INTRODUCTION TO OVARIAN CYST
Ovarian cysts are closed, sac-like structures within an ovary that contain a liquid, or semisolid substance. “Cyst” is merely a general term for a fluid-filled structure, which may or may not represent a tumor or neoplasm (new growth). If it is a tumor, it may be benign or malignant. The ovary is also referred to as the female gonad.
CAUSES OF OVARIAN CYST
Most ovarian cysts form in response to hormonal changes in your body, so anything that affects your hormone levels can sometimes lead to cysts forming. These include:
- Using progestogen contraception – the progestogen-only pill, the intrauterine system (the coil – for example, Mirena) or the contraceptive implant
- Being pregnant
- Taking hormones used to treat infertility
- Taking hormone therapy for breast cancer
- Having an under active thyroid
You can also get ovarian cysts if you have endometriosis or polycystic ovary syndrome (PCOS).
TYPES OF OVARIAN CYSTS AND SIZES
There are various types of ovarian cysts, such as dermoid cysts and endometrioma cysts. However, functional cysts are the most common type. The two types of functional cysts include follicle and corpus luteulm cysts.
During a woman’s menstrual cycle, an egg grows in a sac called a follicle. This sac is located inside the ovaries. In most cases, this follicle or sac breaks open and releases an egg. But if the follicle doesn’t break open, the fluid inside the follicle can form a cyst on the ovary.
Corpus luteum cysts
Follicle sacs typically dissolve after releasing an egg. But if the sac doesn’t dissolve and the opening of the follicle seals, additional fluid can develop inside the sac, and this accumulation of fluid causes a corpus luteum cyst.
Other types of ovarian cysts include:
- dermoid cysts: sac-like growths on the ovaries that can contain hair, fat, and other tissue
- cystadenomas: noncancerous growths that can develop on the outer surface of the ovaries
- endometriomas: tissues that normally grow inside the uterus can develop outside the uterus and attach to the ovaries, resulting in a cyst
Some women develop a condition called polycystic ovary syndrome. This condition means the ovaries contain a large number of small cysts. It can cause the ovaries to enlarge. If left untreated, polycystic ovaries can cause infertility.
WHAT ARE THE SYMPTOMS OF AN OVARIAN CYST?
An ovarian cyst usually only causes symptom if it splits (ruptures), is very large or blocks the blood supply to the ovaries.
In these cases, you may have:
- Pelvic pain– this can range from a dull, heavy sensation to a sudden, severe and sharp pain
- Pain during sex
- Difficulty emptying your bowels
- A frequent need to urinate
- Heavy periods, irregular periods or lighter periods than normal
- Bloating and a swollen tummy
- Feeling very full after only eating a little
- Difficulty getting pregnant – although fertility is usually unaffected by ovarian cysts
See a doctor if you have symptoms of an ovarian cyst.
RISK FACTORS FOR OVARIAN CYST
Your risk of developing an ovarian cyst is heightened by:
- Hormonal problems.These include taking the fertility drug clomiphene (Clomid), which is used to cause you to ovulate.
- Sometimes, the cyst that forms when you ovulate stays on your ovary throughout your pregnancy.
- This condition causes uterine endometrial cells to grow outside your uterus. Some of the tissue can attach to your ovary and form a growth.
- A severe pelvic infection.If the infection spreads to the ovaries, it can cause cysts.
- A previous ovarian cyst.If you’ve had one, you’re likely to develop more.
COMPLICATIONS OF OVARIAN CYST
Though most ovarian cyst are not threatening and go away on their own, few may raise severe complications. Complications of Ovarian Cyst are-
- Reduced fertility: Though in premenopausal woman most Cysts resolve themselves, but sometimes recurrent Cysts can decrease the fertility.
- Ruptured Cyst: Cyst may get ruptured leading to internal bleeding and excruciating pain. This can further cause infection inside body. This can be fatal unless attended urgently. Though this is also a rare condition.
- Ovarian torsion: This is a rare condition where ovary is twisted due to presence of large Cyst. This can move ovary from its original position to such a position where its blood supply can get cut off. This is a dangerous condition and if not treated immediately, can damage ovarian tissue leading to its death.
- Risk of developing cancer:Most Cysts resolve themselves but some may possess risk of becoming cancerous, especially in postmenopausal women.
Complications of Ovarian Cyst are grave in nature and may put even life at risk. Hence, it is advised an early treatment for each and every case of Ovarian Cyst.
PREVENTION OF OVARIAN CYST
- Stop smoking. Smoking increases your risk of developing ovarian cysts. As well as increasing your risk for other negative conditions such as cancer and emphysema. If you smoke, ask your doctor for help with quitting. There are medications and smoking cessation programs available that may help you quit.
- Loose weight. Being overweight can contribute to your risk of developing conditions such as polycystic ovary syndrome (PCOS), which increases your risk of ovarian cysts. If you are overweight, then do what you can to get down to a healthy weight.
For women who have PCOS, losing just 10% of their weight can resolve the problem and is usually a more realistic goal.
Start a food diary to keep track of how much you eat each day.
Limit your caloric intake so that you burn more than you eat.
Eat more fruits and vegetables.
Exercise for at least 30 minutes five days per week.
- Consider taking birth control.Birth control pills are often recommended as a way to prevent ovarian cysts. Birth control pills may also reduce your ovarian cancer risk. Talk to your doctor if you are interested in trying birth control to help control your ovarian cysts. Just keep in mind that birth control pills have other side effects as well.
- Birth control works by suppressing ovarian function and preventing ovulation. For this reason, pills, patches, ring, injections, and implants all work.
- Get treated for conditions that increase your risk of ovarian cysts.Some conditions increase the likelihood that you will develop ovarian cysts, so it is important to get treated for these conditions. You are at an increased risk of developing ovarian cysts if you have
- Polycystic Ovary Syndrome (PCOS)—This is a condition that causes your ovaries to produce cysts and you may not ovulate if you have PCOS. It is also more common to have a high level of male hormones when you have PCOS.
- Endometriosis— This causes uterine tissues to grow outside of your uterus. This condition can cause pain, heavy periods, and infertility.
- Determine if fertility medication may be to blame.Some medications that promote ovulation may also increase your risk of developing ovarian cysts, but make sure that you talk to your doctor before stopping any medication. If you are taking clomiphene (a fertility drug) then you are at an increased risk of developing an ovarian cyst. Clomiphene is also known as:
DIAGNOSIS OF OVARIAN CYST
Your healthcare provider will first rule out pregnancy as the cause of your symptoms. He or she then may use the following tests to diagnose an ovarian cyst:
- A pelvic exam: During this exam, the doctor uses an instrument to widen the vagina, which allows the doctor to examine the vagina, cervix and uterus. The doctor also feels the reproductive organs for any lumps or changes.
- Blood tests: These tests are used to measure the levels of certain hormones in the blood.
- Ultrasound: This test uses sound waves to create images of the body’s internal organs. It can be used to detect cysts on the ovaries.
- Laparoscopy: This is a procedure, performed in an operating room, in which the doctor inserts a small device through an incision (cut) in the abdomen. He or she views the reproductive organs and pelvic cavity using the device. If a cyst is diagnosed at this time, it can be removed.
HOW ARE OVARIAN CYSTS TREATED?
Most ovarian cysts in women of childbearing age are follicular or corpus luteum cysts (functional cysts) that disappear naturally in one to three months, although they can rupture and cause pain. They are benign and have no long-term medical consequences. They may be diagnosed coincidentally during a pelvic examination in women who do not have any related symptoms. All women have follicular cysts at some point that generally go unnoticed.
Ultrasound is useful to determine if the cyst is simple (just fluid with no solid tissue, suggesting a benign condition) or compound (with solid components that often requires surgical resection).
In summary, the ideal treatment of ovarian cysts depends on the likely cause of the cysts and whether or not it is producing symptoms. The woman’s age, the size (and any change in size) of the cyst, and the cyst’s appearance on ultrasound help determine the treatment. Cysts that are functional are usually observed (watchful waiting) with frequent monitoring unless they rupture and cause significant bleeding, in which case, surgical treatment is required. Benign and malignant tumors require operation.
Treatment can consist of simple observation, or it can involve evaluating blood tests such as a CA-125 to help determine the potential for cancer (keeping in mind the many limitations of CA-125 testing described above).
There are no natural or home remedies to treat ovarian cysts, other than taking non-steroidal anti-inflammatory drugs for pain management.
Although most cases of ovarian cysts involve monitoring, some cases require surgery. This may involve removing the cyst, or one or both ovaries. Technique is typically laparoscopic: unless the cyst is particularly large, or if pre-operative imaging suggests malignancy or complex anatomy. In certain situations, the cyst is entirely removed, while with cysts with low recurrence risk, younger patients, or which are in anatomically eloquent areas of the pelvis, they can be drained. Features that may indicate the need for surgery include.
- Persistent complex ovarian cysts
- Persistent cysts that are causing symptoms
- Complex ovarian cysts larger than 5 cm
- Simple ovarian cysts larger 10 cm or larger than 5 cm in postmenopausal patients
- Women who are menopausal or perimenopausal