Ovarian Cysts

The ovaries are part of the female reproductive system. They are two almond-shaped organs that are on each side of the uterus. 

The ovaries have two primary functions: 

• As part of the menstrual cycle, to release an egg every 28 days, approximately.
• To release oestrogen and progesterone, which are essential for reproduction.

Fluid-filled sacs that develop on or in the ovary are known as ovarian cysts. An ovarian cyst may affect only one ovary or both simultaneously. They are prevalent in women of all ages and are usually asymptomatic (no symptoms).

The majority of ovarian cysts occur naturally and resolve within a few months without therapy. Cysts can range from less than one centimetre (half an inch) to over 10 cm (4 inches).

Types of ovarian cysts

Functional cysts

This is the most common type of ovarian cyst and is linked to the menstrual cycle. They usually do not cause any symptoms and do not require treatment.

Functional cysts are non-cancerous (benign) and often harmless. They may, however, occasionally cause symptoms such as pelvic pain.

Pathological cysts

Pathological cysts are unrelated to the menstrual cycle and are caused by abnormal cell growth. They can develop prior to and after menopause.

Pathological cysts originate from either the cells responsible for the production of the ovum or the cells that line the outer surface of the ovary. They may occasionally burst or grow extensively, obstructing the blood supply to the ovaries.

Most pathological cysts are benign (non-cancerous), but a small percentage are malignant (cancerous) and may need to be removed surgically.

Ovarian cysts symptoms

Most ovarian cysts are asymptomatic except if it ruptures, are large and block the blood supply to ovaries.

Some symptoms include:

• Pelvic pain – dull, heavy, sudden, or sharp pain
• Difficulty emptying bowels 
• Pain during sexual intercourse
• Delayed, irregular or unusually painful periods
• Bloating and swelling of the abdomen
• Frequent urination
• Feeling full after eating minimal food 
• Difficulty getting pregnant 

Causes of ovarian cysts

The most common causes of ovarian cysts are determined by whether an individual is premenopausal (still menstruating) or postmenopausal (stopped menstruating for at least a year).

For premenopausal women

1. Polycystic ovarian disease (PCOS): Many small and harmless cysts develop on your ovaries. The cysts are small follicles that do not mature to ovulation and are due to altered hormone levels.
2. Endometriosis: The lining of the uterus (endometrium) is present outside the uterus in the ovaries, fallopian tubes, vagina, intestine, bladder, or rectum. At times, blood-filled cysts may form in this tissue.
3. Pregnancy: During early pregnancy, an ovarian cyst typically develops to support the pregnancy until the placenta forms. In certain instances, the cyst remains on the ovary until the latter stages of pregnancy.
4. Severe pelvic infections: Pus-filled cysts form near the ovaries or/and fallopian tubes. 
5. Non-cancerous growth 
6. Cancer

For postmenopausal women

1. Non-cancerous growth 
2. Fluid collection in the ovary

New growth is more likely to be caused by cancer compared to premenopausal women.

Ovarian cysts risk factors

The following risk factors put you at a higher risk of developing ovarian cysts: 

• Infertility treatment – ovulation induction by gonadotropins or other agents
• Pregnancy – may form in the second trimester when the hCG levels peak
• Hypothyroidism 
• Smoking 
• Tubal ligation 
• Maternal gonadotropins

Ovarian cysts complications

The outcomes of ovarian cysts can vary widely. The cyst is usually non-cancerous and asymptomatic; therefore, no treatment is required, and it will resolve independently.

However, in some cases, complications can occur. Complications include:

• Torsion: Large-sized cysts can cause the ovaries to move and twist, which can be very painful
• Rupture: Occasionally, the cyst can rupture and cause heavy bleeding

Ovarian cysts diagnosis

Diagnosis is made based on various investigations. Your doctor would first question your general health, symptoms and conduct a thorough physical examination. 

• Imaging tests such as ultrasound, computed tomography (CT) scan or magnetic resonance imaging (MRI) are performed to provide information on the cyst size, location, and other characteristics.
• Blood test such as cancer antigen 125 (CA 125) is often recommended for postmenopausal women with an ovarian cyst, premenopausal women with a larger ovarian cyst or suspicious of cancer.

Treatment for ovarian cysts

Most ovarian cysts do not require treatment. Ovarian cysts in premenopausal women typically resolve within one to two months without treatment, whereas it is less likely to resolve in postmenopausal women.

If a cyst is large, painful or appears suspicious of cancer, the cyst or the entire ovary is typically surgically removed.

1. Watchful waiting

   For premenopausal women:
   • Monitoring symptoms such as pelvic pain or pressure
   • Repeat pelvic ultrasound 6-8 weeks
   • If cyst size remains the same or decreases in size, ultrasound is repeated at regular intervals
   • No further testing or follow-up is required if the cyst resolves
   For postmenopausal women:
   • Based on the results of the initial diagnostic tests (ultrasound and CA 125)
   • Watchful waiting may be an option if the cyst does not appear to be cancerous
   • Ultrasound and CA 125 are to be repeated every 3-6 months for a year or until the cyst resolves
   • However, ovarian cysts may not always resolve in women who have reached menopause
   • Surgical removal of the cyst may be advised if the CA 125 levels increase or if the cyst grows or changes in appearance

2. Surgery

   Surgery is recommended if:
   • A cyst causes prolonged pain or pressure, or it could rupture or twist
   • Cyst is caused by endometriosis
   • Large cysts (>5cm to 10 cm) compared to smaller cysts. However, the size of a cyst does not determine the nature of the cyst (cancerous or non-cancerous)
   • If the cyst is suspected of cancer, the whole ovary has to be removed

   If the likelihood of ovarian cancer is low, but the cyst does not resolve after multiple ultrasounds, you may decide to have it removed after consulting with your doctor. Nevertheless, surgical removal is usually not recommended in this instance.

   Types of surgeries include laparoscopy (keyhole, minimally invasive surgery) and laparotomy (open incision). Laparotomy is performed if the cyst is particularly large or if it could be cancerous

FAQ on ovarian cysts

1. Does spicy food cause ovarian cysts?

   No. There is no direct scientific correlation between ovarian cysts and the consumption of spicy food.

2. What type of diet is recommended for women with ovarian cysts?

   It is recommended to consume a high-fibre, low-fat diet. Additionally, foods that have anti-inflammatory properties may help.

3. What are the chances of getting pregnant with ovarian cysts?

   It depends on the cause of the ovarian cyst. Most individuals with cysts can become pregnant.

Read more: Fibroids vs Cysts

Book an appointment at Gleneagles Hospitals

Are you concerned about the risk factors of ovarian cysts? Get in touch with us to book an appointment with an O&G specialist at Gleneagles Hospitals today. We assure you the best possible care tailored to your specific needs.