Ovarian Cysts

Based on their development, ovarian cysts are categorised into two classes:

• Functional cysts develop during the ovulation cycle (the release of an egg from the ovary), reflect normal ovarian activities, and usually shrink on their own.
• Pathological cysts arise from abnormalities and are much less common. These include:
  • Cystadenomas, which are fluid-filled cysts on the ovarian surface.
  • Dermoid cysts (teratomas) are cysts containing tissues such as hair, teeth, skin, and even brain tissues.
  • Endometriomas, cysts consisting of endometrial tissue, that normally lines the uterus.
  • Ovarian cancer cysts, which are solid tumours containing malignant cells.

Most ovarian cysts may not cause symptoms, but large cysts or ruptured cysts may lead to:

• Pelvic pain usually occurs on one side, below the bellybutton, and can range from a dull, persistent sensation to a sudden, sharp pain.
• Bloating, with a sensation of heaviness or fullness in the abdomen.
• Changes in the menstrual cycle, including irregular periods, abnormal bleeding, or painful periods.
• Pain during intercourse (dyspareunia), causing discomfort during sex.
• Urinary problems, such as difficulty emptying the bladder or frequent urgency.
• Bowel difficulties, including constipation or pain when passing stool.

Ovarian cysts can result from hormonal changes or other underlying conditions. Other causative factors include:

• Endometriosis an lead to the formation of endometriomas (ovarian cysts) in advanced stages of the disease.
• Pelvic inflammatory disease (PID) may cause scarring and infected ovarian cysts that if ruptured, can result in sepsis.
• Genetic factors may increase susceptibility.
• Obesity can contribute through associated hormonal imbalances.

Doctors use several approaches to diagnose ovarian cysts.

• Pelvic examination allows detection of lumps (abnormal masses) or tenderness in the pelvic region.
• Ultrasound provides details about the cyst’s size, type (cystic, solid, or mixed), location, contents, and blood supply. Patients undergoing ultrasound for ovarian cysts must arrive with a full bladder.
• Blood tests measure reproductive hormones such as luteinising hormone (LH), follicle-stimulating hormone (FSH), oestradiol, and testosterone to assess hormonal imbalance.
• Cancer antigen 125 (CA 125) test helps detect ovarian cancer, particularly in postmenopausal women, or those with suspicious cysts.
• Magnetic resonance imaging (MRI) distinguishes benign from malignant cysts with high accuracy by identifying fat, fluid, solid, or blood.
• Computed tomography (CT), though less common, is preferred for imaging haemorrhagic ovarian cysts. 

Treatment depends on cyst type, size, patient age, and severity of symptoms. Here are some common treatment options:

• Medications such as hormonal contraceptives or birth control pills prevent new ovarian cysts, but do not shrink existing ones. Pain relief can be achieved with over-the-counter drugs (acetaminophen, ibuprofen, naproxen) or stronger narcotics (oxycodone and morphine sulphate) for moderate to severe pain.
• Laparoscopic ovarian cystectomy removes cysts smaller than 3 inches using minimally invasive surgery, usually allowing same-day discharge.
• Ovarian cystectomy via laparotomy is performed for larger or possibly cancerous cysts, requiring a large incision and longer recovery. 

Seek medical attention if:

• You experience severe pelvic pain or abdominal pain.
• You exhibit symptoms of a ruptured cyst, e.g., sudden, sharp pain, nausea, vomiting, or faintness.
• You notice changes in your menstrual cycle or unusual bleeding.
• When your urinary or bowel symptoms persist.

Although ovarian cysts cannot always be prevented, some measures reduce risk. They are:

• Regular gynaecological check-ups help detect cysts early.
• Maintaining a healthy weight lowers hormonal imbalance
• Prompt treatment of pelvic infections reduces complications.

Gynaecologists are the primary specialists for ovarian cyst evaluation and treatment. In complex cases, especially where cancer is suspected, consultation with a gynaecologic oncologist is recommended.