Definition of Ovarian cysts
Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. Women have two ovaries — each about the size and shape of an almond — located on each side of the uterus. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during your childbearing years.
Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months.
However, ovarian cysts — especially those that have ruptured — sometimes produce serious symptoms. The best ways to protect your health are to know the symptoms that may signal a more significant problem, and to schedule regular pelvic examinations.
Symptoms of Ovarian cysts
Most cysts don’t cause any symptoms and go away on their own. A large ovarian cyst can cause abdominal discomfort. If a large cyst presses on your bladder, you may feel the need to urinate more frequently because bladder capacity is reduced.
The symptoms of ovarian cysts, if present, may include:
- Menstrual irregularities
- Pelvic pain — a constant or intermittent dull ache that may radiate to your lower back and thighs
- Pelvic pain shortly before your period begins or just before it ends
- Pelvic pain during intercourse (dyspareunia)
- Pain during bowel movements or pressure on your bowels
- Nausea, vomiting or breast tenderness similar to that experienced during pregnancy
- Fullness or heaviness in your abdomen
- Pressure on your rectum or bladder that causes a need to urinate more frequently or difficulty emptying your bladder completely
When to see a doctor
Seek immediate medical attention if you have:
- Sudden, severe abdominal or pelvic pain
- Pain accompanied by fever or vomiting
These signs and symptoms — or those of shock, such as cold, clammy skin, rapid breathing, and lightheadedness or weakness — indicate an emergency and mean that you need to see a doctor right away.
Most ovarian cysts start during the normal function of your menstrual cycle. These are known as functional cysts. Other types of cysts are much less common.
Your ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and progesterone and release an egg when you ovulate. Sometimes a normal monthly follicle just keeps growing. When that happens, it becomes known as a functional cyst. There are two types of functional cysts:
- Follicular cyst. Around the midpoint of your menstrual cycle, an egg bursts out of its follicle and begins its journey down the fallopian tube in search of sperm and fertilization. A follicular cyst begins when something goes wrong and the follicle doesn’t rupture or release its egg. Instead it grows and turns into a cyst.
Corpus luteum cyst. When a follicle does release its egg, the ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. This changed follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst.
The fertility drug clomiphene (Clomid, Serophene), which is used to induce ovulation, increases the risk of a corpus luteum cyst developing after ovulation. These cysts don’t prevent or threaten a resulting pregnancy.
Functional cysts are usually harmless, rarely cause pain, and often disappear on their own within two or three menstrual cycles.
Some types of cysts are not related to the normal function of your menstrual cycle. These cysts include:
- Dermoid cysts. These cysts may contain tissue such as hair, skin or teeth because they form from cells that produce human eggs. They are rarely cancerous.
- Cystadenomas. These cysts develop from ovarian tissue and may be filled with a watery liquid or a mucous material.
- Endometriomas. These cysts develop as a result of endometriosis, a condition in which uterine endometrial cells grow outside your uterus. Some of that tissue may attach to your ovary and form a growth.
Dermoid cysts and cystadenomas can become large, causing the ovary to move out of its usual position in the pelvis. This increases the chance of painful twisting of your ovary, called ovarian torsion.
Complications of Ovarian cysts
Some women develop less common types of cysts that may not produce symptoms, but that your doctor may find during a pelvic examination. Cystic ovarian masses that develop after menopause may be cancerous (malignant). These factors make regular pelvic examinations important.
Infrequent complications associated with ovarian cysts include:
- Ovarian torsion. Cysts that become large may cause the ovary to move out of its usual position in the pelvis. This increases the chance of painful twisting of your ovary, called ovarian torsion.
- Rupture. A cyst that ruptures may cause severe pain and lead to internal bleeding.
Preparing for your appointment
Your first appointment will likely be with either your primary care provider or a doctor who specializes in conditions that affect women (gynecologist).
Because appointments can be brief, and it can be difficult to remember everything you want to discuss, it’s a good idea to prepare in advance of your appointment.
What you can do
- Write down any symptoms you’re experiencing. Include all of your symptoms, even if you don’t think they’re related.
- Make a list of any medications and vitamin supplements you take. Write down doses and how often you take them.
- Have a family member or close friend accompany you, if possible. You may be given a lot of information at your visit, and it can be difficult to remember everything.
- Take a notebook or notepad with you. Use it to write down important information during your visit.
- Prepare a list of questions to ask your doctor. List your most important questions first, in case time runs out.
Some basic questions to ask include:
- What’s likely causing my symptoms?
- What kind of tests might I need?
- Do ovarian cysts usually go away on their own, or will I need treatment?
- Do you have any printed material or brochures I can take home with me? What websites do you recommend?
Make sure that you understand completely everything that your doctor tells you. Don’t hesitate to ask your doctor to repeat information or to ask follow-up questions for clarification.
What to expect from your doctor
Some potential questions your doctor might ask include:
- How often do you experience these symptoms?
- How long have you been experiencing symptoms?
- How severe are your symptoms?
- Do your symptoms seem to be related to your menstrual cycle?
- Does anything improve your symptoms?
- Does anything make your symptoms worse?
Tests and diagnosis
A cyst on your ovary may be found during a pelvic exam. If a cyst is suspected, doctors often advise further testing to determine its type and whether you need treatment.
Typically, doctors address several questions to determine a diagnosis and to aid in management decisions:
- Size. What size is it?
- Composition. Is it filled with fluid, solid or mixed? Fluid-filled cysts aren’t likely to be cancerous. Those that are solid or mixed — filled with fluid and solid — may require further evaluation to determine if cancer is present.
To identify the type of cyst, your doctor may perform the following procedures:
- Pregnancy test. A positive pregnancy test may suggest that your cyst is a corpus luteum cyst, which can develop when the ruptured follicle that released your egg reseals and fills with fluid.
- Pelvic ultrasound. In this painless procedure, a wand-like device (transducer) is used to send and receive high-frequency sound waves (ultrasound). The transducer can be moved over your abdomen and inside your vagina, creating an image of your uterus and ovaries on a video screen. This image can then be photographed and analyzed by your doctor to confirm the presence of a cyst, help identify its location and determine whether it’s solid, filled with fluid or mixed.
- Laparoscopy. Using a laparoscope — a slim, lighted instrument inserted into your abdomen through a small incision — your doctor can see your ovaries and remove the ovarian cyst.
- CA 125 blood test. Blood levels of a protein called cancer antigen 125 (CA 125) often are elevated in women with ovarian cancer. If you develop an ovarian cyst that is partially solid and you are at high risk of ovarian cancer, your doctor may test the level of CA 125 in your blood to determine whether your cyst could be cancerous. Elevated CA 125 levels can also occur in noncancerous conditions, such as endometriosis, uterine fibroids and pelvic inflammatory disease.
Treatments and drugs
Treatment depends on your age, the type and size of your cyst, and your symptoms. Your doctor may suggest:
- Watchful waiting. In many cases you can wait and be re-examined to see if the cyst goes away on its own within a few months. This is typically an option — regardless of your age — if you have no symptoms and an ultrasound shows you have a small, fluid-filled cyst. Your doctor will likely recommend that you get follow-up pelvic ultrasounds at periodic intervals to see if your cyst has changed in size.
- Birth control pills. Your doctor may recommend birth control pills to reduce the chance of new cysts developing in future menstrual cycles. Oral contraceptives offer the added benefit of significantly reducing your risk of ovarian cancer — the risk decreases the longer you take birth control pills.
Surgery. Your doctor may suggest removal of a cyst if it is large, doesn’t look like a functional cyst, is growing, or persists through two or three menstrual cycles. Cysts that cause pain or other symptoms may be removed.
Some cysts can be removed without removing the ovary in a procedure known as a cystectomy. In some circumstances, your doctor may suggest removing the affected ovary and leaving the other intact in a procedure known as oophorectomy.
If a cystic mass is cancerous, however, your doctor will likely advise a hysterectomy to remove both ovaries and your uterus. Your doctor is also likely to recommend surgery when a cystic mass develops on the ovaries after menopause.
Although there’s no definite way to prevent the growth of ovarian cysts, regular pelvic examinations are a way to help ensure that changes in your ovaries are diagnosed as early as possible. In addition, be alert to changes in your monthly cycle, including symptoms that may accompany menstruation that aren’t typical for you or that persist over more than a few cycles. Talk with your doctor about any changes that concern you.