Ovarian Cysts

Women have two ovaries (a left and a right) within the pelvis. They attached either side of the uterus and are in close proximity to the left and right Fallopian tubes. Collectively, the ovaries along with the Fallopian tubes and uterus are are essential to natural reproduction and the menstrual cycle.

Ovaries are highly functional organs that store, mature and release the female reproductive egg. This leaves the ovaries susceptible to an overgrowth of cells creating a sac (‘cyst’). The contents of an ovarian cyst reflects the different types of cells that make up the ovary. Ovarian cysts are commonly filled with clear or straw-coloured fluid, mucous, endometriosis fluid (as seen in an ‘endometrioma’) and are sometimes contain hair and bone structures (as seen in a ‘dermoid’ or ‘mature teratoma’).

Typically, the bigger the cyst, the more symptoms a woman will have. Ovarian cysts more than 4cm in diameter are generally less likely to go away on their own and therefore more likely to cause problems. Some cysts may cause pain when they burst and their contents irritate the internal organs (known as a cyst accident). Similarly, if the ovarian cyst leaks blood, this irritates the internal organs.

As a cyst grows in size, it increases in volume and this can make the ovary twist on itself. This blocks off the blood supply to the ovary (called ‘ovarian torsion’). Ovarian torsion is an emergency because if the ovary is deprived of blood supply for too long, the ovary can die, harming a woman’s reproductive wellbeing.

When women experience these symptoms, urgent review is recommended to manage pain and ensure there are no other associated complications.

The risk of malignancy from an ovarian cyst is overall low, but each cyst is evaluated for this before surgery. If the risk of ovarian malignancy is increased, you might need a further opinion or review by a Gynaecological Oncologist. Dr Dunn works closely with Gynaecological Oncologists in Brisbane to coordinate this care if needed.

One in three women will experience an ovarian cyst that causes some sort of problem, like pain or discomfort. Many more women will develop an ovarian cyst at any given time. However, because the ovaries are so active, and most cysts are small in size, they are resorbed by the body within a a month or two, and so the cyst will go before any treatment is needed. Some cysts however won’t resorb and will usually need surgery to remove them.

Symptoms of Ovarian Cysts

Many ovarian cysts are asymptomatic.

When symptoms occur, they may include:

• Pain in your abdomen or pelvis that might severe, dull, constant or that comes and goes.
• Changes to your bladder function (pain when you pass urine, or passing urine more frequently, or difficulty emptying the bladder)
• Changes to your bowel function (having difficulty or pain with a bowel movement)
• Pelvic pain around the time of your period or in between periods (‘mid-cycle’)
• Irregular menstrual cycles
• Pain during sex
• Pain brought on by certain activities or movements like sports or exercise
• Bloating, swelling, pressure or heaviness in your abdomen
• A lump or growth in your abdomen or pelvis. (sometimes this is more noticeable when you’re lying down)
• Nausea or vomiting

Types of Ovarian Cysts

There are different types of ovarian cysts. The ovary is made up of many different types of cells and these can be overstimulated which leads to a cyst forming.

Causes

• Hormonal Imbalances: Often related to the menstrual cycle.
• Pregnancy: Cysts can develop early in pregnancy.
• Endometriosis: Can lead to the formation of endometriomas.
• Severe Pelvic Infections: Can spread to the ovaries and fallopian tubes.
• Previous Ovarian Cysts: Increases the likelihood of developing more cysts.

Diagnosis

• Pelvic Exam: Initial discovery of cysts.
• Ultrasound: Provides detailed images to determine the cyst’s size, shape, and composition.
• Blood Tests: May check for hormone levels or cancer markers like CA-125.
• CT Scan or MRI: Used if more detail is needed.

Impact of Ovarian Cysts

Severe pain might be an emergency known as ovarian torsion which is when the ovary twists, blocking off blood supply and putting the ovary at risk of ‘ischaemia’ or losing its reproductive function. fortunately the ovary has two sources of blood supply so there is often time to arrange assessment and ultrasound before considering surgery.

• Most ovarian cysts do not affect fertility.
• Conditions like endometriomas and PCOS can impact the ability to conceive.

Treatment

There is no diet or lifestyle changes that are shown to prevent ovarian cysts forming or to make a cyst shrink and go away. The COCP can at times suppress ovarian function which will stop ovulation and therefore, may prevent ovarian cysts forming. Medications like paracetamol and ibuprofen can help reduce some pain from an ovarian cyst, but these medications don’t make the cyst go away.

1. Watchful Waiting: Many cysts resolve on their own.
2. Hormonal Contraceptives: Can prevent the formation of new cysts.
3. Surgery:
   • Cystectomy: Removal of the cyst while preserving the ovary.
   • Oophorectomy: Removal of one or both ovaries if necessary.

Complications

• Rupture: Can cause severe pain and internal bleeding.
• Torsion: The ovary twists, cutting off its blood supply, requiring emergency surgery.
• Malignancy: Some cysts, though rare, can be cancerous.

Risk Factors

• Hormonal imbalances
• Pregnancy
• Endometriosis
• Severe pelvic infections
• Previous ovarian cysts

Prevention

• Hormonal contraceptives may help reduce the risk by preventing ovulation.
• Regular pelvic exams can help detect cysts early.

When to Seek Medical Attention

• If experiencing symptoms such as pelvic pain, bloating, or irregular periods.
• Difficulty in conceiving.
• Seek immediate medical attention if there is sudden, severe abdominal or pelvic pain, pain with fever or vomiting, or signs of shock (rapid breathing, lightheadedness, weakness).

Prognosis

Most ovarian cysts are benign and resolve without treatment. Regular monitoring and appropriate management can help address any complications and ongoing discomfort.