Ovarian cysts

There are several different types of ovarian cysts. The most common are called functional cysts. Functional cysts develop as a woman goes through her menstrual cycle. The eggs in a woman's ovary develop inside small swellings called follicles. Every month, one of these follicles grows larger, until it eventually bursts, releasing the egg. Functional cysts develop from these follicles. They include:

• follicular cysts - these develop when the follicle fails to burst
• corpus luteum - this is formed when the egg has been released by the follicle, but the follicle fails to break down - instead it becomes filled with fluid or blood

These types of cysts tend to go away by themselves.

Other types of ovarian cysts don't form during the menstrual cycle, but are due to unusual growth of cells in the ovary. These include:

• cystadenomas - these are formed from cells that cover the outer surface of the ovary - they can be filled with a watery liquid (serous cystadenoma) or a thicker, sticky fluid (mucinous cystadenoma)
• dermoid cysts - these develop from the cells that make eggs in the ovary - they may contain several types of tissue, including hair, teeth and other material
• endometriomas - these are often associated with endometriosis and form when endometrial tissue (the cells lining the womb) starts to grow in the ovaries

These types of cysts may also be referred to as ovarian tumours. A tumour just means an uncontrolled growth of cells. Most ovarian tumours are benign (they aren't cancerous, and don't invade other tissues or spread to other parts of the body).

However, a tumour may occasionally turn out to be malignant (cancerous). This means it may spread to other parts of the body and invade surrounding tissue. This is why it is important that all cysts are checked by your doctor.

It is not known at present why some women develop ovarian cysts. Some medicines used for the treatment of infertility can sometimes trigger the development of follicular cysts.

Most ovarian cysts don't cause any symptoms at all, so you may not even realise you have one. However, depending on the type of cyst you have, it is possible that you may get some of the following symptoms:

• pain - it is rare for a cyst to be painful, but you may sometimes feel a dull or sharp ache in your lower abdomen (tummy), or pain during sexual intercourse
• discomfort, if your cyst grows quite large
• having to pass urine more often, or sometimes finding it harder to pass urine (urinary retention)
• a feeling of pressure or fullness in your lower abdomen/pelvis
• menstrual changes, such as longer or heavier periods than usual, or sometimes shorter periods than usual

These symptoms aren't always due to ovarian cysts, but if you have them, you should visit your doctor.

Occasionally, a cyst can twist (this is called torsion) or suddenly burst (rupture). This can cause severe pain in your abdomen. You may also feel sick or vomit. You should seek urgent medical attention if you have been diagnosed with a cyst and get a sudden severe pain in your abdomen. You may need to have hospital treatment if you have a twisted or burst cyst.

As you may not have any symptoms from your ovarian cyst, it may only be discovered if you are having an examination or ultrasound scan for some other reason.

If you visit your doctor with symptoms of an ovarian cyst, he or she will ask about your symptoms and conduct an internal examination. Your doctor may be able to feel a swelling on your ovary if you have an ovarian cyst.

If your cyst is large or your doctor thinks it needs further investigation, he or she will refer you to a gynaecologist - a doctor specialising in women’s reproductive health.

You will usually need to have further tests to diagnose an ovarian cyst. These may include the following.

• An ultrasound - this uses sound waves to produce an image of the inside of the body or part of the body. A radiologist (a doctor who specialises in using imaging methods to diagnose medical conditions) or radiographer (a health professional trained to perform imaging procedures) may perform this test. He or she will look at your ovarian cyst by placing an ultrasound probe on your lower abdomen, or sometimes into your vagina (transvaginal ultrasound), which can give a clearer picture of your ovaries.
• Blood tests - these may be carried out for a substance called CA-125, which can be increased in women who have ovarian cancer or benign ovarian cysts.

Monitoring
If your cyst is found to be quite small (less than 5 cm across), your doctor will probably just need to monitor it. It is likely to disappear on its own within a couple of months and not cause any problems.

You may be advised to take the contraceptive pill if you have a functional cyst, or if you are prone to getting them. The contraceptive pill can help to prevent this type of cyst.

If your cyst is large, causing you any pain or discomfort, or doesn't start to go away after several weeks, your gynaecologist may suggest you have surgery to remove it. The extent and type of surgery you have will depend on many factors, including the size and type of cyst you have, your age and your desire to have children.

Ovarian cyst removal
Many women can have a procedure that involves just removing the cyst (without having to remove your ovary). If your cyst is small and unlikely to be malignant, it can be carried out as a day case using a type of surgery called laparoscopy (or keyhole surgery). This involves using tiny instruments inserted through small cuts in your skin to remove the cyst.

Some women need open surgery instead of a laparoscopy to remove their ovarian cyst. In this procedure, a larger cut is made in your abdomen in order to remove the cyst. Both types of procedure are done under general anaesthesia, which means you will be asleep during the operation.

Further surgery
If there is any doubt about whether your cyst is malignant (cancerous), your surgeon may advise that you have one or both of your ovaries and fallopian tubes removed, or a total hysterectomy (where your womb is removed too). This is an important decision because it will affect your ability to have children.

Whether your surgeon will advise this type of surgery depends on your age and the type of cyst you have. You will have an opportunity to talk to your surgeon about your options before your operation, and any surgery will only be carried out after you have signed a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

This information was published by Bupa Group's Health Content Team and has been reviewed by appropriate medical or clinical professionals. To the best of their knowledge the information is current and based on reputable sources of medical evidence, however Bupa (Asia) Limited makes no representation or warranty as to the completeness or accuracy of the Content.

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