Ovarian cysts

The symptoms, causes and treatment of ovarian cysts.

By Miss Louise Hayes MBBS (Lond.) FRCOG
Consultant in Gynaecology & Women’s Health
Published May 9th 2023

Ovarian cysts are very common. Most of the time they’re painless with no symptoms they are often a sign of your ovulation. However, sometimes they can indicate an underlying condition that may need attention. Your ovaries are part of your reproductive system and are located in the lower abdomen, one on each side of the uterus. They produce eggs, as well as the hormones oestrogen and progesterone.

Dr Louise Hayes, Consultant Gynaecologist at Chrissie Yu Gynaecology & Women’s Health

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Types of ovarian cysts

The most common type of cyst is one that’s filled with fluid formed during your period; these are:

  • Follicular cysts
    During your period, an egg grows in a follicle sac inside the ovaries.
    In most cases, the follicle breaks open and releases an egg. If the follicle doesn’t break open, the fluid inside the follicle can form a cyst on the ovary.
  • Corpus luteum cysts
    The corpus luteum cyst can appear in an ovary after an egg is released. Its job is to release hormones needed for pregnancy. However, it will dissolve after a few days unless a pregnancy starts.

In some cases, it may not dissolve. Instead, additional fluid develops inside it, resulting in a cyst.

Other types of ovarian cyst

Ovarian cysts that aren’t formed as part of the menstrual cycle include:

  • Dermoid cysts: These sac-like growths on the ovaries can contain hair, fat, and other tissue.
  • Endometriomas: Tissues that normally grow inside the uterus can develop outside the uterus and attach to the ovaries. These are also colloquially called chocolate cysts and may affect people with severe endometriosis.
  • Cystadenomas: These growths can develop on the outer surface of the ovaries.

Polycystic Ovary Syndrome

Some people develop a condition called Polycystic Ovary Syndrome (PCOS), in which their ovaries form many small cysts. PCOS can cause the ovaries to enlarge. If left untreated, PCOS can result in infertility.

Symptoms of ovarian cysts

Usually, ovarian cysts don’t cause any symptoms. If the cyst grows, symptoms can then appear, including:

  • Bloated or swollen abdomen.
  • Painful bowel movements.
  • Pelvic pain before or during the menstrual cycle.
  • Painful sexual intercourse.
  • Pain in the lower back or thighs.
  • Tender breasts.
  • Nausea and vomiting.

Symptoms of a burst ovarian cyst

A burst ovarian cyst is rare, but can have serious consequences if left untreated. Severe symptoms can include:

  • Severe or sharp pelvic pain.
  • Fever.
  • Faintness or dizziness.
  • Rapid breathing.

Diagnosing an ovarian cyst

An ovarian cyst can be detected during a routine pelvic examination. Your gynaecologist may notice swelling on one of your ovaries and perform an ultrasound to confirm if it is a cyst.

Most ovarian cysts disappear naturally after a few weeks or months so your gynaecologist may not recommend immediate treatment. The ultrasound test can be repeated in a few weeks.

If there’s no improvement or the cyst grows, you may need further tests such as a pregnancy test or hormone test.

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Treatment for ovarian cysts

Most ovarian cysts are benign and naturally disappear without treatment.
If treatment is required, the type will depend on the type of the cyst. Larger cysts, endometromas, or cancerous cysts may need to be surgically removed.

Surgery can include:

  • Laparoscopy: In a laparoscopy involves making tiny incisions near your navel and inserts a small instrument into your abdomen to remove the cyst.
  • Laparotomy: In this procedure the cyst is removed through a large incision in your abdomen. A biopsy can also be performed if there is a concern about cancer.

Complications of ovarian cysts

In rare cases, a cancerous cystic ovarian mass may be detected during a routine examination.

Another rare complication of ovarian cysts is an ovarian torsion. Ovarian torsions occurs when a larger cyst causes an ovary to twist, cutting off the blood supply. If left untreated, ovarian torsion can cause serious damage to the ovarian tissue.

In rare cases, ruptured cysts can cause intense pain and internal bleeding. This complication carries a high risk of infection and can be life threatening if left untreated.

Prevention of ovarian cysts

If you suffer from recurring ovarian cysts, your gynaecologist can prescribe oral contraceptives to halt ovulation and prevent the development of new cysts.

Taking oral contraceptives can also help reduce your risk of ovarian cancer which is higher in postmenopausal females.

Routine gyneacological examinations can also help detect ovarian cysts early.
Symptoms that may indicate an ovarian cyst, can include:

  • Changes to your menstrual cycle.
  • Ongoing pelvic pain.
  • Loss of appetite.
  • Unexplained weight loss.
  • Abdominal fullness.

Benign ovarian cysts rarely become cancerous. However, symptoms of ovarian cancer can mimic symptoms of an ovarian cyst. Thus, it’s important to visit a doctor and receive a correct diagnosis.

Long-term prognosis for women with ovarian cysts

The longer-term outlook for premenopausal women with ovarian cysts is good as most cysts disappear naturally within a few months.

However, premenopausal women and women with hormone imbalances such as PCOS can experience recurring ovarian cysts.

If left untreated, some types of cysts can decrease fertility.

  • Ovulatory cysts indicate regular menstrual cycles.
  • Edometriomas indicate endometriosis, which can harm fertility.
  • Dermoid cysts can cause pain and make sexual intercourse more painful.
  • To improve fertility, a doctor can remove or shrink the cyst.
  • Laproscopic removal of some types of cysts can also affect fertility.

Depending on cyst size and type, a “wait and see” approach may be appropriate with ovarian cysts.

Because the chance of developing a cancerous cyst or ovarian cancer increases after menopause your gynaecologist may recommend surgery to remove and examine any cyst or growth that develops on your ovaries after menopause.

However, ovarian cysts don’t increase the chance of getting ovarian cancer.

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