What Are Ovarian Cysts?
Functional Cysts
Functional cysts usually disappear on their own and do not tend to cause discomfort.
Follicle Cysts
During ovulation, the follicles that hold egg cells are meant to rupture in order to release the egg. Follicle cysts form when this process is unsuccessful. When they are unable to rupture, the follicle continues to grow and fill with fluid, forming a cyst. These cysts are usually painless, temporary and do not affect a woman’s ability to conceive.Corpus Luteum Cysts
After ovulation, the empty follicle normally transforms into a temporary structure called the corpus luteum, which produces hormones to support early pregnancy. If the opening of this follicle seals prematurely and fluid accumulates, a cyst may form. While these cysts can occasionally cause discomfort, they are typically short-lived and rarely pose a fertility concern.
Pathological Cysts
Pathological cysts are not related to the normal ovulation process and may develop due to abnormal cell growth or underlying health conditions.
Endometriomas
Endometriomas are a type of cyst associated with an often-painful condition called endometriosis. They can affect ovarian function, reduce ovarian reserves and interfere with ovulation, making them one of the cyst types often linked to fertility challenges.Dermoid Cysts
Dermoid cysts are slow-growing cysts that develop from cells present from birth and may contain tissue such as hair, fat, or skin. Although they are usually benign and not linked to hormonal changes, dermoid cysts can grow large over time. If they affect the shape of the ovary or cause pain, surgical removal may be recommended.Cystadenomas
Cystadenomas form from the surface tissue of the ovary and are typically filled with fluid or mucus-like material. While most are benign, they can grow quite large and place pressure on surrounding organs or the ovary itself. Large cystadenomas may interfere with ovarian structure or increase the risk of complications such as ovarian torsion.
Symptoms of Ovarian Cysts
Ovarian cysts do not always cause noticeable symptoms, which is why many are discovered incidentally during routine gynaecological examinations or ultrasound scans. When symptoms do occur, they may vary depending on the size and type of cyst.
Common symptoms of ovarian cysts include:
- Abdominal bloating
- Recurring pain in the pelvis
- Vaginal bleeding that occurs outside of menstruation
- Discomfort or pain during sexual intercourse
- Change in urination and bowel movement patterns
What Causes Ovarian Cysts to Form?
Because many ovarian cysts develop without symptoms, it can be unclear why they form in the first place. In most cases, cysts are linked to normal hormonal changes within the menstrual cycle, while others may arise from underlying gynaecological conditions. Some possible causes are:
- Ovulation-related changes: If the egg is not released or the follicle does not break down during ovulation, a functional cyst may form.
- Hormonal imbalances: Disruptions in hormones that regulate ovulation can interfere with regular egg release, increasing the likelihood of cyst formation.
- Polycystic ovary syndrome (PCOS): PCOS is characterised by irregular ovulation and the presence of multiple small cysts on the ovaries, often accompanied by hormonal imbalance.
- Endometriosis: Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus. This tissue can attach to the ovaries and form cysts known as endometriomas. This is usually highly painful and treatment is often advised.
- Pregnancy-related changes: Certain cysts may develop in early pregnancy to support hormone production and usually resolve on their own as the pregnancy progresses.
- Pelvic infections: Infections that spread to the ovaries or fallopian tubes can sometimes lead to cyst formation, particularly if left untreated.
- Ovarian cancer: In rare cases, ovarian cysts may be related to ovarian cancer. Most ovarian cysts are benign, but persistent, complex or rapidly growing cysts may require further evaluation to rule out malignancy.
How Do Ovarian Cysts Pose Fertility Risks?
Not all ovarian cysts affect fertility, and many women with ovarian cysts are able to conceive naturally. Fertility risks typically arise only when cysts interfere with ovulation, disrupt hormonal balance or affect the structure and function of the ovaries. Ovarian cysts may pose a fertility risk by:
Disrupting Ovulation
Certain cysts can prevent the ovary from releasing an egg regularly, making it more difficult to conceive.
Affecting Hormonal Balance
Cysts may be caused by conditions such as polycystic ovary syndrome (PCOS). These conditions are associated with hormonal imbalances that can lead to irregular menstrual cycles and reduced fertility.
Endometriosis
Endometriosis causes painful, blood-filled cysts that may affect ovarian reserve, egg quality or the surrounding pelvic environment, which can make conception more challenging.
Do Ovarian Cysts Always Need to Be Removed?
Ovarian cysts do not always require surgical removal. Many types of cysts can resolve on their own without affecting fertility or overall health. However, it may still be wise to visit a gynaecologist for monitoring, follow-up scans, and tests.
Other types of cysts can be managed conservatively with hormonal therapy, such as birth control pills, which may help regulate the menstrual cycle and reduce the likelihood of new cysts forming. Pain management, lifestyle adjustments and routine check-ups are often sufficient for women with mild or intermittent symptoms.
However, removal may be recommended in certain situations. Persistent or growing cysts that do not resolve over time may increase the risk of complications and are often advised for removal. Painful or symptomatic cysts, particularly those causing ongoing pelvic pain, bloating or irregular periods, may also require intervention.
Detecting Ovarian Cysts
Doctors assess ovarian cysts using a combination of diagnostic tests.
- Physical Examination: A physical examination is often the first step, during which the gynaecologist gently examines the pelvic or lower abdominal area to check for any signs of swelling or abnormalities that may suggest a cyst.
- Ultrasound Scan: An ultrasound scan is commonly used to obtain detailed images of the uterus and ovaries. This test helps determine whether a cyst is present, as well as its size, position and whether it is fluid-filled or solid.
- Laparoscopy: In some cases, laparoscopy may be recommended. This minimally invasive procedure involves inserting a small camera through a tiny incision in the abdomen, allowing the doctor to directly examine the ovaries and, if necessary, remove certain cysts.
- Blood Tests: Blood tests may also be performed in selected situations, particularly when there is concern about ovarian cancer. These tests assess hormone levels and measure cancer antigen 125 (CA-125), a protein that can be elevated in some ovarian conditions.
Removing Ovarian Cysts
When removal is recommended, the surgical approach depends on the type of cyst, its size and the patient’s fertility considerations.
A cystectomy is the most common procedure. This involves removing the cyst while preserving the ovary and is often preferred for women who wish to maintain fertility. This procedure is usually performed via laparoscopy, a minimally invasive “keyhole” technique that involves small incisions, faster recovery and less post-operative discomfort.
In cases where there is a higher suspicion of ovarian cancer or when the cyst is very large or complex, a total removal of the ovary may be necessary. This may serve as a long-term solution for ovarian cysts. However, as the ovary is a producer of hormones, the patient may need to undergo hormone replacement therapy afterwards, to prevent early menopause from occurring.
