Managing Ovarian Cysts

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Most ovarian cysts are “functional cysts” which contain clear fluid. Such cysts are relatively common and occur in relation to the development of the egg in the ovary during the menstrual cycle. The cysts arise when there are problems with ovulation, and the egg is not released properly.

Other cystic structures in the ovary which are not parts of the ovulation cycle are called “pathological ovarian cysts”. They are also called “tumours”. Such tumours can be cancerous, but often they are benign or noncancerous. Some such ovarian cysts e.g. dermoid cysts, may be filled with various types of tissues, including hair and skin. Other cysts e.g. endometriotic cysts, are filled with old blood, and they form when tissue similar to the lining of the uterus attaches to the ovaries.

Most small functional cysts measuring under 2-3cm, do not cause symptoms. However, the larger the cyst is, the more likely it is to cause symptoms. These include: Irregular menstrual bleeding, or pain in the lower belly, usually in the middle of the menstrual cycle.

Generally, ovarian cysts – especially dermoid cysts – are at risk of ovarian cyst “accidents”. These include ovarian torsion where the ovary twists around its stalk. When this happens, there may be a sudden, severe pain, often with nausea and vomiting.

Other times, the cysts may break open (rupture) and bleed. Some ruptured cysts bleed enough that treatment is needed to prevent heavy blood loss.

In addition, endometriosis and endometriotic cysts tend to cause recurring and worsening pain with each menstrual period, Endometriotic cysts may also lead to pain during sexual intercourse. These cysts are associated with infertility.

Some cysts are hormone-secreting. Such cysts can produce abnormally high levels of certain hormones e.g. testosterone. This can lead to progressive masculinizaton of the female patient, resulting in problems with acne, hairiness and voice deepening.

Factors that may increase the risk for developing a functional ovarian cyst include:

Use of clomiphene citrate or other such ovulation induction medication
Use of low dose progesterone-only contraception such as certain pills, hormone implants, and intra-uterine devices

However, some women just have a natural tendency to develop functional cysts. Below are some treatment options:

Observation

Functional cysts usually resolve without treatment over time. However, some ovarian cysts may be persistent or increase in size over time. If there are symptoms of pain or risks of cancer, surgery may be necessary. Ultrasound scans are useful for the monitoring of ovarian cysts. Blood tests such as ovarian cancer markers like CA 125 may also be performed to monitor the risk for cancer.

Medication & Hormonal Treatment

Medication such as painkillers may be prescribed for pain from the ovarian cyst. In some cases, hormonal suppression of the menstrual cycle with birth control pills or injections may be recommended.

Surgery for Ovarian Cysts

Surgery may be advisable if the cysts cause symptoms, are persistent and there is a risk of cancerous change. Endometriotic cysts in particular, have an adverse effect on fertility and surgery may help increase pregnancy success rates before fertility treatment.

Cystectomy refers to surgery to remove the cysts while leaving the ovary intact. For women keen for fertility, cystectomy allows the cysts to be removed while conserving the ovaries. Cystectomy will enable the cyst to be sent for biopsy and confirm if the cyst is non-cancerous or not. Such surgery is usually performed by laparoscopy (minimally-invasive or key-hole method).

Surgery to remove the ovary, also known as oophorectomy, is the permanent solution for ovarian cysts but the ovary is an important source of hormones. If early menopause occurs, hormone replacement therapy may be needed.

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