Ovarian Cysts

CONDITION

What are ovarian cysts?

Ovarian cysts are fluid-filled sacs that develop in the ovaries. They can affect women at any age, predominantly during the reproductive age.

Ovarian Cyst

Ovarian Cyst

What are the common names for ovarian cysts?

Ovarian cysts are also called cystic ovarian mass.

What is the percentage of population affected by ovarian cysts?

It is estimated that 8 to 18% of women suffer from ovarian cysts.

How do ovarian cysts affect you?

Most ovarian cysts are harmless and cause little or no discomfort. However, large cysts can cause pain.

Which part of the body is affected?

The ovaries are paired organs that are a part of the female reproductive system. Situated on either side of the uterus, their main function is to produce ova and release sex hormones. Each month, one ovum matures, is released and picked up by the fallopian tubes for reproduction.

The ovaries develop cyst-like structures every month called follicles. Each follicle has an egg surrounded by fluid, which provides protection as it develops. When the egg matures, the follicle bursts open, releasing the egg and the fluid.

What are the types of ovarian cysts?

There are two types of ovarian cysts:

  • Functional ovarian cysts are the most common. They do not cause any harm, are non-cancerous and short-lived.
  • Pathological cysts may be benign or cancerous (malignant).

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What are the causes of ovarian cysts?

The causes of ovarian cysts depend on the type.

Functional ovarian cysts

These cysts are associated with the monthly menstrual cycle. They form when

  • fluid inside a follicle is not released at the time of egg release (corpus luteum cyst)
  • the follicle swells up but doesn’t release the egg (follicular cyst)

Pathological cysts

These cysts form as a result of abnormal cell growth of either the cells that form the egg or those that cover the ovary. They are not related to the menstrual cycle. Pathological cysts may include:

  • Dermoid cysts: develop from cells that form the egg and can contain tissues such as skin, hair or teeth. These are usually benign.
  • Cystadenomas: develop from cells that cover the ovary and are usually filled with liquid or mucous
  • Endometriomas: develop when tissue lining the uterus, called endometrium, begins to grow outside the uterus and on the ovaries

Dermoid cysts and cystadenomas can grow big and shift the ovary from its normal position. This increases the chance of painful twisting of your ovary, a condition called ovarian torsion.

What are the signs and symptoms of ovarian cysts?

Some cysts do not show any signs or symptoms. If symptoms present, the most common is pain, which may be characterised as follows:

  • Pelvic pain before your period starts or before it ends
  • Dull pelvic ache that radiates down your lower back and thighs
  • Pain during intercourse
  • Pain with bowel movements

Other symptoms may include

  • Nausea, vomiting or tenderness in your breast like that experienced during pregnancy
  • Abdominal fullness or heaviness
  • Urination problems due to pressure on your bladder

The symptoms that indicate an emergency include:

  • Sudden extreme pelvic or abdominal pain
  • Fever or vomiting that accompanies pain
  • Shock
  • Rapid breathing
  • Weakness or light-headedness
  • Ovarian torsion: painful twisting of the ovary when they grow large and move out of their usual position
  • Rupture of a cyst, causing severe pain and internal bleeding

Cysts are common during pregnancy and can lead to complications such as torsion or rupture. Ovarian cysts present during pregnancy are closely monitored.

Can an ovarian cyst become cancerous?

Ovarian cysts are mostly benign, but some can become cancerous. The risk increases with age as post-menopausal women are at a higher risk for ovarian cancer.

Can ovarian cysts affect your chances of getting pregnant?

Ideally, ovarian cysts do not interfere with your fertility, but certain conditions associated with the cysts, such as endometriosis and polycystic ovarian syndrome (PCOS) can influence your chances of getting pregnant.

How are ovarian cysts diagnosed?

Ovarian cysts are usually detected during a pelvic exam. Other tests that could help in the diagnosis of cysts include a pregnancy test (for corpus luteum cysts), blood test to detect cancer protein, ultrasound and laparoscopy.

TREATMENT

What are the consequences of not treating ovarian cysts?

Some ovarian cysts do not require treatment as they resolve with time. However, some may lead to infection and infertility if left untreated.

When should I consider watchful waiting of ovarian cysts?

In most cases, if you don’t have any symptoms, and your cysts are small and fluid-filled, you will be advised to wait. Your cysts will be closely monitor as most will resolve on their own.

What are the treatment options for ovarian cysts?

The main treatment options for ovarian cysts are:

  • Birth control pills: reduces the risk of new cysts from forming and development of ovarian cancer
  • The surgeries that may be performed include:
    • Ovarian cystectomy: removal of only the cyst, leaving the ovary intact
    • Oophorectomy: removal of cyst along with the affected ovary
    • Total hysterectomy: removal of both ovaries, fallopian tubes as well as the uterus. This is considered if the cyst is cancerous.

Am I a candidate for ovarian cyst surgery?

Your surgeon may suggest ovarian cystectomy in the following cases:

  • Cyst is larger than 7.6 cm
  • Not a functional cyst
  • Cyst continues to grow
  • Cyst does not resolve within two to three menstrual cycles
  • Presence of pain or other symptoms
  • Exclusion of ovarian cancer
  • Cysts in both ovaries
  • Ovarian cysts present in:
    • Menarchal adolescents and adults
    • Post-menopausal women
    • Those using birth control pills

How do I prepare for ovarian cyst surgery?

Before ovarian cyst surgery, you will be advised to stop eating or drinking anything at least 6 hours before the procedure. Discuss all the medications that you are taking on a regular basis so that your doctor can advise you on the ones that you can safely continue and those that may need to be stopped during the time of surgery.

How are the different ovarian cyst surgeries performed?

Ovarian cyst surgeries can be performed by two approaches:

Laparoscopy

Two to 3 small incisions are made on your abdomen. Carbon dioxide gas is introduced to inflate your abdomen so that the surgical area can be viewed clearly. A laparoscope (a narrow lighted tube with a camera) is inserted through one of the incisions to guide your surgeon with the help of images relayed on a large monitor. Other surgical instruments are inserted through the other incisions.

Laparotomy

A single large incision is made on your abdomen to access the surgical site. This method is considered when large cysts need to be removed, and when the whole ovary or uterus must be removed.

Using these approaches, the different types of surgeries that can be performed are briefed below.

Ovarian cystectomy

Ovarian cystectomy is performed under general anaesthesia. The cysts are carefully excised from the ovary, ensuring the contents do not spill out. Once freed from the ovary, the cyst is opened and the contents aspirated to reduce its size. The deflated cyst is then removed through one of the abdominal incisions.

Alternatively, the intact cyst can be removed through the vagina or it can be collected and decompressed within a retrieval bag, minimising the chance of spillage of the cyst’s contents within the pelvic cavity.

Oophorectomy

The affected ovary is separated from the surrounding tissues and blood supply. It is either removed through the incision or it is placed in a pouch before removal.

Hysterectomy

Your surgeon separates the uterus from the surrounding organs and blood vessels, by ligating and sealing the open ends. The uterus is then removed via the abdominal incision or vagina. Along with the uterus, your surgeon will remove the ovaries as well.

What can I expect after ovarian cyst surgery?

Following ovarian cyst surgery, you will be given medication to relieve pain and discomfort. If a laparoscopic approach was done, you may experience back and shoulder pain as a result of the carbon dioxide gas used. This will resolve with time. You may also have spotting or vaginal discharge.

What are the advantages of ovarian cyst surgery?

The advantages of a laparoscopy over laparotomy are:

  • Smaller incisions
  • Reduced blood loss
  • Less scarring
  • Lower post-operative pain
  • Shorter hospital stay and recovery

Describe the stages of recovery and care plan

During your recovery, alert your doctor if you notice any of the symptoms below that may indicate an infection:

  • Severe pain or abdominal swelling
  • Fever
  • Heavy bleeding, or dark or smelly vaginal discharge

What are the outcomes of ovarian cyst surgery?

Ovarian cystectomy can help remove ovarian cysts while preserving fertility, but does not stop other cysts from forming.

What are the potential complications of ovarian cyst surgery?

As with most surgeries, ovarian cyst surgery may be associated with potential complications such as:

  • Bleeding
  • Infection
  • Damage to neighbouring organs such as bowel, ureters and bladder
  • Need for further surgery

What is the downtime of ovarian cyst surgery?

If you have undergone a laparoscopic procedure, you will be able to get back to your daily routine in about 2 weeks; however, you may require about 6 to 8 weeks following a laparotomy.

What is the prognosis of ovarian cyst surgery?

Since there are chances of recurrence, regular monitoring of the ovaries is advised.

What is the cost of ovarian cyst surgery?

Any costs involved will be discussed with you prior to your surgery.

What is the likelihood of ovarian cyst recurrence? How can it be managed?

There is a 6 to 10% risk of recurrence and would requires surgical removal of the cyst.

How can ovarian cysts be prevented?

Further formation of ovarian cysts can be prevented with the use of oral contraceptives., which also protect against ovarian cancer.

What is the current research regarding ovarian cysts?

Extensive research is being done to find better treatment options for ovarian cysts. Some of the recent studies are listed below:

  • Clark M, Zigras T, Bayat L, Kashani S. Minimally Invasive Non-Laparoscopic Ovarian Cystectomy: A Unique Way to Approach Large Ovarian Cysts. J Minim Invasive Gynecol. 2015 Nov-Dec;22(6S):S150.
  • Mehdizadeh Kashi A, Chaichian S, Ariana S, et al. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometrioma. Int J Gynaecol Obstet. 2017 Feb;136(2):200-204.

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