Ovarian cyst

Ovarian cyst
Specialty	Gynaecology

An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. An ovarian cyst can be as small as a pea, or larger than an orange.

Most ovarian cysts are functional in nature and harmless (benign). In the US, ovarian cysts are found in nearly all premenopausal women, and in up to 14.8% of postmenopausal women.

Ovarian cysts affect women of all ages. They occur most often, however, during a woman's childbearing years.

Some ovarian cysts cause problems, such as bleeding and pain. Surgery may be required to remove cysts larger than 5 centimeters in diameter.

Classification

Non-functional cysts

There are several other conditions affecting the ovary that are described as types of cysts, but are not usually grouped with the functional cysts. (Some of these are more commonly or more properly known by other names.) These include:

• Dermoid cyst

• Chocolate cyst of ovary: An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst is caused by endometriosis, and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries.

• A polycystic-appearing ovary is diagnosed based on its enlarged size — usually twice normal —with small cysts present around the outside of the ovary. It can be found in "normal" women, and in women with endocrine disorders. An ultrasound is used to view the ovary in diagnosing the condition. Polycystic-appearing ovary is different from the polycystic ovarian syndrome, which includes other symptoms in addition to the presence of ovarian cysts.
• Ovarian serous cystadenoma
• Ovarian mucinous cystadenoma

Signs and symptoms

Some or all of the following symptoms may be present, though it is possible not to experience any symptoms:

• Dull aching, or severe, sudden, and sharp pain or discomfort in the lower abdomen (one or both sides), pelvis, vagina, lower back, or thighs; pain may be constant or intermittent—this is the most common symptom
• Fullness, heaviness, pressure, swelling, or bloating in the abdomen
• Breast tenderness
• Pain during or shortly after beginning or end of menstrual period.
• Irregular periods, or abnormal uterine bleeding or spotting
• Change in frequency or ease of urination (such as inability to fully empty the bladder), or difficulty with bowel movements due to pressure on adjacent pelvic anatomy
• Weight gain
• Nausea or vomiting
• Fatigue
• Infertility
• Increased level of hair growth
• Increased facial hair or body hair
• Headaches
• Strange pains in ribs, which feel muscular
• Bloating
• Strange nodules that feel like bruises under the layer of skin

Diagnosis

A 2cm left ovarian cyst as seen on ultrasound

An Axial CT demonstrating a large hemorrhagic ovarian cyst. The cyst is delineated by the yellow bars with blood seen anteriorly.

A CT scan showing a 8.5 cm cyst in a 29 year old female.

Ovarian cysts are usually diagnosed by either ultrasound or CT scan.

Treatment

About 95% of ovarian cysts are benign, meaning they are not cancerous.

Treatment for cysts depends on the size of the cyst and symptoms.

Pain caused by ovarian cysts may be treated with:

• pain relievers, including acetaminophen/paracetamol (Tylenol), nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil), or narcotic pain medicine (by prescription) may help reduce pelvic pain. NSAIDs usually work best when taken at the first signs of the pain.

• a warm bath, or heating pad, or hot water bottle applied to the lower abdomen near the ovaries can relax tense muscles and relieve cramping, lessen discomfort, and stimulate circulation and healing in the ovaries. Bags of ice covered with towels can be used alternately as cold treatments to increase local circulation.

• combined methods of hormonal contraception such as the combined oral contraceptive pill – the hormones in the pills may regulate the menstrual cycle, prevent the formation of follicles that can turn into cysts, and possibly shrink an existing cyst. (American College of Obstetricians and Gynecologists, 1999c; Mayo Clinic, 2002e)

Also, limiting strenuous activity may reduce the risk of cyst rupture or torsion.

Cysts that persist beyond two or three menstrual cycles, or occur in post-menopausal women, may indicate more serious disease and should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgical biopsy. Additionally, a blood test may be taken before surgery to check for elevated CA-125, a tumor marker, which is often found in increased levels in ovarian cancer, although it can also be elevated by other conditions resulting in a large number of false positives.

For more serious cases where cysts are large and persisting, doctors may suggest surgery. Some surgeries can be performed to successfully remove the cyst(s) without hurting the ovaries, while others may require removal of one or both ovaries.

References

Ovarian Cyst – Symptoms and Treatment corpusluteumcyst.org