Ovarian Cysts

Ovarian cysts are fluid-filled sacs that develop in or on the ovaries. The ovary is the part of a woman’s body that produces eggs. There are several types of ovarian cysts. The most common type of ovarian cyst is a functional cyst, which often forms as a result of the normal function of the menstrual cycle.

Many ovarian cysts don't cause symptoms and cause no harm. Others can cause a variety of symptoms including: pressure, swelling, or pain in the abdomen; pelvic pain; a dull ache in the lower back and thighs; and changes in menstruation.

Ovarian cysts are most often found during routine pelvic exams, although some may need further testing.

Sometimes ovarian cysts are simply watched for a period of time to see if they disappear on their own. However, some ovarian cysts are treated with birth control pills or surgery.

Many ovarian cysts don't cause symptoms. Others can cause:

• Pressure, swelling, or pain in the abdomen
• Pelvic pain
• Dull ache in the lower back and thighs
• Problems passing urine completely
• Pain during sex
• Weight gain
• Pain during your period
• Abnormal bleeding
• Nausea or vomiting
• Breast tenderness

If you have these symptoms, get help right away:

• Pain with fever and vomiting
• Sudden, severe abdominal pain
• Faintness, dizziness, or weakness
• Rapid breathing

No one knows exactly what causes an ovarian cyst. Some experts think that common ovarian cysts come from a hormonal imbalance. If a woman has a hormonal imbalance, her body will not make eggs (ovulate). In most cases, this imbalance does not last long. The doctor may want to just watch you until the cyst goes away.

The most common type of ovarian cyst is a functional cyst.

Functional cysts often form during the menstrual cycle. The two types are:

• Follicle cysts. These cysts form when the sac doesn't break open to release the egg. Then the sac keeps growing. This type of cyst most often goes away in 1 to 3 months.
• Corpus luteum cysts. These cysts form if the sac doesn't dissolve. Instead, the sac seals off after the egg is released. Then fluid builds up inside. Most of these cysts go away after a few weeks. They can grow to almost 4 inches. They may bleed or twist the ovary and cause pain. They are rarely cancerous. Some drugs used to cause ovulation, such as Clomid® or Serophene®, can raise the risk of getting these cysts.

Other types of ovarian cysts are:

• Endometriomas. These cysts form in women who have endometriosis. This problem occurs when tissue that looks and acts like the lining of the uterus grows outside the uterus. The tissue may attach to the ovary and form a growth. These cysts can be painful during sex and during your period.
• Cystadenomas. These cysts form from cells on the outer surface of the ovary. They are often filled with a watery fluid or thick, sticky gel. They can become large and cause pain.
• Dermoid cysts. These cysts contain many types of cells. They may be filled with hair, teeth, and other tissues that become part of the cyst. They can become large and cause pain.
• Polycystic ovaries. These cysts are caused when eggs mature within the sacs but are not released. The cycle then repeats. The sacs continue to grow and many cysts form. For more information about polycystic ovaries,

Ovarian cysts are often felt, if large enough, during routine pelvic exams. Once a cyst is found, tests are done to help plan treatment. Tests include:

• An ultrasound. This test uses sound waves to create images of the body. With an ultrasound, the doctor can see the cyst's:
  • Shape
  • Size
  • Location
  • Mass — if it is fluid-filled, solid, or mixed
• A pregnancy test. This test may be given to rule out pregnancy.
• Hormone level tests. Hormone levels may be checked to see if there are hormone-related problems.
• A blood test. This test is done to find out if the cyst may be cancerous. The test measures a substance in the blood called cancer-antigen 125 (CA-125). The amount of CA-125 is higher with ovarian cancer. But some ovarian cancers don't make enough CA-125 to be detected by the test. Some noncancerous diseases also raise CA-125 levels. Those diseases include uterin fibroids and endometriosis. Noncancerous causes of higher CA-125 are more common in women younger than 35. Ovarian cancer is very rare in this age group. The CA-125 test is most often given to women who:
  • Are older than 35
  • Are at high risk for ovarian cancer
  • Have a cyst that is partly solid

Be sure to have regular pelvic examinations in order to help ensure that changes in your ovaries are diagnosed as early as possible.

Pay attention to your menstrual cycle. Watch for symptoms that are not normal for you. Talk with your doctor about any changes that concern you.

Watchful waiting. If you have a cyst, you may be told to wait and have a second exam in 1 to 3 months. Your doctor will check to see if the cyst has changed in size. This is a common treatment option for women who:

• Are in their childbearing years
• Have no symptoms
• Have a fluid-filled cyst

It may be an option for postmenopausal women.

Surgery. Your doctor may want to remove the cyst if you are postmenopausal, or if it:

• Doesn't go away after several menstrual cycles
• Gets larger
• Looks odd on the ultrasound
• Causes pain

The two main surgeries are:

• Laparoscopy – Done if the cyst is small and looks benign (noncancerous) on the ultrasound. While you are under general anesthesia, a very small cut is made above or below your navel. A small instrument that acts like a telescope is put into your abdomen. Then your doctor can remove the cyst.
• Laparotomy – Done if the cyst is large and may be cancerous. While you are under general anesthesia, larger incisions are made in the stomach to remove the cyst. The cyst is then tested for cancer. If it is cancerous, the doctor may need to take out the ovary and other tissues, like the uterus. If only one ovary is taken out, your body is still fertile and can still produce estrogen.

Low-dose birth control pills stop a woman's body from releasing eggs (ovulation), allowing time for the cyst to go away on its own before the body resumes its regular cycle.

You can also use Depo-Provera. It is a hormone that is injected into muscle. It prevents ovulation for 3 months at a time.

If the cyst does not go away, or if it grows larger, then surgery may be considered.

 The good news is that most cysts:

• Don't cause symptoms
• Are not cancerous
• Go away on their own

Talk to your doctor or nurse if you notice:

• Changes in your period
• Pain in the pelvic area
• Any of the major symptoms of cysts

Most functional ovarian cysts occur during childbearing years. And most of those cysts are not cancerous. Women who are past menopause (ages 50­–70) with ovarian cysts have a higher risk of ovarian cancer. At any age, if you think you have a cyst, see your doctor for a pelvic exam.