Ovarian Cysts

What are ovarian cysts?
When the surface of the ovary is filled with watery fluid/ blood/ fat/ hair or any other substance, cysts are formed in the ovary.

Where are ovaries located?
Ovary is a pair of female reproductive gonads located in pelvis on each side of the uterus. They are the size of a walnut and measure 3.5*2.5*1.5 cm on an average in the reproductive age and usually shrink by about 1 cm after menopause. They produce two hormones – oestrogen & progesterone & eggs (ova) and also regulate healthy pregnancy & menstrual cycle. Ovaries are responsible for development of female body characteristics like voice, breasts, body hair & body shape.

Types of ovarian cysts
  • Dermoid cysts (a type of complex cyst) – cysts filled with hair, fat, teeth, skin or any other tissue.
  • Cystadenomas (a type of complex cyst) – mucous or water-filled cysts growing on outer surface of ovaries.
  • Corpus leuteal cysts – Cysts develop when the follicle sac doesn’t dissolve and the opening of follicle seals. These may grow further.
  • Hemorrhagic cysts( new small cysts are simple cysts) – Cysts filled with blood. If left untreated, these may result in a ruptured cyst or infected cyst.
  • PCOS – multiple cysts in one or both ovaries. These may be true cysts present in both ovaries or not. But if left untreated, they may result in infertility.
  • Functional or Follicular cysts ( a type of simple cyst) – most common cysts found in women of reproductive age. They often cause no symptoms and go away in about 3 months.
  • Ruptured cysts – When the wall of the cyst ruptures. The women with chocolate ovarian cysts have higher levels of FSH and few eggs. Infertility is a consequence in untreated cases.
  • Cancerous ovarian cysts – They often appear as solid masses or abnormal complex masses in diagnostic scans and need further blood testing & scanning including biopsy for the confirmation.
  • Complex cysts – Most ovarian cysts are non-cancerous. Complex ovarian cysts contain blood or a solid substance. Solid appearing or big ovarian masses need further evaluation to rule out malignancy.
  • Endometriomas/ endometrioid cysts/ Chocolate cysts of ovary (a type of complex cyst) – When the lining of the uterus grows outside of the uterus. They get their name from old menstrual blood & tissue that fills the cavity of the cyst. Chocolate cysts are basically a subgroup of endometriosis. They may cause pelvic pain & cramps not related to the menstrual cycle. They are formed because the menstrual blood that should leave the vagina, is not able to be expelled because of adhesions and get trapped within the cavity.
Causes of ovarian cysts –
  1. Pregnancy
  2. Endometriosis
  3. Faulty lifestyle
  4. Thyroid disorder
  5. Obesity is a risk factor
  6. Hormonal imbalance
  7. Severe Pelvic infections
Any cyst that is greater than 5 cm needs careful monitoring and further diagnostic procedures to
rule out malignancy. (Symptoms)
  1. Abdominal bloating
  2. Breast tenderness
  3. Painful intercourse
  4. Painful bowel movement
  5. Pain in the lower back or thigh
  6. Flu-like symptoms may be present
  7. Pelvic pain on the side of ovarian cyst before or during periods
  8. Nausea with or without vomiting, particularly before or during periods
Additional symptoms –
  1. Irregular periods
  2. Prolonged periods
  3. Frequent urination
  4. Pelvic pain or pressure
  5. Unexplained weight gain
  6. Scanty periods or bleeding between two menstrual cycles
Symptoms that require immediate medical attention which indicate either ruptured cyst or ovarian torsion (twisting) 
  1. Fever
  2. Vomiting
  3. Faintness
  4. Rapid breathing
  5. Sharp one-sided pain in pelvis or back
  6. Absence of discharge or very heavy bleeding
In post-menopausal women, if the size of ovarian cysts grows (confirmed by two ultrasound scans done time apart or by surprise finding in any other diagnostic procedure), they should meet Gynaecologist as soon as possible.
Diagnosis of Ovarian cysts
  • Pelvic exam – Doctor can feel a lump in the ovary by manual pelvic exam.
  • Abdominal Ultrasound or Trans Vaginal Ultrasound – to determine size, location & content of cyst.
  • MRI – particularly helpful to give staging of ovarian cancers and also, when diagnosis by ultrasound is not clear. These are helpful to see if ovarian cancer has spread to spinal cord and brain.
  • CT Scan – Not recommended for routine small ovarian masses, but CT scan is recommended for biopsy purpose (CT guided needle biopsy) when ovarian cancer has spread to lymph nodes, liver, kidney or nearby structures.
Blood tests
  1. Thyroid profile
  2. Pregnancy test
  3. General hormone profile including LH & FSH
  4. Androgen profile & Diabetes screening for PCOS, Insulin.
  5. HCG, alphafetoprotein & lactate dehydrogenase – to determine germ cell tumor
  6. CA125 – raised levels give rise to suspicion of ovarian cancer, but may mean other organic diseases apart from cancer as well.

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