Dear Ingabire,

Ovaries are two almond shaped structures situated on the side of the uterus, one on each side, and their function is to release eggs on a monthly basis (ovulation) which determine the fertility of a woman. Cysts are fluid filled growths present inside or over the surface of ovary.

Many women develop cysts at some point. They can occur in young as well as middle-aged post-menopausal women. Most of these cysts are small in size and subside over time of a few months and cause no symptoms. However, larger cysts do cause pelvic pain, fullness and heaviness over lower abdomen, along with the sensation of bloating. Rupture of an ovarian cyst is a medical emergency causing severe abdominal pain and shock, which can be fatal.

The ovarian cysts are of different kinds, depending on whether it is formed at time of ovulation or preparing for conception.  Most of them are benign but few are cancerous.  Because risk of cancer increases with advancing age, ovarian cyst in a menopausal woman needs to be investigated.

As such, ovarian cysts are easily diagnosed by ultrasound examination. Whether it is benign or malignant can be determined by CT or MRI scans, and type of cyst can be determined by biopsy. Serial ultrasound examination can also show whether the cyst is growing or reducing in size. CA125 is an antigen, indicative of cancer. Blood test showing high levels of CA125 also help to decide whether the cyst is malignant or not.

A small cyst with no symptoms is just watched and no active intervention is done. However, if a cyst is growing in size, causes uncomfortable symptoms persistently, it has to be removed surgically.  If a cyst is found to be malignant, it needs removal surgically. Depending on the type of malignancy and whether it is localised or spreading, chemotherapy and or radiotherapy can be combined with surgery.

Surgery depends on the size of the cyst and presence or absence of symptoms. A small cyst can be removed by laparoscopic surgery, i.e. just by making a nick in the lower abdomen via laparoscope. A large cyst needs to be removed by opening the abdomen. In case of malignant cysts, a surgeon has to decide whether to remove the cyst or the ovary, whether to remove one or both ovaries. This again depends on size and stage of the malignant tumour.   In case of menopausal women, the risk of removing one or both ovaries has to be weighed against the risk of cardiovascular disease. Post ovary removal, the level of oestrogens in the body can not only reduce but become very scant. This increases the risk of hypertension and related heart problems in post-menopausal women. There is nothing to worry about, any kind of ovarian cyst is treatable.

Dr. Rachna   Pande is a specialist in internal medicine.