OVARIAN CYSTS
The primary female reproductive organs, or gonads, are the two ovaries. Each ovary is a solid, ovoid structure which is about the size and shape of an almond. The ovaries are located in not too deep depressions, called ovarian fossae, there is one on each side of the uterus, in the lateral walls of the pelvic cavity. They are held loosely in place by peritoneal ligaments.
Typically, ovarian cysts are closed, sac-like structures within the ovary that are filled with a liquid or semisolid substance.
Ovarian cysts may normally not cause signs or symptoms. However, larger cysts are more likely to cause signs and symptoms such as:
- Nausea and vomiting
- Pain during sexual intercourse (dyspareunia)
- Pain in the abdomen and or the pelvis, sometimes radiating to the lower back, is the most common symptom
- Pain in the lower right or left part of the abdomen
- A feeling of bloating or indigestion
- Increased abdominal size
- Feeling an urge to have a bowel movement
- Having difficult, painful bowel movements
There are many causes and types of ovarian cysts, for example, follicular cysts, dermoid cysts, and cysts due to polycystic ovary syndrome (PCOS). Most ovarian cysts are not cancerous.
Ovarian cysts are diagnosed with ultrasound or physical examination. Transvaginal ultrasound is another common way to examine ovarian cysts.
The treatment of an ovarian cyst will depend on the cause of the cyst and varies from observation and monitoring to surgical treatment.
The rupture of an ovarian cyst is a complication that produces severe pain sometimes as well as internal bleeding. A ruptured (burst) ovarian cyst usually causes pain on one side that comes on suddenly.
TYPES OF OVARIAN CYSTS
There are various types of ovarian cysts, examples being dermoid cysts and endometrioma cysts. However, functional cysts are the most common type.
The are two types of functional cysts;
Follicle cyst
During a woman's menstrual cycle, an egg grows inside a sac called a follicle. This sac is located inside the ovaries. In most cases, the follicle or sac breaks open and releases an egg. But if the follicle doesn't break open, the fluid inside the follicle will most likely form a cyst on the ovary.
Corpus luteum cysts
Follicle sacs typically dissolve after releasing an egg. But if the sac doesn't dissolve and the opening of the follicle seals, additional fluid can develop inside the sac, and this accumulation of fluid causes a corpus luteum cyst.
Other types of ovarian cysts include:
Dermoid cysts: These are sac-like growths on the ovaries which can contain hair, fat, and other tissue
Cystadenomas: They are noncancerous growths that can develop on the outer surface of the ovaries
Endometriomas: The tissues that normally grow inside the uterus can develop outside the uterus and attach to the ovaries, resulting in a cyst.
Some other women develop polycystic ovary syndrome. This condition means the ovaries contain a large number of small cysts. It can cause the ovaries to enlarge. If left untreated, polycystic ovaries can cause infertility.
CAUSES
Most ovarian cysts develop as a result of a woman's menstrual cycle (functional cysts). Other types of cysts are much less common.
- Functional cysts
Ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and progesterone and release an egg during ovulation. If a normal monthly follicle keeps growing, it's known as a functional cyst. There are two types of functional cysts:
Follicular cyst - Around the midpoint of a menstrual cycle, an egg bursts out of its follicle and travels down the fallopian tube. A follicular cyst begins when the follicle doesn't rupture or release its egg, but continues to grow.
Corpus luteum cyst - When a follicle releases its egg, it begins producing estrogen and progesterone for conception. This follicle is now called the corpus luteum. Sometimes, fluid accumulates inside the follicle, causing the corpus luteum to grow into a cyst.
Functional cysts are usually harmless, rarely cause pain, and would often disappear on their own within two or three menstrual cycles.
- Other cysts
Types of cysts not related to the normal function of a woman's menstrual cycle include:
Dermoid cysts. These can contain tissue, such as hair, skin or teeth, because they form from embryonic cells. Also called Teratomas, they're rarely cancerous.
Cystadenomas. These develop on the surface of an ovary and might be filled with a watery or a mucous material.
Endometriomas. These develop as a result of a condition in which uterine endometrial cells grow outside the uterus (endometriosis). Some of the tissue can attach to the ovary and form a growth.
Dermoid cysts and cystadenomas can become large, causing the ovary to move out of position. Often times this brings about the painful twisting of the ovary called ovarian torsion. Ovarian torsion may also result in decreasing or stopping blood flow to the ovary.
SYMPTOMS OF OVARIAN CYSTS
Most ovarian cysts are small and don't cause symptoms.
- If a cyst causes twisting of an ovary, one may have pain along with nausea and vomiting.
- If a cyst causes symptoms, one may feel pressure, bloating, swelling, or pain in the lower abdomen. This pain may be sharp or dull and may be intermittent.
- If a cyst ruptures, it can cause sudden, severe pain.
Less common symptoms include:
- Dull ache in the lower back and thighs
- Tender breasts
- Unusual vaginal bleeding
- Unexplained weight gain
- Needing to urinate more often
- Pain during sex
- Pelvic pain
- Problems emptying the bladder or bowel completely
- Pain during menstrual period
COMPLICATIONS
Most ovarian cysts are benign and naturally go away on their own without treatment. These cysts cause very little, or no symptoms. In very rare cases, a doctor may detect a cancerous cystic ovarian mass during a routine examination.
Ovarian torsion is another rare complication of ovarian cysts. This is when a large cyst causes an ovary to twist or move from its original position. Blood supply to the ovary is cut off, and if not treated, it can cause damage or death to the ovarian tissue.
Ruptured cysts, which are also rare, can cause intense pain and internal bleeding. This complication increases the risk of an infection and can be life-threatening if left untreated.
RISK FACTORS
The risk of developing an ovarian cyst is intensified by:
Hormonal problems. These include taking the fertility drug clomiphene (Clomid), which is used to cause or induce ovulation.
Pregnancy. Sometimes, the cyst that forms when a woman ovulates stays on the ovaries throughout the pregnancy.
Endometriosis. This condition causes uterine endometrial cells to grow outside the uterus. Some of the tissue can attach to the ovary and subsequently form a growth.
A severe pelvic infection. An infection can cause cysts, if it spreads to the ovaries.
A previous ovarian cyst. Such that if a person had one in the past, she is likely to develop more.
WHEN TO SEE A DOCTOR
Seek immediate medical attention if one:
- Has sudden, severe abdominal or pelvic pain
- Has pain with fever or vomiting
Anyone with these signs and symptoms, or cold clammy skin; rapid breathing; and lightheadedness or weakness should see a doctor right away.
DIAGNOSIS
A doctor can detect an ovarian cyst during a routine pelvic examination. They may notice swelling on one of the ovaries and order an ultrasound test to confirm the presence of a cyst. An ultrasound test (ultrasonography) is an imaging test that uses high-frequency sound waves to produce an image of the internal organs. Ultrasound tests help determine the size, location, shape, and composition (solid or fluid filled) of a cyst.
Other imaging tools used to diagnose ovarian cysts include:
CT scan: A body imaging device used to create cross-sectional images of internal organs
MRI: A test that uses magnetic fields to produce in-depth images of internal organs
Ultrasound device: An imaging device used to visualize the ovary
Because the majority of cysts disappear after a few weeks or months, the doctor may not immediately recommend a treatment plan. Instead, he/she may ask for a repeat of the ultrasound test in a few weeks or months to be double sure on the next step.
If there aren't any changes in the condition or if the cyst perhaps increases in size, the doctor will request additional tests to determine if there are other causes of the symptoms.
These include:
Pregnancy test to make sure the patient is not pregnant
Hormone level test to check for hormone-related issues, such as too much estrogen or progesterone
CA-125 blood test to screen for ovarian cancer
TREATMENT FOR OVARIAN CYSTS
Most ovarian cysts in women of childbearing age are the follicular or corpus luteum cysts (functional cysts) that disappear naturally in one to three months, although they can rupture and cause some pain. They are benign and have no long-term medical consequences. They are usually diagnosed coincidentally during a pelvic examination in women who do not have any related symptoms. All women have follicular cysts at some point that generally go unnoticed.
Ultrasound is useful to determine if the cyst is simple (just fluid with no solid tissue, which suggests a benign condition) or compound (with solid components that often requires surgical attention).
The ideal treatment of ovarian cysts depends on the likely cause of the cysts and whether or not it is producing symptoms. The woman's age, the size of the cyst, and the cyst's appearance on ultrasound will help determine the treatment. Cysts that are functional are usually observed with frequent monitoring unless they rupture and cause significant bleeding, then surgical treatment would be required.
Benign and malignant tumors require operation.
Treatment can consist of simple observation, or it can involve evaluating blood tests such as a CA-125 which is used to look for early signs of ovarian cancer in people with a very high risk of the disease to help determine the potential for cancer.
There are no natural or home remedies to treat ovarian cysts, other than taking non-steroidal anti-inflammatory drugs for pain management.
The doctor may recommend treatment to shrink or remove the cyst if it doesn't go away on its own or if it grows larger.
Birth control pills
If a person has recurrent ovarian cysts, her doctor can prescribe oral contraceptives to stop ovulation and prevent the development of new cysts. Oral contraceptives can also reduce the risk of ovarian cancer. The risk of ovarian cancer is actually higher in postmenopausal women.
Laparoscopy
If the cyst is small and the results from an imaging test rules out cancer, the doctor can perform a laparoscopy to remove the cyst. The procedure involves the making of a tiny incision near the navel and then inserting a small instrument into the abdomen to remove the cyst.
Laparotomy
For a large cyst, the doctor can remove the cyst through a large incision in the abdomen. He will conduct an immediate biopsy, and if he determines that the cyst is cancerous, he may perform a hysterectomy to remove the ovaries and uterus.
Surgery for ovarian cysts
Any type of ovarian mass, including a cyst, can be removed either with laparoscopy, or if needed, laparotomy (an open abdominal incision), especially if it is causing severe pain, or if it is suspicious in any way. Once the cyst is removed, the growth is sent to a pathologist who examines the tissue under a microscope to make the final diagnosis as to the type of cyst.
PREVENTION
Ovarian cysts cannot be prevented. However, routine gynecologic examinations can detect ovarian cysts early.
Benign ovarian cysts don't become cancerous. However, a lot of the symptoms of ovarian cancer can mimic symptoms of an ovarian cyst. Therefore, it is important that women visit their doctors and receive correct diagnosis.
Women should alert their doctor to symptoms such as:
- Loss of appetite
- Changes in menstrual cycle
- Abdominal fullness
- Ongoing pelvic pain
- Unexplained weight loss
HOME REMDIES
Unless a cyst is very large or growing rapidly, a doctor is most likely to advise watchful waiting. This means waiting with care to see if the cyst will go away on its own without treatment.
A doctor may thus perform several ultrasounds over a few months to monitor the cyst and ensure it disappears or does not grow larger.
Home treatment cannot make the cyst disappear. Rather, the goal is always to treat any symptoms and manage pain. It has been established for example, that many women with ovarian cysts experience more significant pain during their periods, so home ovarian cyst treatment often focuses on managing period pain.
Some of the most effective strategies include:
- Over-the-counter medication
Over-the-counter pain killers can provide relief from discomfort. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can treat the pain caused by ovarian cysts, as well as cramps during menstrual periods.
Intense pain may point to a more severe complication therefore women who get no relief from NSAIDs should contact their doctor.
In some cases, a doctor may prescribe different pain medication, such as co-codamol, which contains codeine.
- Massage
Pain from an ovarian cyst can cause surrounding muscles to tense up. This can be particularly uncomfortable during a menstrual period. Massaging the thighs, buttocks, lower back and stomach can help loosen tense muscles and reduce pain.
- Exercise and stretching
Some women get relief from intense exercise such as running, while others prefer gentle stretching and yoga. Exercise and stretching also helps to ease pain linked to ovarian cysts. It can also help ease muscle tension.
Exercise would support healthy body weight in women with PCOS. Even without weight loss, exercise may reduce pain by strengthening the muscles. It may prevent the development of further cysts and help combat insulin resistance.
- Heat
Heat increases flow of blood, and helps to reduce pain. Try applying a heating pad or hot water bottle wrapped in a towel to the stomach or lower back for about 20 minutes. It is safe to repeat this several times a day as long as the pad is not hot enough to burn skin.
- Relaxation techniques
Stress and anxiety can make pain worse. Relaxation techniques, such as meditation, yoga, and deep breathing, may help relieve anxiety and reduce the intensity of the pain. These techniques can also help a person manage pain long-term and improve general health.
Weight loss
Losing weight may help her body better regulate hormones, if a woman is overweight. This would prevent the development of more cysts, and improve symptoms of pain and fatigue. It actually can be difficult to lose weight with PCOS, so women should try not to be discouraged at any point, it may take time.
- Dietary changes
A low-carbohydrate diet may help reduce the symptoms of ovarian cysts. Many women with PCOS are insulin resistant. This can lead to diabetes, and can also make pregnancy more difficult, as well as cause weight gain.
It might be helpful to reduce sugar intake as women with PCOS may have insulin resistance. Sugar is found in a wide variety of foods, including carbohydrates such as bread and pasta.
A doctor can check a person's blood to see if they are at risk of developing diabetes. Choosing to eat healthful whole foods will help a person get their weight within a healthy range.
