Ovarian Cyst

What is Ovarian Cyst?

Ovarian cyst occurs due to the accumulation of fluid inside the ovary and is surrounded by thin walls. Although harmless and benign, it may eventually grow and cause problems like rupture, bleeding or pain. These cysts are common, but most have no symptoms and are painless. To avoid several problems, consulting with a doctor is very important.

Ovarian Cyst

Types & Causes of Ovarian Cysts

There are few common types of ovarian cyst which include:

Functional cyst

  • Follicular cyst: During the menstrual cycle of a woman, a follicle which is a fluid-filled sac, breaks and releases an egg. But if there is no breakage in the follicle it can form a cyst.
  • Corpus luteum cyst: If the follicle seals after the release of the egg, additional fluid develop inside the sac leading to the formation of corpus luteum cyst.
  • Hemorrhagic cyst: It occurs when bleeding occurs within a cyst and is known as a hemorrhagic

Other Ovarian Cysts

  • Dermoid cyst: Also known as teratomas, it is benign in nature and contains tissue like hair, skin or fat.
  • Endometriomas or endometroid cyst: Tissues grow outside the cysts resulting in the formation of a cyst.
  • Polycystic ovaries syndrome: Caused by the hormonal disorder amongst women during pregnancy.
  • Cystadenoma: Filled with a mucous material, it appears on the outer surface of the ovary.
  • Ovarian cancers: Ovarian cysts are benign in nature, but when they irritate, it can be cancerous.

Ovarian Cyst during Pregnancy

An ovarian cyst is usually functional when discovered during the first trimester. The cyst tends to dissolve itself before the birth of a child. The reason behind the formation of an ovarian cyst is due to decreased fertility. Woman’s ability to get pregnant may reduce due to cysts and endometriomas from polycystic ovarian syndrome.

Functional cysts do not create a problem for pregnancy until they are large in size. While being pregnant, the treatment of the cyst may depend upon the size of the cyst.  For example, if the cyst is benign, they do require any surgical intervention, but if the cyst is at the stage of turning into cancer or if the cyst twists (torsion) or ruptures or is too large, then it should be removed surgically.

Risk Factors

Risk factors involved in developing an ovarian cyst include:

  • Infertility
  • Endometriosis
  • Menstrual cycle irregularity
  • Polycystic ovarian syndrome
  • Occurrence of previous ovarian cyst
  • Obesity’
  • Hyperthyroidism
  • Tamoxifen therapy for breast cancer
  • Early age menstruation (11 years or even less)

Symptoms of Ovarian Cyst

Smaller cysts do not show any symptoms, but larger ones indicate some health issues. Some of them include:

  • Endometriosis
  • Pelvic inflammatory disease
  • Ectopic pregnancy
  • Ovarian cancer

Signs & Symptoms of Simply Cysts

  • Swelling & bloating in the abdomen
  • Irregular menstruation
  • Weakness & dizziness
  • Unexpected pregnancy symptoms
  • Painful intercourse
  • Hormonal changes
  • Excessive urination
  • Nausea or vomiting

Signs & Symptoms of Complex Ovarian Cysts

  • Torsion
  • Bursting
  • Cancer

Long Term Complications Related to Ovarian Cyst

Usually, ovarian cysts are non-cancerous and can go away on their own. But sometimes doctors can detect a cancerous ovarian mass during a routine check-up.

When an ovary moves from its original position due to a substantial cyst, then ovarian torsion occurs which is a rare complication. Due to this, the supply of blood to the ovary is cut-off and if not treated on time, it can lead to death or damage to the ovarian tissue. Although ovarian torsion is uncommon, it accounts for only 3% of gynecological surgeries.

Another rare case is a ruptured cyst, which causes internal bleeding and intense pain. This increases the risk factor for having an infection and can be life-threatening.

Diagnosis of Ovarian Cyst

Initially, a determination can be carried out by simple physical examination. If the cyst is unusual in size, then further tests are required to remove it surgically. Some common tests include:

Pelvic and Transvaginal Ultrasound

Pelvic examination can detect an ovarian cyst. The ultrasound allows the doctor to watch the cyst through sound waves and helps them to determine the state of the cyst, i.e. solid or fluid tissue or a mixture of the two. During transvaginal ultrasound, the doctor inserts a probe inside the vagina to examine the uterus and the ovary. This ultrasound gives a more clear vision of the cyst.

Serum CA-125 Assay

A cancer-antigen 125 (CA-125) is a type of blood test that helps in detecting whether the cyst is due to ovarian cancer or not. Although it includes other conditions such as uterine fibroids and endometriosis that can increase the level of CA-125, it does not give a specification of ovarian cancer. CA-125 levels in ovarian cancer cannot be elevated enough to be determined by blood test.

Hormonal levels

To check up the hormonal level, doctors may prescribe pregnancy test and blood tests.

Culdocentesis

Culdocentesis a process done by inserting a needle behind the uterine cervix through the vaginal wall.

Treatment of Ovarian Cyst

As cysts are benign, they can disappear in few months. But at the same time, they can grow and cause complications. Some possible treatments include:

Medications

Ibuprofen, a type of pain reliever might be prescribed to reduce pelvic pain but these anti-inflammatory medications do not prevent in dissolving the ovarian cyst. They only give relief to the symptoms. If a woman has enough functional ovarian cysts, the doctors can prescribe hormonal birth control pills to stop ovulation and decrease the risk of forming new cysts.

Ruptured Ovarian Cysts

Painkillers can help to reduce the symptoms of a ruptured ovarian cyst. Although surgery is not required, a ruptured dermoid ovarian cyst (a type of benign tumor that contains many types of body tissue) may need surgery because the cyst is highly dangerous for the internal organs. Surgery may also be required for ruptured ovarian cysts if there is internal bleeding or possible cancer.

Laparoscopy

The surgery is for small cysts and is done by inserting an instrument in a tiny cut made below the navel to remove the cyst permanently.

Laparotomy

This particular surgery is for larger cysts that can be cancerous. A large incision in the abdomen is made to perform a hysterectomy.

Natural precautions can also be taken to reduce the inflammation which may include:

  • Heat
  • Apple cider vinegar
  • Castor oil pack
  • Epsom salt bath
  • Chamomile tea
  • Beetroot

Ovarian cyst sometimes makes it challenging to conceive. The surgeon tries to maintain the fertility after an operation by leaving the ovaries intact.

Prognosis

Women who have functional ovarian cyst during premenopausal need not worry as these cysts disappear on their own after a few months. However, it depends on the type of the cyst and various other factors such as:

Age

At different stages of life, factors vary for the development of an ovarian cyst. A woman who is still in the phase of menstruation and produces estrogen has more possibility of building a cyst. A woman who is postmenopausal has fewer chances of developing ovarian cyst because she does not ovulate hormones in insignificant amount. A young woman who is producing a substantial amount of hormones has high chances of developing ovarian cyst than a woman at a stage of postmenopausal.

Cyst Size

The size of the cyst ultimately depends upon the rate of their shrink. Usually, functional cysts vary 2 inches in diameter or even less and can be removed non-surgically. But if the cyst is more significant than 4 cm in diameter, then it requires surgical treatment.

Ovarian Cyst Prevention

An ovarian cyst cannot be prevented, but it can be determined through routine gynecologic examinations. Usually, an ovarian cyst is non-cancerous, but its symptoms mimic ovarian cancer. It should be treated immediately if the following problems occur:

  • Continuous pelvic pain
  • Unexpected weight loss
  • Menstrual cycle changes
  • Appetite loss
  • Abdominal fullness

References

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