Ovarian cysts are growths that arise from the ovaries. The ovaries are one of the female reproductive organs. They are two in number lying one on either side of the uterus in the pelvis. The function of the ovary is the production of the egg or ovum (once a month), and production of the female hormones i.e. estrogen and progesterone. A cyst is a fluid-filled structure.

Why do they form

Sometimes the process of ovulation i.e. release of a ripe egg from the follicle does not occur. Instead the follicle accumulates fluid and forms a cyst. Such a cyst is termed functional cyst. It occurs as a normal phenomenon in most women sometime or the other during their reproductive period. The incidence of a functional cyst formation is increased in women who are administered medications for assisted reproduction. Functional cysts are therefore a normal finding.

Scan picture showing Functional Cyst

Cysts that are abnormal include the following:

Endometriotic cyst or Endometrioma: A cyst formed when tissue similar to that lining the uterus is lying in the pelvic cavity i.e. outside the uterus. This tissue makes its way into the pelvis during menstruation via the fallopian tubes. This tissue is also under the same hormonal control as the regular uterine lining and therefore menstruates or bleeds. As there is no outlet for this bleeding to come out, it builds up each month and finally gives rise to the endometriotic cyst. A commonly used term is “chocolate cyst” as the material contained inside looks chocolate-like.

 

• Functional cysts usually don’t cause symptoms or require treatment. Normally they stop growing, shrink, and disappear within one, or at the most three menstrual cycles.
• Endometriotic cysts may cause a dull ache in the abdomen, painful periods, the pain starting prior to menstruation, and heavy bleeding during menses. Many a times these cysts do not cause any symptoms and are discovered during a routine examination.
• Polycystic ovaries do not cause symptoms. However they are often a cause for obesity, excessive hair growth, irregular periods and infertility or the failure to conceive. They are brought to light by diagnostic examinations such as an ultrasound or hormonal assays in the blood.
• Most cancerous cysts do not cause symptoms except for a dull ache or a sense of pressure or fullness in the abdomen.  Pain may result when the cysts twist on their stalk, or bleed inside or the cyst undergoes malignant changes.

Diagnosis

• Ovarian cysts are often first found during a pelvic exam performed routinely, as a regular part of a woman’s health check-up, or for some other unrelated reason. Through a pelvic examination, a cyst can be found before it becomes so large that it ruptures or undergoes torsion.
• The finding is confirmed by an ultrasonography.
• In some cases a laparoscopy (see other pamphlet) may be necessary to confirm the diagnosis.

TreatmentTreatment of ovarian cysts will depend on several factors, including the size and type of the cyst, the woman’s age and overall state of health, her plans to have children, and whether she is having any symptoms. If a cyst is found early, less extensive treatment may be needed.

• Functional cysts usually disappear over a period of observation. Their disappearance may be hastened by giving medications orally.
• Medical treatment is indicated for early stages of endometrioses; and polycystic ovaries.
• Surgical treatment is indicated in the following:
  • Persistent functional cysts.
  • Cysts that are very large
  • A cyst if found in a woman past the menopause
  • Symptoms, such as severe pain or bleeding, are present
  • A cyst becomes twisted (torsion)
  • Sometimes in polycystic ovaries

The extent and type of surgery will vary from laparoscopic removal to a laparotomy (opening the abdomen via a wide incision).