An ovarian cyst is a fluid-filled sac that develops on an ovary. They’re very common and do not usually cause any symptoms.
Most ovarian cysts occur naturally and go away in a few months without needing any treatment.
An ovarian cyst usually only causes symptoms if it splits (ruptures), is very large or twists and then blocks the blood supply to the ovaries.
In these cases, patient may have:
1. Pelvic pain – this can range from a dull, heavy sensation to a sudden, severe and sharp pain.
2. Pain during sex.
3. Difficulty emptying the bowels.
4. A frequent need to urinate.
5. Heavy periods, irregular periods or lighter periods than normal.
6. Bloating and a swollen tummy.
7. Feeling very full after only eating a little.
8. Difficulty getting pregnant – although fertility is usually unaffected by ovarian cysts.
Sometimes, ovarian cysts cause more serious problems. These types of cyst will need hospital treatment.
If a cyst is growing on a stem from an ovary, the stem can become twisted (called torsion).
This stops the blood supply to the cyst and causes a lot of pain in the lower abdomen
The cyst may burst, causing sudden severe pain in the lower abdomen. The pain atient feel depends on what the cyst contained, whether it is infected and whether there is any bleeding.
The 2 main types of ovarian cyst are:
1. Functional ovarian cysts –
Cysts that develop as part of the menstrual cycle and are usually harmless and short-lived; these are the most common type.
2. Pathological ovarian cysts –
A dermoid cyst is the most common type of pathological cyst in women who are under 40 years old.
In women over 40 years of age, a ‘cystadenoma’ is the most common type.
Dermoid cysts :
Dermoid cysts develop from the cells that are used to create eggs. As eggs have the bility to create any type of cells dermoid cysts can consist of a wide range of different types of human tissue, including blood, fat, bone and hair. Dermoid cysts have the potential to grow very large. They can sometimes grow up to 15cm (6 inches) in diameter. They are not usually cancerous, but will usually need to be surgically removed.
Endometriosis :
If a patient has Endometriosis, she may develop ovarian cysts. Endometriosis occurs when pieces of the tissue that lines the Womb (the Endometrium) are found outside the Womb in areas such as the Fallopian tubes, Ovaries, Bladder, Bowel, Vagina or Rectum. Sometimes, blood-filled cysts can form in this tissue.
Polycystic ovarian syndrome :
Polycystic ovarian syndrome is a condition that causes lots of small, harmless cysts to develop on the ovaries. The cysts develop if there is a problem with the balance of hormones that are produced by the ovaries.
Diagnosis :
Most ovarian cysts do not cause any symptoms, therefore they often go undiagnosed.
Sometimes, ovarian cysts are diagnosed by chance – for example, during a pelvic examination.
They can also be spotted when people have an ultrasound scan for an unrelated reason.
Ultrasound scan :
To confirm an ovarian cyst, patient usually need to have an ultrasound scan. An ultrasound scanner works by using sound waves to build up an image of the inside of the body.An ultrasound scan can usually confirm whether you have an ovarian cyst and how big it is.
Blood test :
The blood test will be used to measure levels of a protein called CA125, which is often elevated in cases of ovarian cancer.
Ovarian cysts and fertility :
Ovarian cysts usually do not affect a woman’s ability to conceive. Even if the cyst is larger and needs to be removed, this is usually done using laparoscopy (using ‘keyhole’ surgery), which preserves women’s fertility
In most cases, ovarian cysts disappear in a few months without treatment. A follow-up ultrasound scan may be used to confirm this.
Most ovarian cysts do not need treatment or surgery.
Treatment will depend on:
1.Size and appearance of the cysts.
2.Whether the patient is having any symptoms.
3. Whether the patient is post-menopausal (due to the slightly higher risk of ovarian cancer).
A.Watchful waiting / Observation :
In the majority of cases, a policy of ‘watchful waiting’ will be recommended where patients will receive no immediate treatment. This is because most cysts will disappear after a few weeks without the need for treatment. A follow-up ultrasound scan will
usually confirm that this is the case.
B.Surgical Management :
There are 2 types of surgery used to remove ovarian cysts:
1. Laparoscopy
2. Laparotomy
These are usually carried out under general anaesthetic.
1.Laparoscopic Ovarian Cystectomy :
Most Cysts can be removed using laparoscopy. This is a type of keyhole surgery. Small cuts are made in the tummy and gas is blown into the pelvis to allow the surgeon to access the ovaries.
A laparoscopy is a procedure where a camera (a laparoscope) is inserted into the pelvis via a small cut near the belly button so the surgeon can see the internal organs. The surgeon then removes the cyst through the small cuts in the skin.
After the cyst has been removed, the cuts will be closed using dissolvable stitches.
A laparoscopy is preferred because it causes less pain and has a quicker recovery time. You’ll usually be able to go home on the same day or the following day.
2.Laparotomy :
If a cyst is particularly large, or there is a chance it could be cancerous, a laparotomy may be recommended.
During a laparotomy, a single, larger cut is made in the tummy to give the surgeon better access to the cyst.
The whole cyst and Ovary may be removed and sent to a laboratory to check whether it’s cancerous. Stitches or staples will be used to close the incision.
Patients may need to stay in hospital for a few days after the procedure.
Treatment for cancer :
If the cyst is found to be cancerous, patient may need to have treatment to remove both of the ovaries, Womb (Uterus) and some of the surrounding tissue. This would trigger an early menopause and mean that patients would be not able to have children.
Consultant Gynecologist with specialisation in laparoscopic and robotic-assisted surgeries.
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