An ovarian cyst is a closed sac-like structure that contains fluids. They develop in a woman’s ovaries. Such a condition is common and can occur at any age. There are two types of ovarian cysts, the first types of cysts are functional cysts (follicular cysts, luteal ovarian cysts) they are usually harmless in nature and develop during the menstrual cycle. They are short-lived & are the most common type of ovarian cysts. On the other hand pathological cysts (dermoid cysts, cyst adenomas), are less common and are results of abnormal cell growth. Such cysts can be harmless or cancerous.
As the name suggests, ovarian cysts occur in the ovaries, and they can affect one or both ovaries. The ovaries are part of the female reproductive system; they are small and have a shape similar to beans. They are present on either side of the womb. The ovaries are responsible for two important functions:
- To release an egg every 28 days, thus playing an important role in the menstrual cycle.
- To release hormones like estrogen & progesterone.
CAUSES
The causes of ovarian cysts depend on their classification:
Functional Cysts :
- Follicular ovarian cysts: They are the most common type of cysts. The egg produced by the ovaries moves into the uterus (womb). This egg grows in the follicle, which protects the egg with the help of fluids. Normally, when the egg is released, the follicle should burst, but in some cases, the fluid contained by the follicle is not shredded even after releasing the egg, or in some cases, the follicle does not release the egg itself. As a result, the follicle swells with fluid, forming a follicular ovarian cyst.
- Luteal ovarian cysts: Such cysts are not as common as follicular cysts. They are formed when the corpus luteum is filled with blood. The Corpus luteum is a tissue left behind after the egg is released.
Pathological cysts
- Dermoid cysts (cystic teratomas): Dermoid cysts are the most common pathological cysts for women under 30. It forms due to a totipotential germ cell (a primary oocyte). A totipotential germ cell is a cell that can form all orders of cells that are required to form mature tissues. Dermoid cysts contain bone, skin, hair, and sometimes other tissues (e.g., teeth).
- Cyst adenomas: Cyst adenomas are more common in postmenopausal women. These ovarian cysts develop from cells covering the outer part of the ovaries. Since they are not inside the ovary, they have the potential to grow considerably large.
RISK FACTORS
The two major risk factors to be considered are endometriosis and polycystic ovary syndrome.
- Endometriosis: In this disease, the tissue (called Endometrium), which normally lines the inside of the womb/uterus and which is usually shed off with blood during periods, grows outside the uterus and is seen involving ovaries and many other organs. Such types of cysts are excruciating.
- Polycystic Ovary Syndrome: In this condition, the follicles in which an egg normally grows and matures do not open, resulting in the formation of cysts.
SYMPTOMS
Related to menstrual cycle & sexual activity:
- Pain during sexual intercourse, especially during deep penetration.
- Irregular periods.
- Chronic low back or pelvic pain during the menstrual cycle.
- Vaginal pain or spotty bleeding from the vagina.
- Infertility
Related to digestion & abdomen
- Indigestion.
- Pain in the pelvic or lower abdomen area.
- Pain during urination or bowel movement.
- Nausea or vomiting.
- Problems in having bowel movements & feeling pressure to have a bowel movement.
- Abdominal distension.
- Bloating & feeling of abdominal fullness.
- Abdominal tenderness.
Others
- A feeling of lower abdominal/pelvic pressure or fullness.
- Problems controlling urination.
DIAGNOSIS
The diagnosis of cysts is made based on their size and composition, i.e. does it contain only fluids or a mixture of liquids and solids? In the case of the former, the cysts are likely to be benign, while in the case of the latter, further tests may be required to determine the result. The following are different procedures used to ascertain the presence and nature of the cysts:
- Pregnancy Test: A pregnancy test can be helpful to ascertain cysts caused by the corpus luteum.
- Pelvic Ultrasound: In this procedure, the doctor uses ultrasound waves to produce an image of the cyst if it is present. This procedure helps the doctor determine whether a cyst is present and, if so, its size, location, and composition.
- Laparoscopy: In laparoscopy, the surgeons use a laparoscope—a small, lighted instrument that is inserted through incisions to ascertain the cyst.
- CA 125 blood test: To diagnose whether the cyst is cancerous, the doctor may use the CA 125 blood test. CA 125 is a protein often found in high numbers in women with ovarian cancer.
TREATMENT
Treatment, if needed at all, depends on the following factors:
- Size of the cyst.
- Type of the cyst
- Symptoms experienced
The following options exist for treatment:
- Wait and watch: If your symptoms are not severe and do not affect your daily activities, you can wait for a few months to see if the cyst goes away. You can also schedule an ultrasound a few months after your initial diagnosis.
- Surgery: If the symptoms are severe, surgery should be pursued. There are two options: laparoscopy and laparotomy.
- Laparoscopy: Most types of cysts can be removed using laparoscopy. A laparoscope (a small, lighted microscope) is passed into your abdomen through minimal incisions so that the surgeon can see the internal organs. A laparoscopy is preferred to a laparotomy since the recovery time is shorter in the former.
- Laparotomy: If the cyst is extremely large or cancerous, laparotomy is the preferred procedure. In this case, the incisions are larger than those in laparoscopy.