid, or semisolid substance. "Cyst" is merely a general term for a fluid-filled structure, which may or may not represent a tumor or neoplasm (new growth). If it is a tumor, it may be benign or malignant. The ovary is also referred to as the female gonad.
There are many causes of ovarian cysts, and most ovarian cysts are not cancerous.
Cysts can arise through a variety of processes in the body, including:
Most ovarian cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the abdomen or pelvis is the most common one. The pain can be caused from:
If the cyst has reached a large size, other symptoms may arise as a result of pressure or distortion of adjacent anatomical structures. These other symptoms can include
A ruptured (burst) ovarian cyst will not always cause symptoms, particularly if the cyst is small. However, sometimes a ruptured ovarian cyst can lead to severe pain and internal bleeding. The pain with a ruptured ovarian cyst typically comes on suddenly and occurs on one side only. The pain may begin during physical activity such as vigorous exercise or may begin during sexual intercourse. A ruptured ovarian cyst usually does not cause fever or gastrointestinal symptoms.
Most ovarian cysts are not due to cancer, and having an ovarian cyst does not cause ovarian cancer. However, some ovarian cancers develop cystic areas inside the tumor. Ovarian cancer is much less common than benign ovarian cysts.
Ovarian cysts are sometimes discovered during pregnancy. In most cases, they are an incidental finding at the time of routine prenatal ultrasound screening. The majority of ovarian cysts found during pregnancy are benign conditions that do not require surgical intervention. However, surgery may be indicated if there is a suspicion of malignancy, if an acute complication such as rupture or torsion (twisting of the cyst, disrupting the blood supply) develops, or if the size of the cyst is likely to present problems with the pregnancy.
Ovarian cysts may develop during pregnancy or at any point in a woman's life. Some kinds of ovarian cysts are related to the menstrual cycle and occur before a woman has reached menopause (the time point at which a women has not had a menstrual period for 12 consecutive months). However, postmenopausal women may still develop other types of ovarian cysts.
Sometimes ovarian cysts may be noticed by a doctor during a bimanual examination of the pelvis. If a cyst is suspected based upon symptoms or physical examination, imaging techniques are used. Most cysts are diagnosed by ultrasound, which is the best imaging technique for detecting them. Ultrasound uses sound waves to produce an image of structures within the body. Ultrasound imaging is painless and harmless. Transvaginal ultrasound is a diagnostic tool to better visualize the ovaries using a thin ultrasound probe inside the vagina.
Functional ovarian cysts: If a woman is in her 40's, or younger, and has regular menstrual periods, most ovarian masses are "functional 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.
Cancer risks: 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 still 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, even when it is abnormal, and it may be normal in the presence of malignancy. CA-125 is a protein that is elevated in the bloodstream of many women with advanced ovarian cancer.
Most ovarian cysts in women of childbearing age are follicular or corpus luteum cysts (functional cysts) that disappear naturally in one to three months, although they can rupture and cause pain. They are benign and have no long-term medical consequences. They may be diagnosed coincidentally during a pelvic examination in women who do not have any related symptoms. All women have follicular cysts at some point that generally go unnoticed.
Ultrasound is useful to determine if the cyst is simple (just fluid with no solid tissue, suggesting a benign condition) or compound (with solid components that often requires surgical resection).
In summary, the ideal treatment of ovarian cysts depends on the likely cause of the cysts and whether or not it is producing symptoms. The woman's age, the size (and any change in size) of the cyst, and the cyst's appearance on ultrasound help determine the treatment. Cysts that are functional are usually observed (watchful waiting) with frequent monitoring unless they rupture and cause significant bleeding, in which case, surgical treatment is required. Benign and malignant tumors require operation.
Treatment can consist of simple observation, or it can involve evaluating blood tests such as a CA-125 to help determine the potential for cancer (keeping in mind the many limitations of CA-125 testing described above).
Any type of ovarian mass, including a cyst, can be surgically removed either with laparoscopy, or if needed, an open abdominal incision (laparotomy) if it is causing severe pain, not resolving, or if it is suspicious in any way. Once the cyst is removed, the growth is sent to a pathologist who examines the tissue under a microscope to make the final diagnosis as to the type of cyst present.
Gynecologists-obstetricians are the medical specialists most likely to treat ovarian cysts.
Most functional (related to the menstrual cycle) ovarian cysts resolve on their own and do not cause long-term problems. Benign cysts or benign tumors can be surgically removed. The vast majority of ovarian cysts do not cause any long-term problems. Rarely, cysts may be present within an ovarian cancer. In this case, the prognosis depends upon the extent of spread and exact type of cancer that is present.
REFERENCE: Grabosch, S.M., MD. "Ovarian Cysts." Medscape. Updated: Jan 18, 2017.
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