Ovarian cysts

 

What are the ovarian cysts?

 

Imagine a balloon filled with fluid and shrink it to the size of a pea. Now place it in an ovary and you have an  ovarian cyst. Ovarian cysts may be small as peas or large as watermelons. They can be simple (thin-walled containing fluid) or complex (containing solid bits, thick fluid, blood or even hair). Most ovarian cysts do not cause any problems; however, up to 10% of women may require surgery for them at some point in their lives.

 

Depending on what is the cause of the cyst, there are different types of ovarian cysts:

 

• Simple (functional) cysts: Each month, one of the ovaries releases an egg. This egg matures in fluid-filled follicles; during ovulation they pop and the egg is released. Sometimes they do not disappear but instead they continue to grow, forming cysts. These benign cysts tend to resolve on their own within one to three months.

• Endometriomata: These cysts form when endometriosis is present on the ovaries. They are filled with dark fluid and they are also known as "chocolate cysts".

• Dermoid cysts: They are a particular type of cyst which may contain hair, fat or even teeth. They are also known as teratomas and are usually benign.

 

What symptoms can they cause?

 

Most ovarian cysts cause little or no pain and are innocuous.  However, serious symptoms may be caused, especially by the cysts that have ruptured. These symptoms are:

 

• pain in your lower abdomen and/or pelvis

• pain during sex

• pain when you open your bowels

• appetite changes

• fullness or heaviness in your tummy

• bloating

 

Uncommon complications of the ovarian cysts are:

 

• Torsion of the ovary: If the cyst is big enough, it may make the ovary twist around its blood supply. This decreases or even stops the blood flow to the ovary, risking permanent damage to it.

• Rupture: An ovarian cyst that ruptures, can cause severe pain and internal bleeding. The bigger the cyst, the higher the risk.

 

You should seek immediate medical attention if you have been diagnosed with an ovarian cyst and you develop:

 

• Acute, severe abdominal pain

• Pain with vomiting or fever

 

 

How are the ovarian cysts diagnosed?

 

Depending on the size of the cyst and whether it is symptomatic or not, it may be picked up during a pelvic examination.  The investigations that are helpful to diagnose and further assess an ovarian cyst are:

 

• Ultrasound scan: The most accurate ultrasound scan for the assessment of the ovarian cysts is the transvaginal ultrasound scan. A thin probe is inserted in the vagina and with the use of ultrasound waves, it creates images of the womb and ovaries.

• Tumour markers: These are blood tests that determine the likelihood of the ovarian cyst being cancerous. The most common tumour marker for the investigation of the ovarian cysts is Ca-125.

• Magnetic Resonance Imaging (MRI): MRI scans use a magnetic field to create detailed images of the inside of the body. 

 

 

How are the ovarian cysts treated?

 

After the initial investigations have taken place, an algorithm called Risk of Malignancy Index (RMI) is used to determine the cancerous potential of the cyst. Depending on the RMI score and your symptoms, these are the most common treatment options:

 

• Watchful waiting: Often you can wait and reassess the ovarian cyst after a few months. This is typically a option when you have no symptoms and the cyst is simple​. 

  • If the cyst is smaller than 5cm and simple, treatment is normally not necessary as it is likely to disappear on its own after few months.

  • If the cyst is 5-7cm in diameter, then it should be followed up with an ultrasound scan.

  • If the cyst is bigger than 7cm in diameter, then further investigations (usually an MRI) will be required.

 

If the cyst changes in size and nature however, then you may require surgery. This will be in the form of keyhole (laparoscopic) surgery, unless the cyst is so big that open surgery is required.

 

• Surgery: This is the option for the management of the ovarian cysts that have grown in size, appear complex, are large, persistent and cause pain. Depending on the size of the cyst, your age and your fertility wishes, the cyst may be removed with or without removing the affected ovary.

 

 

 

At Hampshire Womens Health, our expertise in keyhole surgery allows us to remove simple and complex ovarian cysts through tiny incisions

 with excellent cosmetic results.

 

 

Things to remember

 

• Ovarian cysts are common before the menopause.

• Ovarian cancer is rare before the menopause.

• If the cyst is small, simple and does not cause any symptoms, then no treatment is required.

• If surgery is required, then this will most likely be keyhole.

• The pill will not make an ovarian cyst disappear; it may prevent new ones developing in the future.

• Removing fluid from a cyst is not helpful as it will most likely re-accumulate.