What is an Ovarian cyst

For all women, the ovaries make cysts as part of their natural function. The only exception to this would be those who have yet to start their periods or who have become postmenopausal.  In everyone else having periods, it is the norm. So why the interest in ovarian cysts?

Well, this is because in some cases they can cause symptoms like:

  • This can be due to the cyst bursting, bleeding into itself or even twisting and cutting off its own blood supply. This can lead to one losing an ovary.
  • Pressure effects on the bladder or bowel due to their position or large size
  • Feeling or even seeing the presence of a large lump coming out of the tummy
  • Incidental finding when you are examined for other reasons like with an ultrasound

Apart from symptoms, the biggest fear for any woman is that her ovarian cyst may be cancerous.

What is a cyst, I hear you ask. Well, it is essentially like a fluid filled sac which grows in or adjacent to the ovary. In some cases, there may be solid tissue areas filling the cyst and replacing the fluid. In others, the lining of the wall may thicken and become irregular. These are some of the changes we look for in checking to see if the cyst is a good or bad one.

Basically, there are only 2 types of cysts that a woman can have:

  1. The cyst that will go away, or
  2. The cyst that will not go away.

The cyst that will go away.

By far the most common cyst, it is related to the ovary making an egg. Thus it can only happen when the women is still having periods. During the menstrual cycle, as the egg develops, it forms a cyst. When the egg is released, the cyst can persist and then resolves with the onset of the period. Sometimes, these cysts can cause problems usually manifested by pain symptoms. For most women however, they come and go regularly during the menstrual cycle without causing problems.

The oral contraceptive Pill is a good method of preventing such cyst formation. This is because it acts by stopping egg formation, hence being a contraceptive. So women who are on the Pill, will not be forming  these types of cysts, unless the Pill was ineffective.

The cyst that will not go away.

Unfortunately, these cysts simply will not disappear however much you may wish them to. These are the ones more likely to run you into trouble. There are 3 types of cysts :

  • Benign cysts
  • Cancer cysts
  • Borderline cysts

I like to think of borderline cysts as somewhere between cancer and benign. This is not strictly true but it does make the concept easier to understand.

The difficulty is therefore to distinguish which one is which.  Whilst it is true to say that most cysts encountered are benign, this cannot always be assumed to be the case. Each cyst will have to be treated on its merit.  Sometimes it does not matter, as the woman may present with lots of pain requiring urgent treatment. In others, one has the luxury of undertaking investigations to try to determine their nature and plan definitive management.

When time is on your side, there are a number of investigations that can be done to explore the nature of the cyst. These will include:

  1. Pelvic ultrasound. This not only looks at the size but also the site. Some cysts are not on the ovary but next to them. Sometimes a ultrasound can differentiate this. They also look for the blood flow pattern, whether or not there are areas of thickening, nodules or solid areas in the cyst. The presence of blood in the cyst can also help to identify of a cyst is due to conditions like endometriosis or not.
  2. Blood tests for ovarian tumor markers. There are a number of markers that one can use to try to tell if there is a risk of cancer in the cyst. They are not perfect and may be abnormal due to different causes. Even in cancers, the levels may not be helpful. So they need to be interpreted carefully

The management of ovarian cysts will depend on what it thought to be the nature of the cyst. Ultimately there are only 2 options:

  1. Wait and see approach. This likely to be taken if the cyst is thought to be that is likely spontaneously resolve. Small cysts thought to be benign can also be treated this way. The cyst may need to be monitored with repeat ultrasound scanning over time.
  2. Surgical removal. Ultimately if there is concern about a cyst, then usually a laparoscopy or keyhole surgery is used to look for the cyst and where possible remove it. Sometimes this is not possible and a laparotomy or big cut may be required instead.

I believe the important take home message is that for most women, ovarian cysts are common events, most of which cause no problems to the individual. Even with cysts that are persisting, most will be benign. It is prudent however that whenever these cysts are present that they be investigated to ensure that they are of no concern.

These notes reflect my personal opinion and are intended for general advice only. It should not be used for any one individual case. You should consult your own doctor to determine the appropriate management of your own individual situation.