Ovarian cyst

An ovarian cyst is a fluid-filled sac within the ovary. They usually cause no symptoms, but occasionally they may produce bloating, lower abdominal pain, or lower back pain. The majority of cysts are harmless. If the cyst either breaks open or causes twisting of the ovary, it may cause severe pain. This may result in vomiting or feeling faint, and even cause headaches. Most ovarian cysts are related to ovulation, being either follicular cysts or corpus luteum cysts. Other types include cysts due to endometriosis, dermoid cysts, and cystadenomas. Many small cysts occur in both ovaries in polycystic ovary syndrome (PCOS). Pelvic inflammatory disease may also result in cysts. Rarely, cysts may be a form of ovarian cancer. Diagnosis is undertaken by pelvic examination with a pelvic ultrasound or other testing used to gather further details. Often, cysts are simply observed over time. If they cause pain, medications such as paracetamol (acetaminophen) or ibuprofen may be used. Hormonal birth control may be used to prevent further cysts in those who are frequently affected. However, evidence does not support birth control as a treatment of current cysts. If they do not go away after several months, get larger, look unusual, or cause pain, they may be removed by surgery. Most women of reproductive age develop small cysts each month. Large cysts that cause problems occur in about 8% of women before menopause. Ovarian cysts are present in about 16% of women after menopause, and, if present, are more likely to be cancerous.

Signs and symptoms

Ovarian cysts tend to produce non-specific symptoms (i.e., symptoms that could be caused by a large number of conditions). Some or all of the following symptoms may be present, though it is possible not to experience any symptoms:

Abdominal pain. Dull aching pain within the abdomen or pelvis, especially during intercourse. Uterine bleeding. Pain during or shortly after beginning or end of menstrual period; irregular periods, or abnormal uterine bleeding or spotting. Fullness, heaviness, pressure, swelling, or bloating in the abdomen. Some ovarian cysts become large enough to cause the lower abdomen to visibly swell. When a cyst ruptures from the ovary, there may be sudden and sharp pain in the lower abdomen on one side. Large cysts can cause a change in frequency or ease of urination (such as inability to fully empty the bladder), or difficulty with bowel movements due to pressure on adjacent pelvic anatomy. Constitutional symptoms such as fatigue, headaches. Nausea or vomiting Weight gain Other symptoms may depend on the cause of the cysts:

Symptoms that may occur if the cause of the cysts is polycystic ovarian syndrome (PCOS) may include increased facial hair or body hair, acne, obesity and infertility. If the cause is endometriosis, then periods may be heavy, and intercourse painful. The effect of cysts not related to PCOS on fertility is unclear. In other cases, the cyst is asymptomatic, and is discovered incidentally while doing medical imaging for another condition. Ovarian cysts and other "incidentalomas" of the uterine adnexa appear in almost 5% of CT scans done on women.

Complications The most common complications are cyst rupture, which occasionally leads to internal bleeding ("hemorrhagic cyst"), and ovarian torsion.

Cyst rupture When the surface of cyst breaks, the contents can leak out; this is called a ruptured cyst. The main symptom is abdominal pain, which may last a few days to several weeks, but they can also be asymptomatic. A ruptured ovarian cyst is usually self-limiting, and only requires keeping an eye on the situation and pain medications for a few days, while the body heals itself. Rupture of large ovarian cysts can cause bleeding inside the abdominal cavity. Rarely, enough blood will be lost that the bleeding will produce hypovolemic shock, which can be a medical emergency requiring surgery. However, normally, the internal bleeding is minimal and requires no intervention.

Ovarian torsion Ovarian torsion is a very painful medical condition requiring urgent surgery. It can be caused by a pedunculated ovarian cyst that twisted in a way that cuts off the blood flow. It is most likely to be seen in women of reproductive age, though it has happened in young girls (premenarche) and postmenopausal women. Ovarian torsion may be more likely during pregnancy, especially during the third and fourth months of pregnancy, as the internal anatomy shifts to accommodate fetal growth. Diagnosis relies on clinical examination and ultrasound imaging. Cysts larger than 4 cm are associated with approximately 17% risk.

Types

There are many types of ovarian cysts, some of which are normal and most of which are benign (non-cancerous).

Functional Functional cysts form as a normal part of the menstrual cycle. There are several types of functional cysts:

Follicular cyst, the most common type of ovarian cyst. In menstruating women, an ovarian follicle containing the ovum (an unfertilized egg) normally releases the ovum during ovulation. If it does not release the ovum, a follicular cyst of more than 2.5 cm diameter may result. A ruptured follicular cyst can be painful. A luteal cyst is a cyst that forms after ovulation, from the corpus luteum (the remnant of the ovarian follicle, after the ovum has been released). A luteal cyst is twice as likely to appear on the right side. It normally resolves during the last week of the menstrual cycle. A corpus luteum that is more than 3 cm is abnormal. Theca lutein cysts occur within the thecal layer of cells surrounding developing oocytes. Under the influence of excessive hCG, thecal cells may proliferate and become cystic. This is usually on both ovaries.

Non-functional Non-functional cysts may include the following:

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