Ovarian Cysts

Ovarian cysts at a glance

  • An ovarian cyst is a fluid-filled sac that forms on or inside the ovary.
  • Ovarian cysts are very common with more than 3 million cases per year in the United States.
  • Certain types of ovarian cysts may affect a woman’s fertility, including endometriomas, the cysts resulting from endometriosis.
  • The majority of ovarian cysts present little or no pain or discomfort and go away on their own.
  • However, a fertility surgeon may need to remove ovarian cysts that can present infertility issues.
  • Other treatment options include watchful waiting, medications and birth control pills to prevent future cysts.

What are ovarian cysts?

Ovarian cysts are fluid-filled sacs within or on the surface of one or both ovaries. A follicle is a normal ovarian cyst that contains an egg. Follicular cysts grow in size as part of a woman’s regular monthly menstrual cycle. After ovulation, the follicular cyst can get overly large, can sometimes bleed into itself and cause pain. Most of the time these follicular cysts go away on their own in two or three menstrual cycles.

If a cyst does not go away, then it may contain abnormal cells. When a cyst forms before menopause, it is very rare that it is cancer. When cystic ovarian masses develop after menopause they may be cancerous and require surgical treatment.

Ovarian cysts can be caused by hormonal problems, abnormal growth of cells within the ovary, severe pelvic infections and endometriosis. Polycystic ovary syndrome (PCOS) is a condition where there are many small follicular cysts. The cysts are normal but ovulation does not occur in a predictable fashion. The presence of cysts in PCOS are not an indication of abnormal cells. PCOS is an endocrine disorder treated with medication.

Cysts involved in endometriosis, in which tissue from the endometrium (uterus lining) attaches outside the uterus, are called endometriomas. The majority of the time when an endometrioma measures more than 3 cm as determined by ultrasound, the degree of endometriosis is moderately severe or severe. The more severe the endometriosis, the greater impact it has on fertility. According to ASRM, endometriosis may be found in 24 to 50 percent of all women who experience infertility.

Endometriomas from endometriosis can affect fertility in several ways. They can alter the reproductive anatomy (fallopian tubes, uterus and pelvic structures), rendering pregnancy difficult. They can also reduce the quality of eggs, impede embryo implantation, change the hormonal environment and alter the immune system.

Ovarian cyst diagnosis

Primary care physicians or gynecologists generally diagnose ovarian cysts by a pelvic exam or by ultrasound. A pelvic ultrasound is a very reliable evaluation for an ovarian cyst and the specific features seen on ultrasound are very accurate for predicting what type of cyst it is. Cysts can be fluid, solid or a mix of the two. Fluid-filled cysts are not likely to be cancerous, but solid or mixed cysts may require further evaluation to see if a cancer is present. The ultrasound findings are relied upon to determine if other testing is needed, such as an MRI, blood tests for tumor markers (CA 125) or a laparoscopy.

Types of ovarian cysts

  • Functional cysts refer to cysts that occur during a woman’s monthly menstrual cycle.
  • A corpus lutem cyst is also a functional cyst and occurs after a woman’s egg has been released from the follicle when it is producing the reproductive hormones estrogen and progesterone to get ready for a possible baby.

Taking fertility drugs used to induce ovulation for in vitro fertilization (IVF) increases the risk of developing a functional or corpus lutem cyst.

Other less common types of ovarian cysts are dermoid cysts and cystadenomas. These are not cancerous cysts and are commonly found in women of reproductive age. Most of the time they do not cause symptoms and are found incidentally on an annual pelvic exam or by ultrasound.

If a cyst is large, growing, has suspicious characteristics on ultrasound or is causing pain, a laparoscopy is recommended. Laparoscopy is a surgical procedure in which the ovary can be viewed directly with a camera through a small incision. The cyst can be removed and the cyst tissue is submitted for diagnosis by a pathologist.

Symptoms of ovarian cysts

The majority of ovarian cysts do not cause symptoms and disappear on their own. But a larger ovarian cyst may cause some abdominal pain and discomfort. Some women may experience frequent urination due to a reduced bladder capacity. A woman experiencing sudden and severe abdominal pain or pain accompanied with fever and vomiting should immediately seek medical attention.

Some cysts may become large enough to move the ovary out of its normal position in the pelvis, increasing the chance of ovarian torsion, which can be painful. Sometimes the wall of the cyst can break or rupture resulting in serious symptoms, such as severe pelvic or abdominal pain, nausea, vomiting and pain during bowel movements or sex. An ovarian cyst can also cause pain if it becomes too large or interferes with blood supply to the ovary.

There’s no way to prevent the growth of ovarian cysts, but regular pelvic exams are a good way to ensure that changes in the ovaries are diagnosed as early as possible. Women should be alert to changes in their monthly cycle, including menstruation symptoms that aren’t typical to them or persist more than a few cycles.

Treatment of ovarian cysts

Ovarian cysts are usually treated by the size and type of cyst and a patient’s age, symptoms and desire to have children. Functional ovarian cysts usually go away on their own within 8 to 12 weeks. In these cases, a doctor will typically recommend watchful waiting, during which a patient waits a few months to be re-examined in hopes that the cyst will disappear on its own.

A doctor may prescribe birth control pills for women who suffer from frequent functional cysts. The birth control pills may reduce the risk of producing new ovarian cysts, but do not decrease the size of current cysts, and are problematic for women seeking to become pregnant. Women who have cysts caused by PCOS or another disorder should seek additional treatments.

Treatment for endometriomas is often best performed by a surgeon who specializes in infertility. In fact, laparoscopic surgery is the only certain way to diagnose endometriosis.

Surgical removal of the endometriomas can restore fertility by correcting anatomical problems to allow proper reproductive function. If a woman has moderate to severe endometriomas, her chances of pregnancy are improved by surgical treatment. A combination of surgery and medications is often recommended for women with endometriosis who undergo IVF to achieve pregnancy. PCOS-related infertility often involves treating the ovarian cysts causing the issue with medication.

More complex cysts that usually occur in women who are past the age of menopause have a higher risk of being cancerous. In cases like these, laparoscopic surgery to remove the cyst may be needed to ensure there is no cancer.