Ovarian Cysts

What is an ovarian cyst?

Ovarian cysts are fluid-filled sacs or pockets that occur within, or on the surface of, the ovary. Women generally have two ovaries, one on either side of the uterus. Ovarian cysts can occur at any age but are most common from puberty to menopause.

What is the most common type of cyst?

Functional or follicle cysts are the most common, are not cancerous, and most go away by themselves within 8-12 weeks. They occur when an egg, growing and developing within in the ovary, fails to be released or “ovulated”. They mainly contain fluid but sometimes can contain blood. A variation is the corpus leteum cyst, which occurs after an egg has been released.

How do I know if i have a cyst?

Most cysts will not cause symptoms. They are usually picked up with a vaginal ultrasound during routine gynaecological examinations.Typically, it can produce the following:

Pain: consistent, dull, or sometimes only with intercourse.

Pain during movement.

Pressure pain with a full bladder.

Sudden and severe pelvic pain with, or without, nausea and vomiting may be related to bursting or twisting (torsion) of the cyst.

Period abnormalities: late period or spotting between periods.

How is it treated?

Because most will disappear by themselves, a wait-and-see approach is often adopted. A repeat ultrasound in 2-3 months will ensure that the cyst has resolved. Oral contraceptive pills might be prescribed to reduce the risk of new cysts forming.

Surgery for cysts can be either via laparoscopy (key-hole surgery) or an exploratory laparotomy (opening up the abdomen). But only when: cysts cause pain or symptoms that don’t go away, simple cysts are larger than 6-10cm, patient is peri-menopausal or menopausal, if a torsion or twisted cyst is suspected or there is suspicion that the cyst could be cancerous.

How would I know that my cyst is cancerous?

Ovarian cancer usually shows up when the cancer is advanced. Subsequent treatment options are limited and often not curative. The most important point to remember is to have any unusual symptoms checked by your doctor. This vigilance may make the difference and be life-saving.

Symptoms to watch for include: pelvic pain, weight loss, lack of appetite, gastro-intestinal symptoms such as: nausea, constipation, indigestion, increased gas and bloating or a swollen belly area.

These symptoms are more significant if the following factors also exist:

If you are older, especially in your fifties or sixties.

If you have previously been treated for breast cancer.

If you have a family history of breast or ovarian cancer.

If you are carrying the BrCa1 or BrCa2 gene

If you have taken Oestrogen only hormone replacement therapy (not with Progesterone) for five years or more.

Tests can include an ultrasound, CT or MRI scan of the pelvis. A Ca 125 blood test is often performed although, in 20% of women with ovarian cancer, it will still be normal and levels also can be elevated with non-cancerous conditions. The value of this test is not so much for detecting ovarian cancer but rather in monitoring response to treatment or recurrence of disease.

What are the other types of cysts?

Dermoid Cysts: bizarre tumours, usually benign, that contain hair, teeth, bone and thyroid. The average age that they occur is around 30 years. Up to 15% of the time they occur in both ovaries. Surgical removal is the treatment of choice.

Ectopic Pregnancy: this is when a pregnancy implants on, or in, the ovary. Because of the danger of life-threatening, internal haemorrhage this is usually surgically removed.

Endometriotic Cysts: usually occur with endometriosis, when endometrial cells present within the uterus form deposits around the ovary and pelvis. May lead to blood in the ovary. Typical symptoms are painful periods and infertility. Surgery is usually the treatment

of choice.

Polycystic Ovarian Syndrome: Multiple small cysts on the ovary as a result of an associated hormonal imbalance. Other features include difficulty with weight loss, acne, excess body hair and infertility and period abnormalities. Usually treated medically.

Written by Dr Sumayya Ebrahim