GUIDE ON OVARIAN CYST

An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. Such cysts range in size from as small as a pea to larger than an orange.

The vast majority of ovarian cysts are harmless (benign), most are functional cysts.

Ovarian cysts occur in women of all ages including neonatal period and infancy. They are most prevalent during infancy, adolescence and during the childbearing years. With ultrasonography ovarian cysts can be demonstrated in nearly all premenopausal and approximately 18% postmenopausal women.

Some ovarian cysts cause problems, such as bleeding and pain or may raise concerns of malignancy. Surgery may be required to remove cysts larger than 5 centimeters in diameter

SIGNS AND SYMPTOMS

Some or all of the following symptoms may be present, though it is possible not to experience any symptoms

1.    Abdominal pain. Dull aching pain within the abdomen or pelvis, especially on intercourse.

2.    Uterine bleeding. Pain during or shortly after beginning or end of menstrual period; irregular periods, or abnormal uterine bleeding or spotting.

3.    Fullness, heaviness, pressure, swelling, or bloating in the abdomen.

4.    When a cyst ruptures from the ovary, there may be sudden and sharp pain in the lower abdomen on one side.

5.    Change in frequency or ease of urination (such as inability to fully empty the bladder), or difficulty with bowel movements due to pressure on adjacent pelvic anatomy.

6.    Constitutional symptoms such as fatigue, headaches

7.    Nausea or vomiting

8.    Weight gain

Other symptoms may depend on the cause of the cysts

Symptoms that may occur if the cause of the cysts is polycystic ovarian syndrome may include increased facial hair or body hair, acne, obesity and infertility.

If the cause is endometriosis, then periods may be heavy, and intercourse painful.

HOW TO DIAGNOSE OVARIAN CYST

Ovarian cysts are usually diagnosed by either ultrasound or CT scan, with additional endocrinological tests

TREATMENT

Cysts associated with hypothyroidism or other endocrine problems are treated by treating the underlying condition.

About 95% of ovarian cysts are benign, not cancerous.

1.    Functional cysts and hemorrhagic ovarian cysts usually resolve spontaneously. However the bigger an ovarian cyst is, the less likely it is to disappear on its own. Treatment may be required if cysts persist over several months, grow or cause increasing pain.

2.    Treatment for cysts depends on the size of the cyst and symptoms.

3.    Pain associated with ovarian cysts may be treated in several ways

4.    Painrelievers,including acetaminophen/paracetamol (Tylenol or Panadol), nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil), or narcotic pain medicine (by prescription) may help reduce pelvic pain. NSAIDs usually work best when taken at the first signs of the pain.

5.    A warm bath, or heating pad, or hot water bottle applied to the lower abdomen near the ovaries can relax tense muscles and relieve cramping, lessen discomfort, and stimulate circulation and healing in the ovaries.

6.    Combined methods of hormonal contraception such as the combined oral contraceptive pill – the hormones in the pills may regulate the menstrual cycle, and prevent the formation of follicles that can turn into cysts.(American College of Obstetricians and Gynecologists, 1999c; Mayo Clinic, 2002e). However, a Cochrane review in 2011 concluded oral contraceptives are of no benefit in treating already present functional cysts.

7.    Also, limiting strenuous activity may reduce the risk of cyst rupture or torsion.

Cysts that persist beyond two or three menstrual cycles, or occur in post-menopausal women, may indicate more serious disease and should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgical biopsy. Additionally, a blood test may be taken before surgery to check for elevated CA-125, a tumour marker, which is often found in increased levels in ovarian cancer, although it can also be elevated by other conditions resulting in a large number of false positives.

For more serious cases where cysts are large and persisting, doctors may suggest surgery. This may involve removing the cyst, or one or both ovaries.

 Features that may indicate the need for surgery include

Persistent complex ovarian cysts           

Persistent cysts that are causing symptoms

Complex ovarian cysts larger than 5 cm

Simple ovarian cysts larger 10 centimeters or larger than 5 cm in postmenopausal patients

Women who are menopausal or premenopausal

Please see your doctor for more advise.

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