What are Ovarian Cysts?
A cyst is a fluid-filled sac, and can be located anywhere in the body.
On the ovary, different types of cysts can form. These are some of the most common ones:
Functional Cysts:
The most common type of ovarian cyst is actually just a follicle, which forms during the normal menstrual cycle. Each month, tiny follicles that hold the eggs in the ovaries grow. When an egg is mature, the follicle releases the egg, so it can travel through the fallopian tube for fertilization. In some instances the follicular cyst doesn't break open to release the egg and may continue to grow. This type of cyst usually disappears within one to three months.
A corpus luteum cyst can form after normal ovulation in the area where the egg was released. This type of cyst also usually goes away on its own after a few weeks. However, rarely it can grow to almost four inches and may bleed or twist the ovary and cause pain.
Other cysts:
- Endometriomas. These cysts develop in women who have endometriosis, when tissue from the lining of the uterus grows outside of the uterus. The tissue may attach to the ovary and form a growth. These cysts can be painful during sexual intercourse and during menstruation or they may cause no symptoms.
- Cystadenomas. These cysts develop from cells on the outer surface of the ovary. They are often filled with a watery fluid or thick, sticky gel. They can become large and may or may not cause pain.
- Dermoid cysts. The cells in the ovary are able to make hair, teeth, and other growing tissues that become part of a forming ovarian cyst. These cysts can become large and may or may not cause pain.
- Polycystic ovaries. In this condition, the eggs start to mature within the follicles, or sacs, but the sacs don't break open to release the eggs. The cycle repeats, and multiple very small cysts form on the ovary. For more information about polycystic ovaries, refer to our section on PCOS.
How are ovarian cysts found?
Since ovarian cysts may not cause symptoms, they are often found during a routine pelvic exam. During this exam, your doctor may be able to feel the swelling of the cyst on your ovary. Once a cyst is found, the doctor may perform an ultrasound. With an ultrasound, the doctor can see how the cyst is shaped; its size and location; and whether it’s fluid-filled, solid, or mixed. A pregnancy test is also necessary. Hormone levels (such as LH, FSH, estradiol, and testosterone) may also be checked especially if you are trying to get pregnant. Your doctor may want to do other tests as well.
To find out if the cyst might be cancerous, your doctor may do a blood test to measure a substance in the blood called CA-125. The amount of this protein in a woman’s blood is higher if a woman has ovarian cancer. However, some ovarian cancers do not make enough CA-125 to be detected by this test and there are also non-cancerous diseases that increase the levels of CA-125, like uterine fibroids and endometriosis. These non-cancerous causes of increased CA-125 are more common in women under 35, while ovarian cancer is very uncommon in this age group. For this reason, the CA-125 test is recommended mostly for women over age 35 (usually only those who are postmenopausal) who are at high risk for the disease, and have a cyst that is at least partially solid.
How are cysts treated?
- Watchful waiting.The patient waits and gets re-examined in one to three months to see if the cyst has changed in size. This is a common treatment option for women who are in their childbearing years, have no symptoms, and have a fluid-filled cyst. It also might be an option for postmenopausal women.
- Surgery. If the cyst doesn’t go away after several menstrual periods, has gotten larger, looks unusual on the ultrasound, causes pain, or if the patient is postmenopausal, the doctor may want to remove it. There are two main surgical procedures:
- Laparoscopy—if the cyst is small and looks benign on the ultrasound, the doctor may perform a laparoscopy. This procedure is done under general anesthesia. A very small incision is made above or below the navel, and a small instrument that acts like a telescope is inserted into the abdomen. If the cyst is small and looks benign, it can be removed. Usually the patient goes home the same day as the procedure.
- Laparotomy—if the cyst is large and looks suspicious, the doctor may perform a procedure called a laparotomy. This procedure involves making bigger incisions one the abdomen to remove the cyst. While you are under general anesthesia, the doctor is able to have the cyst tested to find out if the tissue is cancerous. If it is cancerous, the doctor may need to remove the ovary and other tissues that may be affected, like the uterus or lymph nodes.
- Birth control pills. If a patient frequently develop cysts, the doctor may prescribe birth control pills to prevent ovulation. This will lower the chances of forming new cysts. Some of the other contraceptive methods can also be used.