Ovarian cysts are very common and, in most cases, are harmless. An ovarian cyst is a fluid-filled sac that develops on or within an ovary. Many cysts form naturally as part of the menstrual cycle and disappear without any treatment.
Some ovarian cysts cause no symptoms at all and may only be discovered during an ultrasound scan for another reason. Others can cause pelvic pain, bloating, changes to your periods or pressure on the bladder or bowel.
Although most ovarian cysts are non-cancerous, the way a cyst is assessed and managed depends on several factors, including its size, appearance, symptoms and whether you have been through the menopause.
At Gynae Solution, we understand that being told you have an ovarian cyst can understandably cause concern. Mr Jafaru Abu will take the time to assess your symptoms, review your investigations and explain what your cyst means and whether any treatment or further monitoring is necessary.
What Are Ovarian Cysts?
The ovaries are two small organs located on either side of the womb. They form an important part of the reproductive system and are responsible for releasing eggs and producing hormones including oestrogen and progesterone.
An ovarian cyst is a fluid-filled sac that develops on an ovary.
Cysts can vary considerably in their size and appearance. Some are tiny and cause no symptoms, while others can become much larger.
There are two broad categories of ovarian cyst:
Functional Ovarian Cysts
Functional cysts are linked to the menstrual cycle and are the most common type of ovarian cyst in women who have not been through the menopause.
Each month, an egg develops inside a small fluid-filled structure called a follicle. Normally, the follicle releases the egg and then disappears.
Sometimes the follicle continues to grow or does not release its fluid as expected, resulting in a cyst.
Functional cysts are usually benign and often disappear naturally within a few months.
Pathological Ovarian Cysts
Pathological cysts are not directly related to the menstrual cycle. They develop as a result of abnormal cell growth and can occur both before and after the menopause.
Most pathological cysts are still benign, although a small proportion can be cancerous.
Other conditions can also cause ovarian cysts. For example, endometriosis can cause blood-filled cysts known as endometriomas.
Symptoms of Ovarian Cysts
Most ovarian cysts do not cause any symptoms.
Symptoms are more likely to occur if a cyst becomes large, ruptures or causes the ovary to twist.
Possible symptoms include:
- Pelvic or lower abdominal pain
- A dull or heavy sensation in the pelvis
- Sudden or sharp pelvic pain
- Bloating or a swollen abdomen
- Feeling full after eating only a small amount
- Pain during sexual intercourse
- Heavy or painful periods
- Irregular periods
- Lighter or different periods than usual
- A frequent need to urinate
- Difficulty emptying your bladder
- Difficulty opening your bowels
- Pressure or discomfort in the pelvis
- Difficulty becoming pregnant in some circumstances
The symptoms can vary depending on the size and location of the cyst.
Some symptoms may also be caused by other gynaecological conditions, such as endometriosis or fibroids, so further assessment may be needed to establish the cause.
When Should I Seek Urgent Medical Advice?
Most ovarian cysts are not an emergency. However, complications can occasionally occur.
A cyst can rupture, causing sudden pain, or the ovary can twist around its supporting tissues. This is known as ovarian torsion and can affect the blood supply to the ovary.
You should seek urgent medical advice if you experience:
- Sudden, severe pelvic or abdominal pain
- Severe pain accompanied by nausea or vomiting
- Rapidly worsening abdominal pain or swelling
- Feeling faint or dizzy alongside severe pain
These symptoms can have a number of causes, but ovarian torsion or a ruptured cyst are among the possibilities and require prompt assessment.
Causes and Risk Factors
Most ovarian cysts develop naturally as part of the menstrual cycle.
However, other factors and conditions can contribute to the development of ovarian cysts.
These include:
- Normal ovulation
- Hormonal changes
- Endometriosis
- Abnormal cell growth
- Certain fertility treatments
- Previous ovarian cysts
Ovarian cysts are particularly common during the reproductive years because functional cysts are associated with ovulation.
Cysts can also occur after the menopause. However, ovarian cysts are less common after menopause, and a greater level of assessment may be recommended because the likelihood of an ovarian cyst being cancerous increases with age.
Having an ovarian cyst does not mean that you have ovarian cancer. The vast majority of ovarian cysts are benign.
How Are Ovarian Cysts Diagnosed?
If you have symptoms that could be associated with an ovarian cyst, your assessment will begin with a detailed discussion about your symptoms and medical history.
Mr Abu may ask about:
- When your symptoms started
- Where you experience pain
- Whether the pain is related to your menstrual cycle
- Changes to your periods
- Bloating or abdominal swelling
- Bladder or bowel symptoms
- Pain during sex
- Previous ovarian cysts
- Previous gynaecological conditions or surgery
- Whether you have been through the menopause
- Your fertility plans
Pelvic Examination
Depending on your symptoms, a pelvic examination may be recommended.
This can help your specialist identify tenderness, swelling or a pelvic mass, although an examination alone cannot confirm whether you have an ovarian cyst.
Ultrasound Scan
An ultrasound scan is the main investigation used to identify and assess ovarian cysts.
A transvaginal ultrasound may be recommended, using a small ultrasound probe inserted gently into the vagina. An abdominal ultrasound may also be used.
An ultrasound can provide important information about:
- The size of the cyst
- Its location
- Whether it is on one or both ovaries
- Whether it appears simple or complex
- Whether it contains fluid or solid areas
- The appearance of the surrounding pelvic structures
The appearance of a cyst helps your specialist determine whether monitoring, further investigation or treatment is appropriate.
Blood Tests
If the appearance of a cyst raises concerns, particularly after the menopause, blood tests may be recommended.
One test that may be used is CA125. CA125 is sometimes raised in ovarian cancer, but it can also be elevated for many non-cancerous reasons, including endometriosis, fibroids, pelvic infection and menstruation.
A raised CA125 therefore does not automatically mean that you have ovarian cancer. Results need to be considered alongside your symptoms and scan findings.
MRI or Other Imaging
In some circumstances, an MRI scan may be recommended to provide more detailed information about an ovarian cyst or pelvic mass.
This can be particularly useful when the ultrasound does not provide enough information to establish exactly what the cyst is.
What Happens If an Ovarian Cyst Is Found?
Finding an ovarian cyst does not automatically mean that you need treatment.
Your specialist will consider:
- The size of the cyst
- Its appearance on ultrasound
- Whether you have symptoms
- Whether the cyst is changing over time
- Your age
- Whether you have been through the menopause
- Your medical history
- Your fertility plans
For many women, particularly those who have not been through the menopause and have a simple cyst with no significant symptoms, watchful waiting may be recommended.
This means having no immediate treatment and potentially having a repeat ultrasound after a period of time to see whether the cyst has disappeared or changed. Many ovarian cysts resolve naturally.
Treatment Options for Ovarian Cysts
Treatment is not always necessary.
If a cyst is small, appears benign and is not causing symptoms, monitoring may be all that is required.
Treatment may be considered if a cyst:
- Is large
- Persists or continues to grow
- Causes significant symptoms
- Has a complex or unusual appearance
- Is associated with complications
- Raises concerns about possible cancer
Monitoring
Monitoring is often the first approach when an ovarian cyst appears benign and there are no significant symptoms.
A repeat ultrasound may be recommended after a number of weeks or months to establish whether the cyst has disappeared or changed.
This approach can avoid unnecessary surgery while still allowing the cyst to be monitored appropriately.
Laparoscopic Surgery
If surgery is recommended, many ovarian cysts can be removed using laparoscopic or keyhole surgery.
This involves making several small incisions in the abdomen and using a small camera and specialist instruments to remove the cyst.
Where possible, the aim is to remove the cyst while preserving healthy ovarian tissue.
Laparoscopic surgery generally involves smaller incisions and a shorter recovery than open surgery. Many patients are able to return home on the same day or the following day, depending on the procedure and their individual circumstances.
Laparotomy
For particularly large cysts, or where there is a concern that the cyst could be cancerous, an open operation called a laparotomy may be recommended.
This involves a larger incision in the abdomen, allowing the surgeon greater access to the ovaries and surrounding structures.
The exact operation required will depend on the size and appearance of the cyst and the findings during your assessment.
Ovarian Cysts and Fertility
An ovarian cyst does not usually prevent you from becoming pregnant.
However, certain types of cyst, particularly those associated with endometriosis, may sometimes affect fertility.
If surgery is required, your fertility should be discussed before the procedure.
Where appropriate, the surgeon will aim to preserve the healthy ovarian tissue and remove only the cyst.
In some circumstances, it may be necessary to remove one ovary. If this happens, the remaining ovary can usually continue to release eggs and hormones, although fertility may be affected in some circumstances.
Very occasionally, removal of both ovaries may be necessary. This would mean that the ovaries could no longer release eggs and would result in an immediate menopause if you had not already been through the menopause.
Your fertility wishes should therefore always be part of the discussion when considering ovarian surgery.
Ovarian Cysts After the Menopause
Ovarian cysts can occur after the menopause, although they are less common.
Because the risk of ovarian cancer is higher after the menopause, a cyst discovered at this stage of life may require closer assessment and monitoring.
Your specialist may recommend ultrasound scans and blood tests to assess the cyst and determine whether it is likely to be benign.
Some cysts can simply be monitored, while others may require surgery depending on their size, appearance, persistence and other clinical findings.
Being diagnosed with an ovarian cyst after the menopause does not mean that you have cancer. The purpose of further investigation is to establish the nature of the cyst and make sure that the appropriate management is offered.
Recovery and Aftercare
If your ovarian cyst is being monitored, you may simply need follow-up appointments and repeat ultrasound scans.
If you undergo surgery, your recovery will depend on the type and extent of the procedure.
Following laparoscopic surgery, you may experience abdominal discomfort, bloating or tiredness for several days. Recovery is generally quicker than following open surgery, although everyone recovers at a different rate.
Following a laparotomy, recovery can take considerably longer because of the larger abdominal incision.
If the cyst is removed surgically, it may be sent to a laboratory for examination. The results can help confirm the type of cyst and whether any further treatment or follow-up is required.
You will be given advice about caring for yourself after surgery, managing discomfort and gradually returning to your normal activities.
Risks and Benefits of Treatment
The benefits and risks of managing an ovarian cyst depend on its characteristics and the treatment being considered.
For a cyst that appears benign, monitoring can avoid unnecessary surgery and preserve normal ovarian tissue.
If surgery is recommended, removing the cyst may relieve symptoms, prevent complications and provide a definitive diagnosis.
However, surgery carries potential risks, including:
- Bleeding
- Infection
- Blood clots
- Complications associated with anaesthesia
- Damage to surrounding organs
- The possibility of needing to remove part or all of an ovary
There is also a possibility that a cyst may recur, depending on its type and underlying cause.
When fertility is important, the potential effect of surgery on ovarian function should be carefully considered.
Mr Abu will discuss the potential benefits, risks and alternatives with you before recommending treatment, so that you can make an informed decision about your care.
Specialist Care for Ovarian Cysts
Being told that you have an ovarian cyst can understandably be worrying, particularly if you have been told that it needs further investigation.
It is important to remember that most ovarian cysts are benign and many disappear without treatment.
At Gynae Solution, Mr Jafaru Abu will assess your symptoms and investigations and explain what your ovarian cyst means for you. Where monitoring is appropriate, he will explain what follow-up is required. If treatment is recommended, he will discuss the available options and consider factors such as your symptoms, age, overall health and fertility plans.
If you have been diagnosed with an ovarian cyst or are experiencing symptoms such as pelvic pain, bloating or changes to your periods, contact Gynae Solution to arrange a consultation with Mr Jafaru Abu.
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