OVARIAN CYSTS

A cyst is a fluid-filled sac. On the ovary, different types of cysts are found. The most common ovarian cyst is the functional cyst - which often forms in the second half of the menstrual cycle after ovulation.

Each month the ovaries produce follicles that contain the eggs. When the egg matures, the follicle sac ovulates to release the egg – which travels through the fallopian tube for fertilization to occur. Usually, the sac dissolves. A functional cyst forms when the sac does not break open to release the egg. This functional cyst usually disappears within one to three months. A corpus luteum cyst, another type of functional cyst, forms if the follicle sac does not dissolve. And instead, fluid builds up inside of it.

This functional cyst usually disappears on its own after a few week period. However, it can grow or remain the same size and cause pain. These functional cysts are almost never associated with cancer.

There are also other types of cysts in the ovary:

Endometriomas
Develop in women who have endometriosis - the tissue from the lining of the uterus grows outside of the uterus and attaches to the ovary or the pelvic wall and continues to grow. The tissue may attach to the ovary and form a growth. Endometriomas can be painful during sexual intercourse and during menstruation.

Cystadenomas
develop from cells on the outer surface of the ovary and are often filled with a watery fluid or thick, sticky gel. Cystadenomas can become large and cause pain.

Dermoid cysts
The cells in the ovary are toti-potential - able to develop into hair, teeth or any body tissue type that will be found within the cyst itself. These cysts also can enlarge and cause pain.

Polycystic ovaries
In patients with polycystic ovaries, the ovaries typically contain numerous small cysts that do not grow on a monthly basis in size but rather remain on the surface of the ovary and interfere with ovulation. Common in patients who typically have excess facial hair and irregular bleeding.

What are the symptoms of ovarian cysts?

Many women have ovarian cysts without symptoms. Sometimes a cyst can cause the following:

• Pressure, fullness, or pain
• Dull ache in the thigh or lower back
• Painful sexual intercourse
   weight gain
• Painful or irregular menstrual periods
• Breast tenderness

How are ovarian cysts found?

When the doctor feels a swell on the surface of the ovary, ovarian cysts are found. They are usually found during an annual pelvic exam.

An ultrasound is done to see how it is shaped; the size and the location, and whether it's fluid-filled or mixed.

To find out if the cyst might be cancerous, a blood test is done to measure CA-125. The amount of CA-125 is higher if a woman has ovarian cancer. Some non-cancerous diseases will increase the levels of CA-125 such as uterine fibroids and endometriosis. The CA-125 test is recommended mostly for women over age 35 or for women who are at high risk for ovarian cancer.

How are cysts treated?

Observation
The patient is re-examined in one month to see if the cyst has changed. This is recommended for women who are in their childbearing years, have no symptoms, and have a fluid-filled cyst with no solid components.

Surgery
If the cyst doesn't resolve after several menstrual periods, has increased in size or causes discomfort, surgery may be considered.

There are two main surgical procedures:

Laparoscopy
used if the cyst is small and appears benign. Laparscopy is done under general anesthesia. A very small incision is made below the navel, and a telescope is inserted into the abdomen.
Laparotomy
If the cyst is large and appears suspicious, the doctor can perform a laparotomy - using a bigger incision. If there is cancer, the doctor may need to remove the ovary and other tissues that may be affected, like the uterus or lymph nodes.

Birth control pills – In some cases, the birth control pills may keep you from forming new cysts.

Can ovarian cysts be prevented?

Unfortunately, ovarian cysts cannot be prevented. If you notice any changes in your period, pelvic pain, or any of the major symptoms listed above, a pelvic exam combined with an ultrasound can determine if a cyst is causing you discomfort. If a woman is not trying to become pregnant and develops frequent functional cysts - future cysts may be prevented by taking oral contraceptives, Depo-Provera, or Norplant.

Why are some women more prone to have ovarian cysts?

Functional ovarian cysts usually occur during the childbearing years. Usually, the cysts in this age group are not cancerous. Women who are past menopause (ages 50-70) with ovarian cysts - have a higher risk of ovarian cancer.

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