Ovarian Cyst
What Is An Ovarian Cyst
An ovarian cyst is a balloon-like formation that may contain thin fluid, blood, mucus, or solid tissue. It usually develops in the ovary, and more rarely it may appear in the fallopian tube. Ovarian cysts vary in size, ranging from a few centimetres up to 20–30 centimetres, and they may be benign (as is often the case in younger women), borderline (of low malignant potential), or even cancerous. In many cases they cause no symptoms and are found incidentally during an ultrasound. In other cases, however, ovarian cysts may cause symptoms such as lower abdominal pain, pain during menstruation or sexual intercourse, as well as pressure on the bladder or bowel, especially if they are large. Complications, mainly in larger cysts, include rupture, internal bleeding, ovarian torsion, and necrosis due to interruption of the blood supply to the ovary.
Classification of Ovarian Cysts
Ovarian cysts are classified as follows:
● functional cysts: These are the most common ovarian cysts seen in women of reproductive age. Functional cysts include follicular cysts, luteal cysts, and corpus luteum cysts. They usually result from disturbances in hormone levels and may in turn worsen hormonal imbalance. Their size ranges from 1.5 up to 5 centimetres, but in some cases they can reach up to 8 centimetres. These cysts are usually reabsorbed within 4 to 8 weeks. However, they may cause various issues such as menstrual cycle disturbances, a feeling of heaviness in the pelvic area, and discomfort during sexual intercourse. In addition, in cases of torsion or rupture of the cyst, severe abdominal pain and bleeding may occur, which requires medical monitoring.
● benign neoplastic cysts: They occur less often and mainly include benign cystic teratoma (dermoid cyst), cystadenomas, and fibromas. They are characterised by slow growth and rarely become malignant. This type of ovarian cyst usually does not cause symptoms, but in some cases it may cause menstrual irregularities or peritoneal pain if it ruptures. They do not disappear over time and, when they persist, further investigation is performed with MRI and laboratory testing of tumour markers. Surgical removal may be required and, in more severe cases, removal of the corresponding ovary may also be necessary.
● malignant cysts: Such an ovarian cyst occurs more often after menopause, however it may arise at any age.
Ovarian Cysts & Symptoms
The most common symptoms of ovarian cysts include:
● pain in the lower abdomen
● discomfort or abdominal pain during exercise, sexual activity, or bowel movements
● increased need to urinate
● a feeling of nausea
● bloating or a feeling of heaviness in the abdomen
● delayed menstruation
How Is An Ovarian Cyst Diagnosed?
Detection of ovarian cysts is carried out by taking a detailed medical history and performing a gynaecological examination, but definitive confirmation requires imaging methods. Transvaginal ultrasound provides detailed information about the size, location, and characteristics of cysts, while in some cases a CT scan or pelvic MRI may also be needed. In addition, blood tests may include the assessment of tumour markers, such as CA-125, which is elevated in 80% of patients with advanced ovarian cancer. At this point it is worth noting that Dr D. Koleskas has served as a Consultant at the university hospital Royal Victoria Infirmary, Newcastle, United Kingdom, in the referral and follow-up department for ovarian cysts suspected of borderline malignancy (borderline) or cancer.
Management / Treatment
Choosing the appropriate treatment for an ovarian cyst is done after evaluation of the results of the above tests, the symptoms, the woman’s age, and her wishes. She will be fully informed about the potential complications of each therapeutic approach. Treatment options include either monitoring or surgical intervention.
If monitoring (conservative management) of an ovarian cyst is agreed instead of surgical removal, this is done with sequential ultrasound scans and tumour markers (where indicated) every 3–4 months, since many cysts smaller than 5 cm that contain only fluid (e.g. a serous cyst) and are found in young women disappear after that period.
Surgical management of an ovarian cyst is performed mainly laparoscopically, either with cystectomy (only the cyst is removed while the ovary is preserved) or with salpingo-oophorectomy, which involves removal of the cyst together with the ovary and fallopian tube, especially in older women or in cases of suspicious lesions. In addition, robot-assisted surgery offers an alternative option with advantages similar to those of traditional laparoscopy. However, when the cyst is very large, removal with open surgery (laparotomy) is recommended.
After removal, histological analysis of the cyst is required for further evaluation.
Recovery
The laparoscopic technique ensures rapid recovery and the patient can leave the hospital the same day and return to her daily activities in the following days. If mild discomfort occurs during the first 24 hours, taking simple painkillers is usually sufficient. However, avoiding intense physical activity, such as exercise or sexual intercourse, is recommended for 10 days to prevent abdominal pain or inflammation. For the care of the small incisions, good airing from the 5th postoperative day onward is sufficient, without the need for special covering.
Frequently Asked Questions
Does The Cyst Go Away With The Period?
Functional ovarian cysts usually disappear on their own with the onset of menstruation or within 2–3 cycles. The same applies to corpus luteum cysts, which typically regress with the next menstrual period. However, if the cyst is large or belongs to another category (e.g. pathological), it may not disappear with the period and medical intervention may be required.
Can Stress Cause An Ovarian Cyst To Appear?
According to the most recent medical information, there is no scientific evidence linking ovarian cysts and stress, as cysts usually form due to hormonal fluctuations during the menstrual cycle.
Do I Need To Take Antibiotics To Treat An Ovarian Cyst?
Antibiotics for an ovarian cyst are recommended only in cases where there is suspicion of infection of the cyst.
The obstetrician, surgeon gynaecologist M.R.C.O.G., C.C.T. D. Koleskas, has excellent theoretical training and more than two decades of practical experience in the field of obstetrics and gynaecology.
In 2009, he specialised in advanced laparoscopy at the hospital Royal Victoria Infirmary, Newcastle, where he performed a large number of laparoscopic surgeries for ovarian cysts (cystectomies, salpingo-oophorectomies). Certification from the Royal College of Obstetricians and Gynaecologists of the UK: Benign Gynaecological Surgery: Laparoscopy, R.C.O.G. (LINK)
For more information about ovarian cysts and the cost of their treatment, please contact the doctor and schedule your appointment.
