Ovarian Cysts

What is an Ovarian Cysts?

An ovarian cyst is a structure filled with fluid in the ovary.  A set of different terms such as para-ovarian (next to the ovary) or para-tubal (next to the fallopian tube) are sometimes used and confused with ovarian cysts.

Since in many cases the only definitive way to determine the proper diagnosis is by a procedure called laparoscopy, until such a procedure is performed some physicians prefer the term “adnexal cyst” which encompasses both cysts of the ovary and the fallopian tube, called together the “adnexa”.

Ovarian cysts are quite common in women during their childbearing years.

In fact the ovary, in the process of normal ovarian function every month (what is called the ovarian cycle) forms a “cyst” called the dominant follicle, which then is ruptured (ovulation) and the oocyte is released.  However, if there is an error in that process, then a follicle doesn’t go through the process and a cyst can remain in the ovary for a few weeks or months.  This is also called luteinized unruptured follicle (LUF) and is a totally benign finding.  In other instances, some follicles develop together with the dominant follicle, which releases the oocyte, but they are smaller and do not release an oocyte.  However they continue to grow and may become a significant problem.  Such cysts are called “functional”, for the most part are harmless and go away on their own.

For that reason, some physicians prefer to do pelvic ultrasounds to evaluate the ovaries early in the menstrual cycle, when there shouldn’t be any large follicles.   More rarely, the ovary produces benign tumors that resemble cysts and/or is afflicted by a condition called endometriosis that may cause the formation of cysts.  Finally and even more rarely, an ovarian cyst may be the only early warning sign of a malignant process.

What are the symptoms of ovarian cysts?

On occasion, benign functional cysts develop to a significant size and cause problems that require treatment.  Such problems are ovarian torsion (where the ovary gets twisted around its stem so the blood supply to it is seriously hindered) and cyst rupture.  Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.  For the most part though, cysts are identified during a routine examination by the Obstetrician Gynecologist and without any complaint.  When such discoveries are made, tests may be recommended to provide more information.

What can a cyst be?

We already discussed the functional cysts and also spoke of the possibility of a benign condition such as a serous cystadenoma, endometriosis, a “dermoid cyst”, a Cyst of Morgagni etc.  All of these are benign conditions that may present as simple cysts.  However, some of them are without significance and some need to be taken care of.  So after seeing a cyst, we must determine if we act or wait.  In order to make this decision, we must have additional tests such as a trans-vaginal ultrasound.  This is an ultrasound of the uterus and adnexae performed via a slender vaginal probe.  The images thus created by the sound waves show the shape, size, location, and makeup of the cyst and help determine if a cyst has a completely benign appearance or has any “suspicious” characteristics.  Another piece of information comes from blood tests.  Especially after menopause, a blood test called CA 125 may assist in deciding the best approach to a finding of a cyst.  Unfortunately in premenopausal women CA 125 level is not as helpful and may confuse the issue.

What can be done about a cyst?

  • Birth control pills may be prescribed to treat some types of ovarian cysts. This treatment will not make cysts you already have go away, but it will prevent new cysts from forming.  Also, the time on the pill will work as a waiting time during which a “functional” cyst will have the opportunity to disappear on its own.
  • If your cyst is large or causing symptoms, your health care provider may suggest surgery. The extent and type of surgery that is needed depends on several factors such as size and type of cyst, your age, the presence or absence of symptoms and the desire to have children
  • An ultrasound guided needle aspiration is a procedure where a fine needle is used to aspirate the fluid out of a cyst causing it to collapse.  Needle aspiration is a simple procedure used where cysts are clearly benign in appearance and patients are anxious to start with an assisted reproductive technology treatment such as IVF.