What are ovarian cysts?
Ovarian cysts are sacs filled with fluid on an ovary with a diameter exceeding 3cm. The sacs come in various sizes, and some can grow as large as a watermelon. Simple cysts are filled with water or mucus, more complex cysts may contain thicker mucus, blood, or solid matter.
The usual occurring cysts are listed as below:
- Simple cysts: occur when a large follicle on an ovary suddenly expands after an egg is released. These cysts are one of the most commonly found and will subside on its own after several months.
- Endometrioma: endometriosis, where cells in the ovaries are found outside the ovary causing endometrioma.
- Dermoid cysts: develops from cells that produces eggs in the ovary, sometimes mixed with fat and hair.
- Other cyst types are very rarely found.
Nearly all ovarian cysts that occur before menopause are harmless. Ovarian cancer prior to menopausal age is also very rare.
How often do ovarian cysts occur?
Ovarian cysts occur frequently among young women and most of them are unaware of it as it rarely causes problems or symptoms. It will only be noticed when a woman undergoes ultrasound during checkups when faced with fertility problems. However, 1 in 10 women may require surgery for it later.
Cysts occurring in women between 50-70 years old are more likely to be cancerous and dangerous.
What are the symptoms or signs of ovarian cysts?
Generally, ovarian cysts do not pose any symptoms. However, if it grows too large you might notice the stomach appearing bloated and lumps on the lower abdomen. Other symptoms include;
- Vomiting and nausea
- Stomachache
- Pain during intercourse
- Difficulty or increased frequency in passing urine
- Stomach feels full and uncomfortable
- Feels heavy in the pubic region
- Difficulty to conceive where the problem is related to endometriosis
Do cysts cause fertility issues?
There are different types of cysts and most of it do not cause or affect the ability to conceive. Most cysts do not disturb the ovulation or fertilization process. However, if you are experiencing Endometriosis or Polycystic Ovarian Syndrome (PCOS), it may relate to fertility issues.
What are the treatments prescribed for ovarian cyst?
Treatments for ovarian cysts depends on the type of cysts you are experiencing. For follicular cysts or corpus luteal cyst, the treatment is usually by “wait and see”. Typically, a gynaecologist will monitor if the cyst continues to grow or changes shape.
Surgical treatment for cyst removal will be recommended if the cyst is found to be getting larger. However, choice given depends on the symptoms, the shape of the cysts and blood test results.
If I have a simple cyst that doesn’t cause any pain – what are my options?
Simple cysts with diameter <5cm:
- Treatment is not required. This type of cyst will subside on its own after several months. Follow up treatment may not be necessary.
Simple cysts with diameter 5-7cm:
- Follow up treatment to be provided, at least an ultrasound a year later.
Simple cysts with diameter >7cm:
- You will have to undergo tests and further examination such as an MRI or surgery.
I have an ovarian cyst and have been advised to undergo a removal surgery, how will it be done?
You will be given an option to undergo laparoscopy (a method involving small incisions and the use of camera), which is less painful than laparotomy. With laparoscopy, you will be able to go home early after the surgery and heal more quickly.
However, laparotomy (a method involving large incisions) is recommended if the cyst is too large or shows signs related to cancer.
Your gynaecologist will discuss the pros and cons of both surgical method and then determine which type of surgery would be best based on the condition of the cyst.
Will my ovaries be removed during surgery?
Usually both ovaries are not removed during surgery. This is because they are important in producing hormones a woman needs before menopause, and in most cases only the cysts are removed.
However, there are situations that require the ovaries to be removed, for example if the cyst is so large that it displaces the ovaries. Ovaries will also need to be removed if the cyst has rotated causing blood circulation to the ovaries to be cut off, or if the cysts have turned cancerous.
What would happen if I am pregnant and ultrasound indicates there are cysts?
Simple cysts during pregnancy that are commonly found during ultrasound will usually disappear on its own during pregnancy. If the cyst is too big, a follow up treatment will be done together with an ultrasound examination after the baby is born. Cyst removal during pregnancy will only be carried out if it causes pain or shows signs of turning cancerous.
Conclusion and important facts
- Ovarian cysts are a normal occurrence among women before menopausal age
- Ovarian cancers rarely happen before menopausal age
- Simple ovarian cysts that are small in size typically do not require treatment
- If surgery is needed, laparoscopy for cyst removal would be the better option, depending on the condition of the cyst
This article is written by Dr Muhammad Izzat Abdul Razak, Registrar of Obstetric & Gynaecology (O&G) currently based at a hospital di Kuala Lumpur. Translated by Nur Nadhirah from the original article in Bahasa Malaysia athttps://www.mmgazette.com/sista-ovari-adakah-berbahaya-perlukah-dibuang-dr-muhammad-izzat/
Reference:
- Ovarian cysts before the menopause – Information for you by Royal College of Obstetricians & Gynaecologists United Kingdom. Published in June 2013 ( next review in 2016 )
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]