Ovarian cysts (ovarian cysts) are fluid-filled sacs in or on an ovary.
A female has two ovaries, similar in shape and size to an almond, located to the left and right of the uterus.
The eggs develop in the ovaries and mature there. In sexually mature women, they are released in 28-day cycles.
Many women have ovarian cysts during their lifetime, even if they have not yet had sexual intercourse. Most ovarian cysts cause little or no discomfort and are benign. Ovarian cysts often heal on their own within a few months without treatment. However, ovarian cysts can also cause serious symptoms, especially if they burst.
The best way to protect health is to know the symptoms caused by serious complications and to have regular gynaecological check-ups.
Causes of ovarian cyst
Ovarian cysts occur mainly between puberty and menopause, after menopause they are less common, but are then more dangerous.
Taking fertility-promoting drugs can cause a disease that leads to the formation of large ovarian cysts called ovarian hyperstimulation syndrome. Cysts usually disappear after menstruation or after pregnancy.
Functional ovarian cysts are different from ovarian tumors (which include ovarian cancer) or cysts caused by hormonal diseases, such as polycystic ovary syndrome. Women often develop cysts after their uterus has been removed (hysterectomy).
Functional cysts usually form during the menstrual cycle.
Classification of cysts according to health risk
Corpus luteum cysts and follicular cysts belong to the functional cysts, which means that they are related to the menstrual cycle and thus occur in fertile age.
They are usually benign tumors that disappear on their own over time.
This type of cyst arises from a cell change and can be malignant.
1) Follicular cysts
Around the middle of the menstrual cycle, an egg exits the follicle and begins its way through the fallopian tube, where fertilization can occur through a sperm cell. A follicular cyst is formed when something goes wrong, the follicle does not burst or release the egg, but grows and turns into a cyst. It can regress on its own within a few weeks or become larger and cause pain in the ovaries.
What are the symptoms of follicular cysts?
In most cases, there are no symptoms.
Rarely, symptoms can be noted, such as:
– severe pain in the right or left flank;
– irregularities in the menstrual cycle (this is the main symptom, if it occurs, the necessary examinations should be carried out).
2) Corpus luteum cysts
When a follicle bursts and releases the egg, the burst follicle begins to produce large amounts of estrogen and progesterone to prepare fertilization. The follicle remains are now referred to as corpus luteum.
Sometimes the opening from which the egg has leaked closes and fluid accumulates in the corpus luteum, as a result of which it enlarges cystically. The cyst is positioned in the intestinal leg rub.
How are corpus luteum cysts characterized?
• Isolated, single occurrence.
• Diameter up to 8-10 cm. • Increased density and blood circulation.
– irregular menstrual cycles;
– pain and feeling of pressure in the side;
– Pain when palpating.
– In more severe cases, the cyst may burst or ovarian peduncle rotation (ovarian torsion) may occur.
Pathological cysts (non-functional)
Endometriosis cysts Endometriosis cysts
, also known as chocolate cysts, form in women who suffer from endometriosis. They can provoke pain during sexual intercourse and during menstruation.
These cysts form from the cells of the outer surface of the ovary.
They usually contain an aqueous liquid or a viscous, sticky gel. They can grow very large and cause pain.
They can be divided into serous cystadenomas (fixed appearance) and mucinous cystadenomas (consisting of mucinous material).
Dermoid cysts Dermoid cysts
consist of many cell types and can contain hair, teeth and other tissues that become part of the cyst. They can grow big and cause pain.Single-chamber cyst A cyst consisting of only one chamber has no internal septum.
If it consists of several chambers, the inside of the cyst is divided by at least one septum.
These cysts develop when the eggs mature in the follicle but are not released. The cycle repeats itself. The follicles continue to grow and form further cysts.
What symptoms and possible complications can occur with ovarian cysts?
Most ovarian cysts are small, benign (not cancerous) and do not cause discomfort. Some cysts can cause the following problems:
- Constant or intermittent pain or discomfort in the lower abdomen.
- Pain in the ovaries during sexual intercourse.
- Irregular monthly cycles, bleeding may be stronger or weaker than usual
- Menstrual pain.
- Weight gain.
- Acne or pimples on the face (especially on the chin) and the rest of the body.
- Nausea and vomiting.
- Irregular or absent menstrual bleeding (amenorrhea).
- Frequent urge to urinate due to increased pressure on the bladder (from a certain cyst size).
- Hirsutism (excessive hair growth).
A cyst may bleed or burst internally. This can lead to sudden severe pain in the lower abdomen.
In rare cases, a peduncle rotation may occur with a cyst that is movably connected to the ovary via a vascular stalk. In this way, the blood flow flowing through the ovary is stopped, thus interrupting the blood supply to the cyst. This can cause sudden pain in the lower abdomen, nausea and fever.
Large cysts can cause swelling of the abdomen or put pressure on the nearby structures. For example, they can crowd the bladder or intestines and cause problems with urination or constipation.
Even though most cysts are benign, there are some types of cysts with a high risk of degenerating into a cancerous tumor. In rare cases, ovarian cysts affect the natural amount of female (or male) hormones, which can cause unusual symptoms.
Preventive examination and diagnosis
The gynecologist may be able to feel the cyst during the gynaecological examination and have additional checks carried out to confirm the diagnosis and obtain more detailed information about the cyst.
When diagnosing, the following criteria must be taken into account:
- regular or irregular form,
- composition and consistency; does the cyst contain only fluid, solids, or both? Solid or mixed cysts can be malignant and therefore need to be carefully analyzed.
Ultrasound examination. This examination method is often used because it provides fast results. The doctor runs the transducer over the abdominal wall or inserts it into the vagina. Transvaginal ultrasound can be used to determine the position and composition of the cyst.
On the pictures you can see a black area.
Ovarian cysts can grow several centimeters in size.
Ultrasound examination must be performed before ovulation, because every month a follicle about 2 cm in size matures, which can easily be mistaken for a cyst.
Pregnancy test. If the pregnancy test is positive, there may be a corpus luteum cyst.
Laparoscopy. With the help of this minimally invasive surgical procedure, the cyst can be examined and removed.
Tumor markers. As a rule, in women with ovarian tumors, the tumor marker “Cancer Antigen 125” is increased in the blood. It stands for the protein Mucin16 and is also called “MUC16”.
What are the risks of ovarian cysts during pregnancy?
Sometimes ovarian cysts are discovered during pregnancy. Most often this happens during routine ultrasound examination. Most ovarian cysts discovered during pregnancy are benign tumors that do not require surgical treatment.
However, an indication for surgery exists when a malignant cyst is suspected, an acute complication occurs, such as the rupture of the cyst or a stalk twist (throttling of the blood supply), or when the size of the cyst could affect the pregnancy.
How can ovarian cysts be treated?
First of all, several factors must be taken into account before determining the appropriate form of treatment for ovarian cysts:
- age of the patient,
- menopause has occurred or not,
- appearance of the cyst,
- Size of the cyst.
What to do if symptoms appear?
Observation – Sometimes the cyst is kept under control, especially if the woman is close to menopause and a small functional cyst (2 to 5 cm) is present.
About a month later, an ultrasound scan is performed to check whether the cyst has disappeared. In menopausal women, a control is done using ultrasound and blood analysis to measure CA125 levels (a protein often found on the surface of cancer cells).
The procedure depends very much on the size of the cyst and whether it has changed over time.
If a woman has small cysts and only one ovary is affected, the risk of cancer is very small. In most cases, such cysts disappear again over the course of three months. Menopausal women should undergo a check-up four months after the cyst disappears.
Birth control pill. To avoid cysts forming again in the future, the doctor may recommend taking the contraceptive pill. This oral contraceptive reduces the risk of developing ovarian cancer.
When does surgery have to be performed?
When symptoms appear, the cyst already has a certain size; If it does not have the appearance of a functional cyst, continues to grow or persists for more than two to three monthly cycles, the doctor may recommend surgical removal of the cyst.
In some cases, when detecting a cyst that does not cause symptoms, surgical intervention may be advisable because without a microscopic examination it is impossible to determine what type of cyst it is. The cyst is removed to avoid becoming malignant.
Laparoscopy (surgical procedure with three small incisions)
Two small incisions are made in the abdomen and in one in the navel. Gas is introduced into the pelvic region to raise the abdominal wall and remove it from the internal organs.
A small tube equipped with a camera (laparoscope) is inserted into the abdomen. The surgeon can thus look at the organs and remove the cyst through the skin incisions with the help of very small instruments.
In some cases, a tissue sample of the cyst is taken to determine the cell type (biopsy). In most cases, the patient can be discharged home on the same day. The woman’s fertility is usually not affected by this procedure and recovery times are short.
Laparotomy (abdominal incision)
This procedure is much more invasive and can be recommended for a cancerous, i.e. much more dangerous cyst.
Above the pubic hair base, a longer incision is made so that the surgeon can better access the cyst.
The cyst is removed and sent to the laboratory.
The patient remains in hospital for at least two days.
If the cyst is malignant, the patient may need surgery to remove organs and tissues, such as ovaries, uterus, omentum and lymph nodes.
In premenopausal women, the cysts are more likely to heal. Menopausal women have a greater risk of cancer.
The complications depend on the underlying disease causing the cysts. Possible complications include:
- Stem rotation
- Endocystic haemorrhage
- Bursting of the cyst
- Cancerous degeneration
Even if the growth of ovarian cysts cannot be prevented, regular gynecological examinations can help to diagnose abnormalities in the ovaries as early as possible.
In addition, attention must be paid to changes in the monthly cycle, whether unusual symptoms occur or persist over several cycles.