Fluid-Filled Sac In Ovaries – Symptoms Risk Factors And Treatment of Ovarian Cysts

Fluid-Filled Sac In Ovaries – Symptoms Risk Factors And Treatment of Ovarian Cysts

Twenty eight year old Preeti was suffering from severe pain in the back and lower abdomen. At first it looked like a case of urinary tract infection, but later when diagnosed, it revealed that she developed a 9 cm cyst that caused her ovary to twist.

One of the most important concerns for a woman is her reproductive health. Considering the fact that ovarian cancer is one of the deadly cancers found in women, regular checks for cysts and tumors should be top priority. While cysts generally are non-cancerous and benign, some cases may turn into cancer. 

Let’s know more about ovarian cysts.

Ovarian Cyst

Ovaries as we all know, is a crucial part of female reproductive system. Every woman has two almond shaped ovaries located on each side of the uterus. These ovaries are responsible for the production of eggs as well as play an important role in producing estrogen and progesterone hormones.

Most of the women at some point of their reproductive life will develop ovarian cysts. Ovarian cysts are tiny sacs filled with fluid that develops on one of the ovaries. Most ovarian cysts are harmless and cause little or no discomfort. In fact majority of them go away without treatment in a few months of time.

Ovarian Cysts in Pregnancy

According to health experts at AIIMS, 1 on 4 women in India suffers from some level of ovarian cysts. This breaks down to 1 in 200 women when it comes to ovarian cysts in pregnancy. This is often an adverse side effect of fertility treatment. According to Dr. Deepmala, gynecologist at Motherhood hospital, it is more common in urban areas.

Majority of the cases during pregnancy do not show any signs or symptoms, neither the mother nor foetus would be in danger. But if the size of cysts are over 6-8 cm, complications could arise which can be fatal in nature.

What Causes Ovarian Cyst?

Most of the ovarian cysts develop as a result of monthly menstrual cycle. During the ovulation process in menstruation, a cyst-like structure containing an egg is formed which is known as follicle. The follicle then breaks and releases an egg for fertilization. But if this process gets obstructed or does not conclude properly, it can result in the formation of cysts. The cause of ovarian cysts can be further clarified by knowing the types cysts.

Types of Ovarian Cysts

The ovarian cysts can be primarily divided into two major forms, functional and non-functional cysts.

Functional Cysts

Functional cysts are related to functioning of the menstrual cycle. These types of cysts are generally harmless and cause no pain and discomfort. They usually resolve on their own within 2-3 menstrual cycles. Following are two types of functional cysts:

Follicular Cyst

Follicular cyst occurs at the midpoint of the menstrual cycle. Normally, the egg breaks out of the follicle and travels through the fallopian tube for fertilization. A follicular cyst can form when the egg doesn’t breaks or ruptures but instead continues to grow.

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Corpus Luteum Cyst

Normally, during the ovulation when follicle releases egg they produce estrogen and progesterone hormones for conception. This hormone producing follicle is known as corpus luteum. Often, fluid starts accumulating inside the follicle that causes the corpus luteum to grow into a cyst.

Non-functional Cysts

These types of cysts are not related to the normal functioning of the menstrual cycle.

  1. Dermoid cysts – These cysts are also called as teratomas. These sac-like growths contains various types of tissues including hair, fat and skin. Dermoid cysts are rarely cancerous.
  2. Cystadenomas – Cystadenomas are filled with watery or mucous material and develop on the outer surface of the ovary. These are also non-cancerous in nature.
  3. Endometriomas – These cysts are also called as ‘chocolate cysts’ of endometriosis. These develop due to a condition known as endometriosis in which uterine tissue grow outside the uterus. Some of the tissue then attaches to the ovaries and form a cyst.

Both dermoid cysts and cystadenomas can become large and can cause the ovaries to move out of its actual position. Some women might also develop a condition known as polycystic ovarian syndrome (PCOS). The condition refers to cysts that develop from buildup of follicles. This can cause ovaries to become enlarged, creating problem for ovulation process. Untreated PCOS is often the reason behind infertility in women.

Symptoms of Ovarian Cyst

Ovarian cyst as mentioned, do not typically cause problem. However, as the cyst grows, signs and symptoms can appear. These are:

When to call the doctor?

If you experience severe symptoms such as sharp pelvic pain, rapid breathing, dizziness and high fever, you must talk to the doctor without delay.

Complications of Ovarian Cyst

The severe symptoms can indicate that the cyst inside have become large and are twisting the ovaries, a condition also known as ovarian torsion. If left untreated, it can block the flow of blood to the ovaries which can eventually result in death of the ovaries. However, ovarian torsion is not common and accounts for nearly 3 percent of all emergency gynecologic surgeries.

Another rare complication is the rupturing of cysts which can cause severe pain and internal bleeding. This can increase the chances of infection and hence, can prove life-threatening if left untreated.

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Diagnosis of Ovarian Cyst

Diagnosis of ovarian cysts and tumor can be performed during the routine pelvic examination. Depending on the size and whether it is solid or fluid filled, the doctor will suggest some tests to determine what type of treatment you need. You would be asked to go through:

  • Ultrasound test to determine the size location and shape
  • RI test for having in-depth images of the internal organs
  • CT Scan for having cross-sectional images of the internal organs

Since majority of the cyst disappear within a few weeks, your physician may not recommend any treatment immediately. Instead, you would be asked to go through ultrasound again in a month or two to assess your condition. If the cysts does not go away or increases in size, your doctor may recommend you following test before taking any serious action:

  • Pregnancy test to rule out pregnancy
  • Hormonal tests to check for estrogen and progesterone levels
  • CA 125 Blood test to check for ovarian cancer

Treatment of Ovarian Cysts

The treatment would depend on the type of cyst, size & shape and whether it is cancerous or not. Your doctor might suggest you following:

Wait and watch

In many cases where cyst is benign and not causing any harm, your doctor will recommend you to wait and re-examine if it goes away on its own. In this case you would be advised to follow-up the routine check-up.

Medication

You might be advised hormonal contraceptives (birth control pills) to keep cyst from recurring. However, birth control pills will not shrink the cyst.

Surgery

  1. Ovarian cystectomy - If the cyst is large and doesn’t look like a functional cyst and continues to grow through 2-3 menstrual cycles, the doctor would be performing laparotomy. In this procedure, a large incision is made into your abdomen to remove the cyst. These surgeries are often called as ovarian cystectomy, means your ovaries remains intact.
  2. Oophorectomy - In some other cases, doctors might advise removing the affected ovaries, a procedure known as oophorectomy.
  3. Hysterectomy - If the cystic mass is huge and cancerous, you will be referred to a gynecologic cancer specialist for removal of the ovaries, uterus and the fallopian tubes. This surgery is known as total hysterectomy. Women who develop ovarian cysts after menopause have more chances of developing malignant cyst. So typically, hysterectomy is recommended to post-menopausal women.

Since ovarian cyst do not usually cause any harm that does not mean it should be ignored. This is especially important for women who have history of cysts that they should go for regular pelvic examination as they are at greater risk of developing cyst again. In case of cancerous cyst, which is rare, early treatment offers high chances and best hope for recovery.

 Sources

1. Yamamoto Y, et al.(2017). Comparison of endometriotic cysts and ovarian cancer in association with endometriotic cysts read more
2. Farahani L, et al.(2017).Reprint of: Benign ovarian cysts read more
3. Ovarian cysts(2016). MedlinePlus read more
4. Ovarian cysts (2017, April 28). Womenshealth.gov read more
5. Ovarian Cysts (2017,April). ACOG read more