Ovarian cysts are common, affecting an estimated 1 из 5 women [1]. While the majority are harmless and often go away on their own, some ovarian cysts can rupture, causing intense pain and possibly needing surgical attention. Below, I cover the main types of ovarian cysts, how to know you might have one, and treatment.
Что такое кисты яичников?
Ovarian cysts are sacs, typically filled with fluid, located either inside or on an ovary [2]. They can vary in size, from very small (around ¼ of an inch or less) to quite large (greater than 4 inches). For reference, an adult ovary is typically 3-5 centimeters (1-2 inches) in length, so ovarian cysts can sometimes grow to be even larger than the ovary to which they’re attached.
There are two types of ovarian cysts, functional cysts and complex cysts. Functional cysts are more common.
Функциональные кисты яичников
Functional ovarian cysts form from the follicles in the ovaries, and there are three ways they can form. Follicular cysts develop from a follicle that hasn’t yet broken open to release an egg during ovulation. If the follicle has already released an egg and has now broken down to become the лютеиновое тело, it could form another type of functional cyst called a corpus luteum cyst.
Наконец-то, theca lutein cysts mainly occur after hormonal treatment for infertility [2]. The added synthetic hormones which stimulate the growth of egg cells can also cause cysts as a side effect. They can also sometimes occur during pregnancy due to the extra hormones that are produced by the body naturally during that time. Overall, functional cysts often do not need treatment and will go away on their own.
Complex ovarian cysts
Complex ovarian cysts are rarer than functional ovarian cysts. There are three types: endometriomas, dermoids, and cystadenomas.
Endometrioma cysts occur when cells similar to the uterine lining (the эндометрий) begin to grow in or around the ovaries [3]. They’re also referred to as “chocolate cysts” because they’re filled with old blood that has turned brown. Endometrial cysts are a sign of эндометриоз.
Dermoid cysts are growths that contain skin or oil glands instead of just fluid, and they can occur anywhere on the body, including in the ovaries [4].
Cystadenoma cysts are benign (non-cancerous) tumors that also contain cell tissue, and are made up of ovarian tissue as well as fluid [5].
Many times, cysts are “silent”
Because ovarian cysts are typically benign (non-cancerous) and often do not cause any problems, most women who have ovarian cysts won’t need any treatment. Many women who have cysts on their ovaries might not even know they have them, as they may not experience any symptoms. However, there are some telltale signs that you may have an ovarian cyst.
Signs you might have an ovarian cyst
The two most common symptoms of ovarian cysts are pelvic pain and changes in your menstrual cycle. A dull, aching pain in your lower abdomen (typically on either one side or the other, depending on which ovary is being affected) is common for symptomatic women. This differs from period cramps or other cycle-related pain in that it occurs without relation to a specific cycle phase. It may occur randomly or constantly. Additionally, some women will experience intermittent sharp pain due to a cyst.
The two most common symptoms of ovarian cysts are pelvic pain and changes in your menstrual cycle.
Ovarian cysts can also cause heavy or irregular periods or spotting between periods. If your cyst has grown to be large, it can also push out into the bowel or the bladder and cause even more discomfort and a feeling of pressure or fullness. Larger cysts may also cause bloating, especially if they’re pushing against other organs.
One of the more alarming (and less common) ovarian cyst signs is a sudden sharp, severe pain. This may mean your cyst has ruptured, which can happen if the cyst has grown to be very large or if you’ve experienced strenuous activity such as exercise or sex or recent abdominal trauma. Ruptured ovarian cysts can also cause vaginal bleeding, intense pelvic pressure, pain during sex, and fluid buildup in the abdomen. Pain with a burst cyst can range from very mild to quite severe. However, the majority of ovarian cysts do не rupture.
Signs to get help right away
While the majority of ovarian cysts, particularly functional cysts, will not need any treatment and will go away on their own, a burst or ruptured cyst does require medical attention to rule out serious complications. Additionally, ovarian torsion is a rare but severe complication of ovarian cysts that requires urgent medical intervention (more on this below). If you experience a sharp and sudden pain near one of your ovaries, especially combined with other symptoms like fever and vomiting, seek medical help immediately. It could be a ruptured cyst or ovarian torsion.
While the majority of ovarian cysts, particularly functional cysts, will not need any treatment and will go away on their own, a burst or ruptured cyst does require medical attention to rule out serious complications.
What causes ovarian cysts?
The most common cause of ovarian cysts is hormonal changes related to puberty or menopause. Cysts most often occur as the egg matures in the follicle or after the mature egg is released during ovulation. These are the follicular and corpus luteum cysts mentioned above.
Синдром поликистозных яичников (PCOS) is another common cause of ovarian cysts. PCOS can lead to the production of multiple small functional ovarian cysts.
Endometriosis and hormonal changes during pregnancy can also cause ovarian cysts, as can hormonal imbalances due to other causes. If you develop an ovarian cyst during pregnancy, it will often happen during the first trimester and typically will be harmless to both you and your baby. However, just like any other kind of ovarian cyst, they also have a chance of rupturing.
Ovarian cyst diagnosis
The main method doctors use in managing ovarian cysts is a series of transvaginal ultrasounds, over time. This allows your doctor to monitor whether or not your cyst is decreasing or increasing in size over time, allowing your doctor to determine whether or not treatment is necessary. While a functional cyst should resolve over time and won’t require intervention, a cyst that does not decrease or even increases in size requires further workup.
The main method doctors use in managing ovarian cysts is a series of transvaginal ultrasounds, over time. This allows your doctor to monitor whether or not your cyst is decreasing or increasing in size over time, allowing your doctor to determine whether or not treatment is necessary.
A doctor will be able to diagnose whether or not you have a ruptured cyst by inquiring about your medical history and performing a pelvic exam and ultrasound. Laparoscopy may also be used, in which a small instrument with a camera is inserted into your abdomen through a small incision.
Ovarian cyst treatment
Laparoscopic cyst removal
There are some cases in which a cyst would need to be removed, such as in cases of ovarian torsion or if the cyst has become persistently large or if it is suspected to be cancerous. Removing an ovarian cyst can usually be done using minimally invasive laparoscopy, in which patients are typically able to go home on the same day.
There are some cases in which a cyst would need to be removed, such as in cases of ovarian torsion or if the cyst has become persistently large or if it is suspected to be cancerous.
Cystectomy vs oophorectomy
Some cysts are able to be removed without also removing the ovary (this is called a cystectomy), but sometimes the ovary has to be removed along with the cyst (an oophorectomy). Oophorectomy is more common in cases in which the cyst is abnormally large, suspected to be cancerous, or in cases of ovarian torsion that aren’t able to be otherwise repaired.
Ruptured cysts
Ruptured functional ovarian cysts are often able to be обработанный by pain medication alone and do not need to be removed, and your doctor may have you follow up with multiple ultrasounds to make sure you are healing properly. Ruptured complex cysts may need further treatment, such as IV fluids if you’ve experienced fluid loss, monitoring your red blood cell count via blood draws, surgical removal of the burst cyst, and repeated ultrasound monitoring.
Functional cysts that have burst will probably cause pain for a few days, but any worsening in pain or other symptoms like fever or dizziness are an indicator to contact your doctor. Complex ruptured cysts may require a hospital visit, especially if you needed surgical removal of the cyst. Some ruptured cysts—whether functional or complex—may cause a lot of bleeding, which also necessitates medical attention.
Could it be cancer?
It’s also important to note that some ruptured ovarian cysts are caused by cancer. Your doctor may perform other types of imaging and blood tests to rule this out. Thankfully, cancerous ovarian cysts are very rare—less than 1 percent of ovarian cysts are related to ovarian cancer in women who have not yet been through menopause. Postmenopausal women are at a повышенный риск for cancerous cysts, but the chances are still extremely low if their cysts are functional. Complex cysts are more likely to be malignant than functional cysts, especially for postmenopausal women.
Surgery for ovarian torsion
Alternatively, severe pain could indicate ovarian torsion, a twisting of the ovarian blood vessels that restricts blood flow to the ovary [6]. This is more common with larger ovarian cysts and can also happen with blunt force trauma (like might occur in a car accident) or strenuous physical activity, particularly activity that involves jerking or twisting motions.
Ovarian torsion may start as a one-sided, mild, sharp, or cramping pain, but quickly progresses to pain so incapacitating that a woman cannot physically stand up, may vomit, and may even lose consciousness. Without help, the ovary will die due to lost blood supply, which may lead to sepsis and death. An ovarian torsion is therefore a true medical emergency, requiring surgery as soon as possible to prevent the ovary from dying and any further downstream complications.
Ovarian torsion may start as a one-sided, mild, sharp, or cramping pain, but quickly progresses to pain so incapacitating that a woman cannot physically stand up, may vomit, and may even lose consciousness.
Whereas most ovarian cyst surgeries are laparoscopic outpatient procedures, ovarian torsion may require a laparotomy. Laparotomies are open abdominal surgeries typically only used when patients are unstable and need surgery right away to remove the cyst. Laparotomies are faster to complete than laparoscopies (which makes them the better option in cases of emergencies), but involve larger incisions and longer recovery times with a hospital stay.
Do cysts come back?
Unfortunately, having one or more ovarian cysts removed doesn’t preclude needing more removed in the future. Recurrence rates for ovarian cysts are 40% after treatment, with a higher chance of the cyst coming back for larger cysts. Functional ovarian cysts and endometriomas are скорее всего to recur than other types of cysts.
Some claim that women who have experienced ovarian cysts should take hormonal birth control to prevent future cysts from forming, as the pill prevents ovulation and thus the hormonal changes which can sometimes cause cysts to grow. However, this idea is not evidence-based. Множество исследования have shown no benefit from using hormonal birth control to prevent ovarian cysts [7].
Some claim that women who have experienced ovarian cysts should take hormonal birth control to prevent future cysts from forming, as the pill prevents ovulation and thus the hormonal changes which can sometimes cause cysts to grow. However, this idea is not evidence-based. Multiple studies have shown no benefit from using hormonal birth control to prevent ovarian cysts.
Do ovarian cysts cause infertility?
The answer to this question is it depends. While there are correlations between women who have ovarian cysts and women who struggle with fertility, it is largely неизвестно what the exact connection is between ovarian cysts broadly and infertility [8]. That being said, ovarian cysts that are caused by endometriosis (which are called endometriomas) and cysts resulting from PCOS are both linked to infertility. PCOS is one of the наиболее распространённый causes of female infertility, but a nutritious диета и moderate exercise, plus other изменение образа жизни (and, if necessary, хирургия) can help.
On the flip side, functional cysts and other kinds of complex cysts не generally affect fertility. Functional cysts especially are a sign that you это ovulating, which means that conception is (in theory) possible.
Women who have undergone surgery to remove an ovarian cyst of any type do report a higher rate of infertility than those who have not undergone cyst removal, but the exact cause of infertility in these women is unknown [9]. Researchers posit that removal of cysts may cause removal of some healthy ovarian tissue in the process, especially for women who had an ovary removed along with the cyst. Of all the types of ovarian cysts, removal of endometriomas is most associated with decreased fertility.
Итоги
It’s important to keep in mind that the vast majority of ovarian cysts do not need to be removed, and increasingly more and more doctors are calling for “watchful waiting” of cysts rather than jumping straight to surgical removal. Especially since the most common ovarian cysts will disappear in just a matter of months, in the absence of concerning symptoms, it’s often best to let them go away on their own.
