Ovarian Cysts

Experienced Evaluation, Recommendations, and Interventions for a Common Gynecologic Condition

 Cysts involving the ovaries are a common condition. These lesions are roundish, fluid-filled or semisolid sacs in the ovary.  When they are small, they are not unlike normal ovarian cysts, which are blister-like protrusions formed as part of normal egg development and in preparation for egg release into the fallopian tube.

Sometimes these pockets fail to break open and release their eggs, or they swell after release, in both cases growing larger.  Most often cysts do not cause symptoms and may only be noticed incidentally by touch or during a medical examination.  The fact that they are usually only discovered during a physical evaluation by a medical professional, however, illustrates the importance of regular pelvic examinations for women.


When Cysts Begin to Compromise Life
Usually cysts are not a significant concern, but in some women they cause a variety of symptoms, most importantly:

  • aching, pain, or pressure in the lower abdomen;
  • menstrual irregularities;
  • discomfort during sexual activities or exercise;
  • bloating;
  • unexpected vaginal bleeding;
  • or pressure on the rectum or bladder.

Differential evaluation is important for ovarian cysts, as their symptoms are similar to those for other conditions that can cause pelvic pain or discomfort, or abnormal uterine bleeding.

Most ovarian-cysts conditions are of the following types:

  • functional cysts.  These thin-walled, fluid-rich cysts result from the routine process of egg release.  They are harmless and will usually go away on their own after a few months.
  • endometriomas.  Sometimes tissue from the lining of the uterus (endometrium) grows outside of the uterus and attaches to the ovary to form a cystic growth called an endometrioma.  These types of cysts can occur in other places in the pelvis as well.
  • polycystic ovarian syndrome (PCOS).  This condition occurs when multiple egg follicles fail to release their contents and form numerous cysts.  Symptoms from this condition cycle closely with menstrual periods.
  • other types of cysts.  Cystadenomas form on the outer surface of ovaries and can be filled with thick, gelatinous fluid.  The ovary can also sometimes generate types of tissue not normally associated with it, such hair or skinlike areas, which can form the basis of masses called dermoid cysts.

Sometimes cysts can become twisted (causing pain that can be sudden, severe, and sharp, as well as nausea or vomiting), or they can rupture and bleed (adding vaginal blood loss to the symptoms).  A woman who experience signs of such events should seek care at our Center for Gynecology and Women's Health or elsewhere as soon as possible.

The Latest Approach When Surgery Is Necessary
The center’s staff can provide and coordinate comprehensive assessment and care for these conditions.  A pelvic examination and pelvic ultrasound are key steps in diagnosing ovarian cysts.  (A sonogram is especially important if the patient is post-menopausal but still has a persistent cyst.)  Ultrasound helps the team know the size and location of the
cyst and whether is its contents are more fluid or solid.  CT or MR imaging may also be useful.

Most cysts are never noticed and will resolve without symptoms and without the woman noticing that they are there.  Most cysts will recede and disappear on their own after several menstrual cycles.  But for women with detected, recurrent, symptomatic cysts, birth control pills are a common remedy because they stop the ovulation process.  Pain relieving and anti-inflammatory medications are also useful.

If an existing cyst does not go away, though, laparoscopy may be a next step in evaluating the condition, and sometimes the team will surgically treat the cyst by removing it during the same laparoscopic procedure, especially if the cyst appears to be small and benign.  Or, the team may biopsy the cyst during the procedure.  If the gynecologic surgery team needs to explore a larger area or potentially remove a large cyst or one that appears suspicious for cancer, it may use conventional, open, abdominal surgery (laparotomy).  In either approach, the team can remove noncancerous cysts, leaving the ovary intact (cystectomy), or it may remove an entire ovary (oophorectomy), leaving the other intact (to preserve fertility or ovarian hormonal function or both).  

Specialists may treat also attempt to treat endometriomas by using needle aspiration to drain the dark, reddish-brown blood that often fills them or by endometrial ablation.  A key objective in any of these interventions is avoid damage to the ovary, in women who seek to preserve fertility.

Ovarian Cysts and Cancer
The vast majority of ovarian cysts are benign and do not indicate increased risk for ovarian cancer, which is a rare cancer.  If, however, a patient with a persistent cyst condition also has family members who have had ovarian cancer or the patient has other significant risk factors for ovarian cancer, the medical team may want to perform some additional testing, which can include blood tumor-marker tests or surgical biopsy.  Cysts that occur despite the use of oral contraceptives, that are solid in appearance, or that persist after menopause are also cause for additional testing.

Cysts in women of childbearing years are almost always benign.  Women over the age of 50 are at greater risk for cancer.  Doctors will often recommend that women in this age group have a persistent cyst removed surgically.  If a cystic mass is cancerous, the gynecologic team will likely recommend surgery to remove the uterus and both ovaries.

In its initial stages, ovarian cancer is difficult to discern from its symptoms, which are vague and only gradually increase.  But some women with the disease experience these signs:

  • abdominal discomfort and cramps that last for a week and are not accompanied by digestive system symptoms
  • abdominal bloating;
  • difficulty eating;
  • increasing difficulty in bladder control;
  • and gynecologic symptoms such as irregular vaginal bleeding.