Ovarian cysts are fluid-filled (or occasionally solid) growth within the ovary. Most ovarian cysts are benign (non-cancerous).
Ovarian cysts are very common in pre-menopausal women with regular menstrual cycles. Women may have ovarian cyst forming and spontaneously resolving every month without being aware of it unless it causes problems.
Many cysts (such as functional cysts) are not symptomatic, and are found incidentally during a scan (such as ultrasound, CT or MRI) for other reasons. Others can cause pelvic pain when there is bleeding into the cyst (haemorrhagic cysts) or when endometriosis is involved (endometriomas). Women may also feel more bloated and full when they have ovarian cysts.
Torsion is another problem that can occur with ovarian cysts. It happens when the ovary (with cyst within it) twists on its pedicle (containing its blood supply) and therefore cuts itself off its own blood supply. This causes severe pelvic pain which typically comes and goes over the duration of the pain, often with associated nausea. This is a surgical emergency as the woman risks losing the ovary.
If you have ovarian cyst, you may also experience:
Common types of ovarian cysts include:
Less common cysts are:
Polycystic ovary is described when the ovary contains many small follicles (cysts), usually in the periphery of the ovary. These are common findings in women, and is considered normal unless it is associated with abnormal menstrual cycles or abnormal hormonal profile (increased androgen) – which would in this case be considered polycystic ovarian syndrome.
Polycystic ovary in itself does not cause any pain or bloating, it is a metabolic syndrome associated with irregular prolonged menstrual cycles, fewer or no ovulation (therefore reduced fertility), increased androgens (causing acne or abnormal hair growth), increased risk of abnormal overgrowth of the internal lining of the uterus, and abnormal sugar control (like in diabetes).
Most ovarian cysts are benign (not cancerous), especially in younger pre-menopausal women. The risk of ovarian cysts being cancerous increases with age. It is important for persistent ovarian cyst to be assessed thoroughly and removed if necessary to rule out malignancy, and also to avoid cyst complications such as bleeding, rupture (bursting) or torsion (twisting).
Investigations which may be helpful to differentiate the different types of cysts are:
Most functional cysts resolve spontaneously over time, these are normally followed-up through serial pelvic ultrasound.
Other cysts such as dermoid cysts, endometriomas or large cystadenomas will require surgical excision, most commonly through laparoscopic (key-hole) surgery by a gynaecologist. It is important to remove suspicious looking cyst or ovary (as per pelvic ultrasound finding) for diagnosis (through pathological examination) and prompt treatment if required. Removing the ovarian cyst is also important to prevent torsion, especially when the cyst is large (more than 4cm in diameter).