Ovarian Cysts

An ovary can frequently become enlarged by a cyst – a fluid-filled compartment or sac formed by an envelope of ovarian tissue.  These enlargements distinguish cysts from solid tumors that may also cause an increase in ovarian size.  A cyst in an ovary may be part of the ovary's normal function, or it may be part of a tumor.  These cysts may cause pain and pressure symptoms, or may be completely 'silent'.  Those cysts that have not caused pain are usually found during gynecologic exam or ultrasound.

A follicular cyst is one in which the egg-making follicle of the ovary enlarges and fills with fluid.  A corpus luteum cyst is a yellow mass of tissue that forms from the follicle after ovulation.  These types of cysts come and go each month and are associated with normal ovarian function.

Types of Cyst

• Functional cysts – are the most common type.  These cysts are related to variations in the normal function of the ovaries.  For example, they form when an egg fails to release as it should during normal ovulation.  They can last 4-6 weeks.  Rarely do they secrete hormones.

• Abnormal or neoplastic cysts – result from cell growth and are mostly benign.  In rare cases, they can be cancerous.  Abnormal cysts require medical treatment by your doctor.  Examples include:

  • Dermoid cyst – which consists of a growth filled with various types of tissue such as fatty material, hair, teeth, bits of bone and cartilage.
  • Polycystic ovaries – caused by a buildup of multiple small cysts which cause hormonal imbalances that can result in irregular periods, body hair growth and infertility.  Polycystic Ovary Syndrome, a separate condition, causes follicular cysts to develop as a result of pituitary overproduction of luteinizing hormone in an attempt to initiate ovulation.

Women with healthy ovaries normally release an egg from a small ovarian cyst each month.  The small cyst becomes a corpus luteum cyst and then lasts for two to three weeks waiting to support a new pregnancy.  If pregnancy does not occur, the woman will experience a menstrual period as part of the process of the disappearing corpus luteum cyst.  These normal cysts, also called functional cysts, are usually only 2-3cm in size but may reach 6-8cm if filled with blood or lots of fluid.  Functional cysts resolve within one to two menstrual cycles and so can be identified by their disappearing behavior.  Their presence explains why women of reproductive age have small cysts in the ovary all the time.  What is not as common are functional cysts that grow so fast as to cause pain, or so large as to be easily felt on exam.

Causes and Development; Contributing Risk Factors

Ovarian cysts may result from corpus luteum cysts, malignancy or dermoid cysts.

They are most common between the ages of 20 and 35 and in women who have endometriosis, pelvic inflammatory disease (PID) or the eating disorder bulimia.  Those who take a drug for epilepsy called Valporate are also at increased risk.

Signs and Symptoms

Symptoms include:

• A feeling of fullness or swelling of the abdomen.
• Weight gain.
• A dull constant ache on either or both sides of the pelvis.
• Pain during intercourse.
• Delayed, irregular or painful menstrual periods.
• Increased facial hair.
• Sharp, severe abdominal pain, fever and/or vomiting.  This may be caused by a bleeding cyst or one that breaks or twists.

Diagnosis and Tests

Your doctor may order a pelvic ultrasound if a mass is found during the pelvic exam.  The ultrasound will evaluate the ovaries and any suspected cysts.  Functional cysts are characterized by being fluid-filled and composed of one single sac or chamber.  The ultrasound can identify the cyst as being single-chambered.  Confirming a functional cyst means it will not likely need treatment and should simply be observed.  If that cyst does persist over two to three months, then it should be re-evaluated and treated.

Treatment and Prevention

When an ovarian cyst is found, the first important decision to be made is whether this cyst will go away without treatment.  Spontaneous resolution is expected and normal for the functional cysts related to ovulation.

Any ovarian growth with multiple cystic areas or mixed solid and cystic features should be considered a tumor and possibly a malignancy.  These should be surgically removed to determine the exact diagnosis.  When a functional cyst or simple benign tumor is identified, the ovary can be preserved for younger women because only the cyst is removed in those cases.

Prognosis

Ovarian cysts are common and will resolve over time, thus confirming that they were functional cysts instead of something more serious.