What Is Ovarian Cyst?
Ovarian Cysts are benign fluid-filled sacs that are usually small (e.g. <1.5 cm) and occur most commonly prior to menopause. They can be found on the ovaries, the structures that produce eggs in women.
The majority of ovarian cysts do not cause symptoms. If an ovarian cyst is causing symptoms, the treatment is dictated by what is necessary to eliminate symptoms. They can occur with no identified cause but are also associated with disorders like polycystic ovary syndrome. They often only become known to an individual or physician because of abdominal pain, nausea, vomiting, or constipation caused in cases of rupture, hemorrhage, or ovarian torsion [1,2].
You should see your doctor as soon as possible, but it is not urgent enough to warrant an immediate ER visit. Diagnosis is made with an ultrasound, which can rule out a cancerous cause of the cyst. However, worrisome signs on ultrasound will warrant further testing, like an MRI in some cases. Treatment of cysts with no signs of cancer is just repeat ultrasound in 2-3 months.
How common is Ovarian Cyst?
Ovarian Cyst is also known as
- Benign ovarian follicular cyst
Ovarian Cyst Symptoms
Although some ovarian cysts are initially benign or asymptomatic, they can cause specific complications — each with their own symptoms — detailed below.
Rupture of a cyst that has an ample blood supply can lead to hemorrhage, or bleeding, — which if prolonged either due to high volume or an inability to coagulate — can be life-threatening.
- Severe lower abdominal pain after sex: The hemorrhage of an ovarian cyst is most commonly identified after intense and localized pain in the lower abdomen following intercourse, however, it should be noted that in many cases, especially in younger women, hemorrhage may be asymptomatic until a large quantity of blood is lost or begins to irritate the lining of the abdomen.
- Severe shoulder pain: This may occur as blood collects in the abdomen.
- Upper abdominal pain: This can occur as well while blood collects in the abdomen as well as increased pain when sitting.
Inflammation of the abdominal lining
Inflammation of the lining of the abdomen, or peritonitis, is a painful and possibly life-threatening condition caused by the release of an irritant (e.g. bowel contents, blood, or ascites) from the bowel or pelvic organs.
- Localized or general pain: This pain generally occurs as either localized (e.g. in one area or spot) or generalized abdominal pain (e.g involving the entire belly).
- Diarrhea or constipation: If fluid irritates the peritoneum it can cause diarrhea or constipation. If constipation lasts for a long period of time, it may even cause a blockage of intestines leading to perforation. Depending on the amount of fluid and qualities of the fluid, it may even be a surgical emergency.
- Nausea or vomiting: This may also occur if fluid irritates the peritoneum.
Any mass attached to the ovary raises the risk of twisting and blockage of the blood vessels that supply the ovary. Torsion is a surgical emergency because if blood flow is not restored, an ovary that undergoes torsion can lose blood flow and die, causing loss of a significant amount of reproductive potential. Aside from the importance of saving reproductive potential, a torsion is important to correct because if an ovary loses blood flow and dies it can lead to a serious and life-threatening infection.
- Extremely painful or painless: In most cases, torsion is extremely painful, and discomfort is common, but it can occur in the absence of pain.
- Other common symptoms of torsion: This may include nausea, vomiting, diarrhea, or even constipation.
Rupture of a cyst, particularly a large cyst, can lead to peritonitis or hemorrhage as discussed earlier. Cyst rupture is most commonly associated with intercourse and the character of the fluid (e.g. blood, pus, cystic fluid) determines the intervention. A large amount of fluid may lead to upper abdominal pain or shoulder pain or increased pain with sitting due to irritation of the nerves of the belly and muscles along the spine, respectively. Irritation is more common in the case of blood — cystic fluid is not particularly irritating and usually does not lead to peritonitis .
If a cyst is of particularly large mass, it can place pressure on the bowels. As it does so, this can lead to constipation or difficulty defecating. While medical treatment can increase the amount of stool that passes, a large cyst should be removed surgically. Depending on the contents of the cyst, this can be done with minimally invasive surgery or may require more invasive techniques if spillage of material would negatively impact the individual.
Ovarian Cyst Causes
Polycystic ovarian syndrome
Polycystic ovarian syndrome (PCOS) is a series of signs with no single determinate cause. It is, however, associated with higher than normal amounts of androgen, a decrease in both ovulation (e.g. release of the eggs into the ovary), an increase in the number of cysts, and less frequent menses . Cysts are usually detectable using ultrasound and there is no cure. Treatment for PCOS specifically involves oral contraceptives to treat the androgen-estrogen imbalance and a drug called clomiphene citrate to increase fertility. It is also important to increase physical activity.
Most ovarian cysts develop as a byproduct of a normal menstrual cycle. These are called functional cysts as they are a response to normal menses. A follicular cyst is one type of cyst. Normally a cyst forms and bursts just prior to ovulation; however, if that cyst does not burst or recede but continues to grow slowly it is called a follicular cyst. These cysts are commonly associated with polycystic ovarian syndrome. Other types of cysts include corpus luteum cysts. These occur when the corpus luteum, a type of tissue that regulates menses, begins to retain fluid and creates a cyst. Functional cysts usually do not cause pain or cause only mild pain.
Dermoid cysts are a type of “undifferentiated tissue,” in other words, they are formed from a type of cell that can differentiate into any tissue type. Often these dermoid cysts contain hair, skin, or teeth . They are non-malignant, but if they rupture and spill a material called “sebaceous material” into the abdomen. This can cause a severe reaction known as “chemical peritonitis” and lead to the intestines adhering to each other and causing severe constipation or even a life-threatening bowel perforation. Usually, these require no management, if they become excessively large, they are removed.
Treatment Options and Prevention for Ovarian Cyst
Determination of malignancy
To rule out malignancy (the cyst is cancerous) and blockage of blood vessels, a pelvic ultrasound is the most appropriate diagnostic method. A pelvic ultrasound uses sound waves and can allow a trained practitioner to see the outline of the cyst as well as whether the cyst contains simple fluid or move complex tissues like teeth. It can also help a trained practitioner differentiate between an ovarian cyst and an abscess in the correct clinical setting. Determination of malignancy is necessary before any surgery is undertaken. In the case of malignancy, cancer treatment can also begin.
Removal of cysts/ovaries
Surgical removal is widely accepted as the management of very large cysts at risk of rupturing, cysts with characteristics suspicious for malignancy, or cysts causing pain or discomfort that significantly interferes with your activities of daily living. As most cysts are asymptomatic — unless there is a serious complication — surgery is not a preferred treatment in most cases.
When to Seek Further Consultation for Ovarian Cyst
Most ovarian cysts are benign, do not cause symptoms, and are found incidentally on ultrasounds or CT scans obtained for another reason. However, if found, it is likely you and your care team will have to monitor your cyst for changes.
If you are experiencing a complication of an ovarian cyst
You should seek urgent consultation if an ovarian cyst has caused a complication. Hemorrhage, constipation, or loss of blood flow threatening the viability of an ovary are all potential complications of an ovarian cyst rupture or torsion.
If you know you have an ovarian cyst and experience concerning symptoms
You should seek medical evaluation for further examination to ensure that a dangerous life-threatening or fertility-threatening process is not taking place. Signs include:
- Severe abdominal pain or cramps
- Nausea or vomiting
- Prolonged constipation
Questions Your Doctor May Ask to Determine Ovarian Cyst
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- When was your last menstrual period?
- Have you ever had any surgeries?
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Do you currently smoke?
- Is your abdominal pain getting better or worse?
The above questions are also covered by our A.I. Health Assistant.
- SG McNeeley. Benign Ovarian Masses. Merck Manual Professional Version. Revised March 2017. Merck Manuals Professional Version Link
- Levine D, Brown DL, Andreotti RF, Benacerraf B, et al. Management of Asymptomatic Ovarian and Other Adnexal Cysts Imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2006;256(3). Radiology Link
- Pinkerton JV. Polycystic Ovary Syndrome (PCOS). Merck Manual Professional Version. Revised September 2017. Merck Manuals Professional Version Link
- What is Ovarian Cancer? American Cancer Society. Revised April 11, 2018. American Cancer Society Link