An ovarian cyst is a fluid-filled sac in an ovary or on its surface. Ovarian cysts are usually found during a pelvic exam or on an imaging test, such as a pelvic ultrasound.
Ovarian cysts are fairly common and often go away on their own without treatment. If you have an ovarian cyst that does not go away, gets larger or causes pain, our doctor will recommend tests to determine its type and whether you need treatment.
Treatment options depend on your symptoms, age and the type and size of your cyst. The most common treatment options include watchful waiting (especially with small cysts), hormone treatment and surgery.
What Are Ovarian Cysts?
The ovaries are small organs in the pelvis that contain egg cells and make hormones, such as oestrogen and progesterone. Ovarian cysts, which can contain either fluid or semisolid material, can develop on or within one or both of your ovaries.
An ovarian cyst that develops after menopause may occasionally be cancerous. In this case, you may need to undergo a hysterectomy.
There are two main categories of ovarian cysts, namely functional cysts and pathological cysts.
Function cysts are common and develop because of the normal function of the menstrual cycle in pre-menopausal women. These cysts are usually harmless and often disappear on their own within a few months.
There are two types of functional cysts, namely follicle cysts and corpus luteum cysts.
During the menstrual cycle, an egg grows inside the ovary in a structure known as a follicle. The follicle contains fluid, and it bursts when the egg is released, but if this does not happen, the fluid found inside the follicle may produce a cyst on the ovary.
Corpus Luteum Cysts
When a follicle sac does not burst or dissolve after the release of an egg, extra fluid may build up inside of the sac, causing a corpus luteum cyst.
Pathological Ovarian Cysts
These types of cysts are relatively uncommon and develop because of an abnormal cell growth. They are not linked to the normal function of your menstrual cycle. Pathological cysts can grow very large and cause ovarian torsion (twisting of the ovary). These cysts include dermoid cysts, cystadenomas and endometriomas.
- Dermoid Cysts - These cysts contain tissue, such as hair, skin, fatty tissue, or teeth and can grow quite large. These cysts are congenital (present and birth) and should be surgically removed to avoid complications.
- Cystadenomas - These cysts grow from cells which cover the outer layer of the and are typically attached by a stalk to the ovary. Although benign (non-cancerous) they should still be surgically removed.
- Endometriomas - These ‘chocolate’ cysts develop because of endometriosis. This condition results in uterine endometrial tissue growing outside the uterus (womb), causing cysts on the ovaries.
What Causes Ovarian Cysts?
It is very common for women to develop ovarian cysts while of child-bearing age. These cysts, which are related to the hormonal fluctuations of the menstrual cycle, usually disappear by themselves. There are, however, some conditions that can also cause ovarian cysts. These include:
- Endometriosis - this occurs when pieces of the tissue that line the uterus (endometrium) are found outside the uterus in the fallopian tubes, ovaries, bladder, bowel, vagina or rectum.
- Polycystic Ovary Syndrome (PCOS) - this condition causes lots of small, benign (harmless) cysts to develop on the ovaries.
- Pelvic Inflammatory Disease (PID) - people with this disease are more likely to develop infected ovarian cysts. This infection of the pelvic area is usually caused by gonorrhoea or chlamydia.
How Are Ovarian Cysts Removed Or Treated?
This conservative approach is most suitable if you have no symptoms, and an ultrasound only detects a small, fluid-filled cyst. In many cases you can wait a few months before being re-examined or having a follow-up pelvic ultrasound to see if the cyst has gone away.
Contraceptives (birth control pills) can stop you ovulating, and thereby stop the productions of cysts. Birth control pills, however, will not shrink an existing cyst.
Surgery can often be done using minimally invasive surgery with a laparoscope. If the cyst is large or cancer is a concern, an open abdominal procedure using a larger cut may be necessary. The two ways in which surgeons remove ovarian cysts are:
Laparoscopic Ovarian Cystectomy
Laparoscopy is a minimally invasive surgery that surgeons can use to remove cysts from the ovaries. The laparoscope is a slim, lighted instrument that enables your doctor to clearly view your reproductive and pelvic organs.
During this procedure a laparoscope is inserted into your abdomen through a small incision. The surgeon makes two additional small incisions and places his surgical tools inside. The ovarian cysts is then removed through those incisions.
Open Cystectomy (Laparotomy)
This method is most often chosen if the ovarian cyst is large or if your doctor suspects that the cyst is cancerous. During this procedure, your surgeon uses one large incision in your abdomen to remove the ovarian cyst.