A B C D E F G H I J K L M N O P R S T U V W

OVARIAN CYSTS

What are Ovarian Cysts ?

There are two ovaries, one at the end of each Fallopian tube or oviduct on either side of the womb. The function of the ovaries is to produce hormones, and an egg each month. Over 12 months each ovary will probably produce six eggs but not necessarily alternately. However, if one ovary is removed, the remaining ovary is capable of ovulating each month. This makes no difference to the menstrual cycle. Following each period, a little cyst starts to grow in one ovary: this contains the egg. It continues to grow for the first 2 weeks of the cycle and when it reaches about 2 cm across, it bursts and releases the egg. This cyst is called the follicle and makes the hormone oestrogen. The cyst changes to a more solid structure in the second half of the cycle. It is then called a corpus luteum and makes the hormones, oestrogen and progesterone. Ovarian cysts can therefore be normal: every woman in each monthly cycle makes a small cyst. However, any cyst which does not go away or is bigger than 5 cm may be abnormal. Cysts may cause pain which is usually dull and not severe. There may be quite severe pain on intercourse. If the cyst produces hormones it can cause abnormal bleeding. A cyst may become as large as a full term pregnancy: it will then cause swelling and may press on the bladder and bowel. Occasionally a cyst may block the bladder and stop the passage of urine. It may be silent and just found at a routine examination. Sometimes acute problems can arise in an ovarian cyst. It can twist round on itself causing gangrene in the ovary. This is acutely painful and is treated as an emergency. Occasionally a blood vessel may burst inside a cyst causing acute pain, or a cyst may rupture into the abdominal cavity. Both are emergency situations. Certain ovarian cysts may be malignant. This is more likely in women over the age of 40 or where the cyst contains areas of solid tissue instead of just fluid. Sometimes, both ovaries develop multiple small cysts at quite an early age. These are called polycystic ovaries and their hormone effects are discussed elsewhere.

Why do Ovarian Cysts occur ?

Women being treated with fertility drugs are more likely to develop cysts. Endometriosis may also cause ovarian cysts. Otherwise little is known about their actual cause.

Treatment Involved for Ovarian Cysts

Management is based on deciding if the cyst is causing trouble, or might do so in the future. The biggest worry is whether the cyst is cancerous, or might become so. An ultrasound scan is invariably done. This will confirm the diagnosis, measure the cyst and check the other ovary. If there is a strong suspicion of cancer, other tests may be done. In general the doctor will probably suggest surgery for any cyst greater than 5 cm. It will depend on age and history and the desire for future pregnancies. Some cysts are assessed at laparoscopy. If they look simple and in no way dangerous, a needle may be inserted. Fluid is removed and sent for analysis. Alternatively the doctor will recommend that the cyst or whole ovary is removed. This may be done through an incision in the bikini line, or as a laparoscopy. If there is a risk of the cyst being malignant, especially if the woman is over 40 and has completed her family, removal of both ovaries and the womb might be recommended. It is not always possible to be sure that a cyst is benign until it is examined in the laboratory after removal. However, malignant cysts are very rare in young women. Cysts caused by endometriosis may be treated by laser, or with drugs. Those cysts caused by use of fertility drugs do not usually require surgery as they resolve naturally.

During Treatment for Ovarian Cysts

Laparoscopy often means only being in hospital for a day. A cyst where the fluid is withdrawn in this way is more likely to recur. An abdominal operation means being in hospital about a week, with 2 to 4 weeks off work. If only one ovary is removed, periods should resume a normal cycle. Driving a car should be put off for 3 or 4 weeks, but one can resume intercourse at any time. There is no scar in the vagina, nor on the womb. If the tubes are healthy, you are just as likely to conceive with one ovary as with two. Endometriosis and polycystic ovaries, however, do themselves reduce fertility.

After Treatment for Ovarian Cysts

The greatest anxiety about all ovarian cysts is their possibility of becoming malignant. If there is any doubt at all it is much better to remove a cyst. Cysts may also continue to grow and become very big, indeed weighing several pounds and incapacitating the woman. Never ignore an ovarian cyst. Always seek expert advice if there is any question of having a cyst.

If Ovarian Cysts are Left Untreated

Ovarian cysts may recur. Taking the oral contraceptive pill reduces the risk of getting ovarian cysts. If a cyst is malignant and not removed the cancer might be more difficult to treat at a later stage. If the cyst Is large there is risk of twisting or bleeding into a cyst.