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Ovarian Cysts

What are ovarian cysts?

Ovarian cysts are fluid-filled sacs that develop in or on the ovary (see Figure).  Ovarian cysts commonly develop in women of all ages.  Some women with ovarian cysts experience pain or pelvic pressure, while others have no symptoms.

Fortunately, most ovarian cysts do not require surgical removal and are not caused by cancer.  Cysts can vary in size from less than one centimeter (one-half inch) to greater than 10 centimeters (4 inches).

Symptoms

Ovarian cysts may be either symptomatic or asymptomatic.  Women with symptoms from ovarian cysts typically experience pain or pressure in the lower abdomen on the side of the cyst.   This pain may be dull or sharp; it may be constant or come and go.  Crampy lower abdominal pain is not usually related to ovarian cysts.  If an ovarian cyst ruptures, a woman may experience a sudden sharp pain, which may be severe.  Women with torsion (twisting) of an ovary may feel pain along with nausea and vomiting.  Abnormal periods or vaginal bleeding is not usually related to ovarian cysts.

What causes ovarian cysts?

The most common causes of ovarian cysts depend upon whether a woman is still having her menstrual periods (premenopausal) or if she has stopped menstruating for at least one year (postmenopausal).

For premenopausal women, the most common causes of ovarian cysts include:

  • Ovulation – “Functional” ovarian cysts develop when a follicle (sac) grows, but does not rupture to release the egg.  These cysts usually resolve without treatment.
  • Dermoid cysts – Dermoid cysts (teratomas) are one of the most common types of cysts found in women between the age 20 and 40 years.  A dermoid cyst is made up of ovarian germ cells (germ cells are reproductive cells, eg, eggs) and can contain teeth, hair or fat. Most dermoid cysts are benign, but rarely, they can be cancerous.
  • Polycystic ovary syndrome (PCOS) – women with PCOS may have many small cysts.  These cysts do not need to be removed or treated with medication, but women with PCOS may need treatment for other PCOS problems, such as irregular menstrual periods.
  • Endometriosis – Women with endometriosis can develop a type of ovarian cyst called an endometrioma.
  • Pregnancy – An ovarian cyst normally develops in early pregnancy, to help support the pregnancy until the placenta forms.  In some cases, the cyst stays on the ovary until later in the pregnancy.
  • Severe pelvic infections – Severe pelvic infections may spread to involve the ovaries and fallopian tubes.  As a result, pus-filled cysts form close to the ovaries and/or fallopian tubes.
  • Non-cancerous growths
  • Cancer – Cancer is a relatively uncommon cause of ovarian cysts in premenopausal  women; less than 1 percent of new growths on or near the ovary are related to ovarian cancer.

For postmenopausal women who have stopped having menstrual periods, the most common causes of ovarian cysts include:

  • Non-cancerous growths
  • Fluid collection in the ovary

Diagnosis

Ovarian cysts can sometimes be detected during a pelvic examination, although a pelvic ultrasound is necessary to confirm the diagnosis.  Imaging tests can provide information about the cyst’s size, location, and other important characteristics.  One or more blood tests may be recommended if you are found to have an ovarian cyst.  The blood test(s) can help to determine the nature of the cyst.

How are ovarian cysts treated?

Ovarian cysts do not always require treatment.  In premenopausal women, cysts may resolve on their own within 1-2 months, without treatment.  In postmenopausal women, ovarian cysts are less likely to resolve.

If a cyst is large, causing pain, or appears suspicious for cancer, treatment usually involves surgery to remove the cyst or the entire ovary.

Watchful waiting

In premenopausal women, watchful waiting usually involves monitoring for symptoms (pelvic pain or pressure) and repeating the pelvic ultrasound after six to eight weeks.   If the ovarian cyst does not enlarge or if it resolves during the period of watchful waiting, it does not usually require surgical removal.  Some premenopausal women will be advised to take a birth control pill during this time to help prevent new ovarian cysts from developing.

If a cyst decreases in size or does not change, the ultrasound is often repeated at regular intervals until your healthcare provider is certain that the cyst is not growing.  If the cyst resolves, no further testing or follow-up is required.

In postmenopausal women, the decision to undergo watchful waiting depends upon the initial testing.  If the cyst does not appear to be cancerous, watchful waiting may be an option, and includes a pelvic ultrasound and bloodwork every three to six months for one year, or until the cyst resolves.  However, ovarian cysts do not always resolve in postmenopausal women.
If blood work shows that the cyst has grown or has had changes in appearance, then surgery to remove the cyst may be recommended.

If surgery is needed to remove an ovarian cyst, the procedure is usually done in a hospital or surgical center.  Whether the surgery involves removing only the cyst or the entire ovary depends upon your age and what is found during the procedure.

 

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