What are ovarian cysts?

Dear Doctor,

What does it mean if you have cysts on your ovaries? I’ve heard people talk about this but I’m ignorant about the subject. Is it dangerous? Mutesi

Dear Mutesi,

Ovaries are part of the reproductive system of a woman. They are two in number located on each side of the uterus. Eggs are produced in the ovary since birth and released on a monthly basis, determining conception. The hormones estrogen and progesterone which regulate the menstrual cycle and pregnancy and lactation are also produced in the ovaries.

Cysts are fluid filled sacs that are formed on one or both ovaries. Many women may have a cyst sometime in their lifetime, but it may cause no symptoms and pass unnoticed.

There are many types of cysts, depending on their location and type of tissue, they contain dermoid cyst, follicular cyst, and etcetera. Some women develop multiple small cysts in the ovaries, a condition called polycystic ovarian syndrome. This causes multiple symptoms and can affect fertility as well.

Often, a cyst may be asymptomatic and resolve spontaneously within a few weeks or months.  However, as a cyst grows in size, it may produce symptoms due to the pressure exerted. These include, pain in the lower abdomen and pelvis, painful intercourse, painful menstrual cycles, sense of fullness over abdomen, backache, pain in the thighs and calf muscles, sense of fullness and tenderness over breasts, nausea, and vomiting. One may have one or more of these symptoms. Some cysts including polycystic ovarian syndrome can affect fertility.

At times, an ovarian cyst may get twisted or may rupture. This is manifested as severe lower abdominal pain, dizziness, fever, rapid breathing, and etcetera, and is an emergency needing immediate medical attention. Untreated torsion/rupture of an ovarian cyst is dangerous. Rarely, a cyst can become cancerous. An ovarian tumour can also mimic features of an ovarian cyst.  

A cyst can be detected by physical examination. Its presence is confirmed by imaging techniques like X-ray, ultrasound, C.T. scan and MRI. Additional tests may be needed to exclude pregnancy, check hormone levels, biopsy and CA 125 blood test to exclude cancer.

As majority of cysts subside without treatment, immediate treatment is not needed. Regular monitoring is done to see its growth or reduction in size. Hormonal pills help in reduction of the cyst and prevent new cyst formation. However, one has to be cautious to avoid exposure to excess estrogen as it carries risk of cardiovascular disease, clotting in legs and cancers.

If the cyst is growing in size, if it produces persistent or severe symptoms, it is removed by surgical intervention. Type of intervention is decided by the size and growth of the cyst and presence or absence of cancer. Rupture or torsion of ovarian cyst is indication for urgent intervention.

 Dr. Rachna   Pande is a specialist in internal medicine.

 

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