Dr Sumayya Ebrahim explains why women get ovarian cysts, how are they treated and if they can become cancerous.
Almost all genetic females will have two ovaries that form part of the internal reproductive organs.
Each is situated lower down in the pelvic region of the body. The function of the ovaries is to produce hormones like oestrogen, progesterone and testosterone. Ovaries are also responsible for storing all our eggs, from the time of birth until none are left at menopause. It’s within each ovary that the cyclical process of ovulation takes place.
An ovarian cyst is when a fluid-filled sac or collection is present in the ovary or on it’s surface.
Types of ovarian cysts
Functional or follicle cysts
These are the most common cysts that are found on ovaries. They aren’t cancerous. Most go away by themselves within 8-12 weeks. They occur when the growing and developing monthly follicle within the ovary fails to be released or ovulated. They mainly contain fluid but sometimes can contain blood. When this happens the cyst is called a corpus luteum cyst.
These are bizarre tumours, usually benign, that contain hair, teeth, bone and thyroid tissue. This is because they develop from cells in the ovary that have the potential to develop into any type of cell. The average age that they occur is around 30 years. Up to 15% of the time, they occur in both ovaries. They can grow to be very big, up to 15cm across. Surgical removal is the treatment of choice.
These usually occur as part of the condition of endometriosis when the endometrial cells (normally only present within the uterus) form deposits around the ovary and pelvis. Sometimes this leads to a collection of blood in the ovary. This is also called a chocolate cyst. Typical symptoms are painful periods and infertility. Usually surgery is the treatment of choice.
These are usually benign cysts that can contain either serous fluid (thin yellow), called serous cystadenomas, or mucinous fluid (thick clear), called mucinous cystadenomas. They originate from the surface cells of the ovary. A very small percentage of these cysts are cancerous.
Polycystic ovarian syndrome
Multiple small cysts on the ovary occur here. This happens as a result of an associated hormonal imbalance. Other features that co-exist are: difficulty with weight loss, acne, excess body hair, infertility and period abnormalities. This condition is usually treated medically.
All the cysts described above are mostly benign. The chances of transformation into an ovarian cancer is extremely rare.
Treatment of ovarian cysts
Because most will disappear by themselves, often a wait-and-see approach is undertaken. A repeat ultrasound in two to three months is advised to ensure that the cyst has resolved.
In some instances, oral contraceptive pills are prescribed for short periods. Longer term usage may reduce the risk of new cysts forming.
Surgery for cysts may be necessary under special circumstances. This can be either a laparoscopy (key-hole surgery) or an exploratory laparatomy (opening up the abdomen).
This is performed in the following situations:
- Persistent cysts that are causing pain or symptoms.
- Simple cysts larger than 6-10cm
- Cysts in women who are perimenopausal or menopausal.
- If a torsion or twisted cyst is suspected.
- If there is any suspicion that the cyst could be cancerous (solid or irregular areas are seen within the cyst).
Special points to consider
When an ovarian cyst occurs with the following factors, it’s extremely important to exclude cancer, by discussing with your doctor and having the appropriate tests:
Symptoms to watch for:
- Pelvic pain especially if increasing
- Weight loss
- Lack of appetite
- Gastro-intestinal symptoms: nausea, constipation, indigestion, increased gas
- Bloating or swollen belly area
These symptoms are very vague and general but are more significant if the following factors co-exists:
- Older age, especially fifth or sixth decade of life.
- Previous treatment for breast cancer.
- Family history of breast or ovarian cancer.
- Carriers of the BCRA1 or BCRA2 gene defects.
MEET THE EXPERT – Dr Sumayya Ebrahim
Dr Sumayya Ebrahim is a gynaecologist in private practice in Johannesburg, Gauteng. She is also a blogger. Check out her blog Vaginations by Dr E on vaginations.co.za
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