What causes ovarian cysts?

Dear Doctor,

I recently learnt of ovarian cysts and how they rupture. What is the main cause of ovarian cyst?  What are the symptoms of a burst ovarian cyst and how is it fixed? Can this be avoided?

Miriam

Dear Miriam,

Ovarian cysts are fluid filled sacs present over the surface or inside ovary. Majority of women do develop ovarian cysts, once or more in their reproductive years, as they are formed during ovulation. But they subside spontaneously causing no problem.

Ovarian cyst may form due to hormonal problems or due to drugs used to induce ovulation. They may be associated with abnormal functioning of thyroid gland. They may form due to endometriosis, a condition where uterine tissue grows outside the uterus. Polycystic ovary syndrome (POCS) is a condition where multiple cysts are formed in ovary due to high levels of male hormones in a woman.  An ovarian cyst may develop early during pregnancy to support the pregnancy till placenta is formed. It may subside later on or stay when it has to be removed surgically. Pelvic infections can spread to the fallopian tubes and ovary and cause cysts to form.

Most of the times, ovarian cyst causes no symptom and is detected on routine ultrasound for some other problem. At times, it may cause pain in lower abdomen or back and or painful intercourse. Depending on the site and size of the cyst, urinary or bowel disturbances may occur. It may cause menstrual irregularities or abnormal bleeding pattern. Fertility is usually not affected by ovarian cyst unless it is caused by endometriosis or POCS.

A cyst may rupture or get twisted causing severe lower abdominal pain, with or without nausea and vomiting and even shock. Rarely, a cyst may be malignant. Ovarian cysts occurring in menopausal women are more likely to be malignant. Rupture of cyst may occur due to fluctuations of hormone levels. Big cysts can rupture due to sexual intercourse.

Ovarian cyst can be detected by pelvic examination and ultrasound. A biopsy done can help to ascertain the exact type of cyst and whether it is benign or malignant.

Ovarian cysts cannot be prevented in a woman who is menstruating. However, if the cysts are recurrent, troublesome, then hormonal pills can be used to regulate menstruation and minimise risk of cyst formation. Weight loss in case of obesity, measures to avoid stress are things that can help to regulate hormone imbalance, thus indirectly prevent cyst formation.  

Small cysts are best left untouched. Regular follow up can help to see whether they have subsided or not. Recurrent or persistent small cysts can be treated by hormones. Big cysts causing symptoms are removed by surgery. Torsion and rupture are emergencies needing urgent surgical intervention.

If there is a malignant cyst, it needs to be removed surgically. If it is advanced, conservative surgery with or without radiotherapy and chemotherapy are other measures used to treat malignant ovarian cyst.

Dr. Rachna  Pande is a specialist in internal medicine. 

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