Although often harmless, many women will develop an ovarian cyst at some point in their lives. Caused by a range of factors and often varying in severity, ovarian cysts may affect individuals very differently. Some women remain completely unaware of cysts affecting the ovaries, but for some, these can be a source of severe pain and present as a medical emergency that requires urgent treatment.
What are ovarian cysts and how are they caused?
Despite being relatively common, the development of an ovarian cyst is bound to cause some anxiety, so it’s important to understand what they are and how they are caused. There are many different types of cysts and it is important to differentiate between normal functional cysts such as normal follicles and corpus luteum cysts. Both of these cysts occur every menstrual cycle in adult women before the menopause and spontaneously regress. These cysts should be simple cysts (single locule) and less than 5 cm. Cysts occurring after the menopause, complex cysts (multiple loculations and or solid and cystic components) and cysts greater than 5cm in premenopausal women are not normal. They can also be more prevalent in those with existing gynaecological conditions such as endometriosis or polycystic ovary syndrome (PCOS). The majority of cysts are benign, particularly before the menopause, but some may be cancerous and this is more common after the menopause.
In terms of appearance, ovarian cysts take on the form of fluid-filled sacs and can vary greatly in size. They can develop on either ovary and can sometimes affect both ovaries simultaneously. Whilst it’s true that they can affect any woman at any point in their lifetime, ovarian cysts often emerge and disappear without showing any symptoms. Sadly, this isn’t always the case.
Types and symptoms
The ovarian cysts that occur as a result of the menstrual cycle are known as functional ovarian cysts. These are by far the most common variety of this cyst and usually cause no harm. Pathological ovarian cysts, which appear as a result of irregular cell growth, are far less common and can experience various complications. Cysts may rupture, causing instant pain, or the enlarged ovary can twist on its own blood supply and prevent blood from reaching the ovary causing rapid inset of severe pain. Cysts which grow greater than 5 cm in size may put pressure on surrounding organs including the bladder, bowel and stomach. It’s in cases such as this that their surgical removal may be necessary.
Ovarian cysts may cause a wide variety of symptoms including pelvic pain, frequent bloating, pain during sex, feeling the need to urinate more often, heavy periods, a noticeable change in your periods or difficulty trying to conceive. If you have symptoms which indicate that you have an ovarian cyst, it is advisable to seek out medical advice as soon as you can.
Investigation and treatment
When investigating the possibility of ovarian cysts, you will normally need to undergo a number of tests including initially an ultrasound scan and blood tests. Sometimes further tests including MRI and CT imaging are also required. In some circumstances a diagnostic laparoscopy may also be required to provide you with a more concrete diagnosis. Ovarian cysts may be removed if they are deemed harmful to your health or if you are experiencing severe symptoms. Depending on the nature of the cyst this may be done with laparoscopic surgery or with a traditional open operation if there is a concern the cyst could be cancerous. Your gynaecologist should also take into account whether or not you have been through the menopause and whether or not you want to have any more children.
With over 25 years of experience, Mr Francis Gardner is a specialist in Advanced Gynaecology. He is an expert in both minimal access surgery and gynaecological cancer surgery. Throughout his time in this important medical field, he has maintained a steadfast commitment to all of his patients, staying focused on patient-centred care. To book in for a consultation with Mr Gardner or a One Stop See and Treat appointment, please make an appointment today.
Functional ovarian cysts occur each month are often inseparable from the menstrual cycle, their development is not uncommon. Those with a history of gynaecological health conditions may be more predisposed to developing ovarian cysts but these can affect any woman at any point in their lives.
In a lot of cases, ovarian cysts can cause women to experience painful and concerning symptoms. Although there is a chance that these cysts are indicative of, or could lead to, the development of ovarian cancer, this is not usually the case. Most of the time, these cysts are found to be benign and not cancerous.
If an ovary becomes twisted as a result of a large cyst (measuring 5 cm or more), this can cause severe pain and can become a medical emergency. If this issue is not treated in a timely manner, the ovary can become non-viable and non-functional or die. In these situations, surgical treatment will be required to potentially remove the affected ovary. The loss of one ovary does not significantly impair fertility as the remaining ovary may ovulate every month, making pregnancy a realistic possibility.
Furthermore, if a cyst is allowed to grow too large and requires surgical treatment, then it is not sometimes impossible to conserve any normal ovarian tissue and the ovary may need to be removed. However, in the overwhelming majority of cases, normal ovarian tissue can be conserved and will continue to function normally after the removal of a cyst.
Ovarian cysts are normally identified using an ultrasound scan. Depending on the size of the cyst, either a transabdominal or a transvaginal ultrasound may be required. It is also not uncommon for blood tests to be taken to identify if there is a significant risk of ovarian cancer. In some cases, it may be recommended to have further imaging tests such as a magnetic resonance imaging (MRI) scan or computer tomography (CT) scan to clarify the nature of the problem. In the majority of cases, a keyhole (laparoscopic) procedure will be recommended. This procedure will be performed in an operating theatre. You will need a short general anaesthetic to ensure that the procedure is performed painlessly. It may be possible to go home on the same day of the procedure (day case) or stay a maximum of one night in hospital.
This decision is usually made by taking several things into consideration. After investigation and testing, the risks and benefits of various treatments will be discussed with you, including conservative and surgical treatments. Based on these discussions, you will be empowered to make an informed choice as to which treatment is best for you as an individual.