Ovaries are an important part of the female reproductive system; they produce eggs or ova and also secrete the female hormones estrogen and progesterone. These hormones are responsible for the development of the female body and also regulate the menstrual cycle and play an important part in pregnancy.
Cysts in the ovaries are small sac like structures that might contain water, gas or semisolid substances and might not necessarily represent a tumor. ‘Ovarian cysts can be physiological, benign or malignant. Most of the time these cysts seem to be asymptomatic and stays tucked in the organ without showing any signs or symptoms. A women might not even know that she has developed cysts until it’s too late and needs urgent treatment,’ informs Dr Pooja Mehta, consultant gynecologists, Paras Hospital, Gurgaon. That said not all cysts should cause a woman to end up in the operation theater.
Ovarian cysts can happen due to a number of reasons and are of different types. Here are the four different types of ovarian cysts that affect women:
Physiological cysts: ‘The physiological cysts resolve spontaneously over the course of time and might come back during the next menstrual cycle to meet the same fate,’ says Dr Mehta. If the cysts doesn’t dissolve on its own and grows beyond three or five centimeters it is termed as cystic. These are further divided into two main types namely -
- Follicular cyst: The most common type of ovarian cysts is a follicular cyst that results from the growth of a follicle. The follicle is the normal fluid-filled sac that contains an egg. This cyst resolves on its own in a month or so.
- Corpus luteum cyst: Another type of cyst that happens during the menstrual cycle is the corpus luteum cyst. Corpus luteum is the remnant of the follicle after the egg has released and moved to the fallopian tubes. This normally degrades within a week or less.
Benign cysts: These cysts vary in size and may occur at different sites of the ovary. Often they are non-cancerous and harmless. The follicular cysts and the corpus luteum are also considered to be benign cysts.
Malignant cysts: Malignant cysts might be present on the epithelium of the ovaries, fallopian tubes and primary peritoneal (the lining inside the abdomen). But remember ovarian cancer is rare in women younger than the age of 40. After that age, an ovarian cyst has a higher chance of being cancerous than before that age, although most ovarian cysts are benign even after age 40.
Endometrioma - Blood filled cysts that might occur on the ovaries are called as endometrioma. The ovary is the common spot for this abnormal growth. The endometrial tissues that grow over the ovaries form small blood filled cysts that can bleed over time. Read to know more about endometriosis.
Follicular cysts - A follicular cyst forms when the follicle grows larger in size during the menstrual cycle and doesn’t open to release the egg.
Benign cysts - A benign cyst arises when the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. ‘A benign cyst that grows beyond five centimeter can be of risk. It can rotate on its own axis and can cause discomfort like pain and internal bleeding which could lead to an emergency,’ says Dr Mehta.
Malignant cysts – These generally occur from the epithelium or lining cells of the ovary. At times these cysts might not show any symptom of severity and are only noticed when the condition has reached a threatening limit.
Endometriosis - This happens due to a condition called endometriosis where the cells that normally grow inside the uterus to form its lining, start to grow outside it, or at other locations.
Most of the time ovarian cysts produce no symptoms at its onset. But at times there can be signs that could indicate a problem within:
Pain in the abdomen: ‘With a cyst in the ovary usually women complain about lower abdominal pain,’ says Dr Mehta. The pain can be due to rupture of the cyst, rapid growth, bleeding of the cyst or because of torsion i.e., if it rotates on its own axis.
Menstrual abnormalities: It might be tough to gauge the presence of cysts due to menstrual irregularities or abnormalities as it could also be indicative of other health conditions. ‘But usually with cysts it is possible that you may experience delayed periods, heavy bleeding due to a rupture of cyst or you may suffer from dysmenorrheal or painful bleeding due to endometriosis,’ says Dr Mehta. There can be a lot of reasons that could lead to menstrual irregularities, know more about this condition and when to reach out for your doctor.
Pain in the genitals: ‘With a condition like endometriosis one can also experience some pain in the rectum area during menstruation. Also it can be painful during a sexual intercourse,’ says Dr Mehta. If a cysts presses on the urinary bladder it can also lead to painful urination or urine retention. Genital pains could also indicate other problems, know if this could be indicative of other health crisis like an STD.
Other physiological symptoms: Ovarian cysts can also lead to abdominal swelling or fullness. If the cysts interfere with hormone producing capacity of the ovaries it can lead to facial hair growth as well.
Infertility: ‘A condition like endometriosis which can lead to polycystic ovarian syndrome (PCOS) can also lead to infertility issues in women. Often a treatment for infertility brings to notice an underlying condition like PCOS,’ points Dr Mehta. Also read 5 ways how obesity can lead to infertility.
An ovarian cyst can be diagnosed in the following ways:
A physical examination: If you experience any of the above mentioned symptoms your doctor might first do a physical examination to ascertain the same.
Ultrasound: ‘An ultrasound is the best way to determine the position, size and severity of a cyst present anywhere on the ovaries,’ says Dr Mehta.
CT scan: ‘A CT scan would be further done to differentiate a benign cyst from the malignant one to assure the right treatment for the same,’ says Dr Mehta.
MRI: An MRI is also an effective way to have a look at the cysts to ascertain their nature, severity and growth.
Blood test: ‘A CA-125 marker test is done to check for the potentiality of cancer due to ovarian cyst,’ says Dr Mehta. CA-125 blood testing can be used as a marker of ovarian cancer, but it does not always represent cancer. It may be normal in the presence of malignancy too. CA-125 is a protein that is elevated in the bloodstream of approximately 80% of women with advanced ovarian cancer. If the report indicates the chance of a cancerous cyst, further screening for cancer is recommended.
The treatment of ovarian cyst depends on three factors: The age of the women, the size of the cyst, and its appearance on ultrasound.
Medical observation: If a woman is in her early 40s or younger with regular menstrual cycles, most of the cysts developed would be physiological in nature like follicular cysts or corpus luteum. They usually don’t have any medical consequences and would disappear on their own. ‘For women who are in their 20s and 30s these cysts are observed for some time to verify if they disappear on their own,’ says Dr Mehta. Cysts that are benign are usually closely monitored unless they call for emergency attention like surgery.
Surgery: Both malignant and begin tumor would need surgical intervention. If a benign tumor ruptures and bleeds it would call for an emergency. If diagnosis shows the presence of a malignant tumor or cyst a surgery is always recommended to stop further spread of the condition. ‘A cyst is usually removed laproscopically after complete examination and requisite tests done to ascertain its severity,’ says Dr Mehta.