Author: Dr Peter England, Obstetrician and Gynaecologist
The finding of a cyst on one of your ovaries is usually a very confronting event. However, most of the time an ovarian cyst is easy to manage. As you’ll see, ovarian cysts are a very common occurrence in all women. They can be broadly divided into three categories.
- Physiological or Ovulatory Cysts
- Benign Cysts
- Malignant Cysts otherwise called Ovarian Cancer
Physiological or Ovulatory Cysts
Every month during the menstrual cycle, a woman releases an egg in the middle of the month. This is called ovulation. The egg is developed for release in a cyst called a follicle. The follicle grows to 20-25 mm across then ruptures, releasing the egg. In some women, there is pain with this. Often called ovulation pain, or the “mittleschmurz” (after the German word meaning ‘the little pain’).
While this pain is usually mild, on occasion it can be quite severe, leading to a checkup at the doctor, an ultrasound and some pain relief. Fortunately, if you have this pain it usually subsides in 24-48 hours.
Benign Ovarian Cysts
There are many kinds of benign tumours or cysts that can grow on the ovary. The ovary is composed of many different cell types, each type of cyst can give rise to benign growths. The cysts can be solid, fluid-filled or a mixture of both. They tend to grow slowly, can be painless or painful, and can be easily treated for the most part with laparoscopic surgery (i.e. keyhole technique).
Some of the better-known benign cysts are:
1: endometriomas (cysts full of endometriosis, which cause significant pain at the time of your period).
2: dermoid cysts: these curious growths contain tissue types of every organ type, most commonly hair, sweat gland, teeth and bone, neural cells, even tissue resembling parts of the gut!
3: cystadenomas: these benign cysts usually have clear fluid (serous type) or thicker fluid (mucinous type) within a thin wall (or capsule as it is known).
Malignant Cysts (Ovarian Cancer)
This terrible disease remains a difficult challenge to diagnose and can be complex from the point of view of treatment. There is currently no effective screening program and symptoms are often quite vague. Fortunately, ovarian cancer represents much less than 1% of ovarian cysts.
What symptoms would I have if I have ovarian cancer?
The pain will be the commonest symptom of an ovarian cyst. Sometimes this presents as a new pain during sexual intercourse. Sometimes, if the cyst is large enough there may be bladder or bowel symptoms noted. Occasionally there are no symptoms at all, and the cysts are found during a routine checkup.
Will I need an Ultrasound?
If an ovarian cyst is suspected then a pelvic ultrasound, which is a simple easy test, will give images of the cyst and often clues as to what type of cyst you might have.
Combined with your symptoms and the exam findings, I can then advise what the management plan will be.
Will I need surgery?
The answer is sometimes yes, and sometimes no. If the cyst is equal to 5cm or more in diameter, surgery is usually required. As these cysts will continue to grow and can undergo twisting (known as tortion). This can endanger your whole ovary. Smaller cysts that are persistent and painful will often need removal by laparoscopy too.
Many cysts presenting with pain are caused by bleeding into an ovulatory follicle (known as a “haemorrhagic corpus luteum”). These can usually be observed and reassessed in 4-6 weeks after another cycle passes. Mostly they resolve on their own, requiring no formal treatment, just a little rest and some simple painkilling tablets.
If you are concerned you may have an ovarian cyst, see your doctor or make an appointment with my rooms and we can assess your personal health concerns.
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This article has been written by Dr Peter England – Expert Obstetrician and Gynaecologist. Read more about Dr Peter England
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