Ovarian cysts affect about 7% of women worldwide at some stage in their lives. Ovarian cysts are fluid-filled sacs or bags in the ovary. They are common and typically appear during ovulation.Women who have ovarian cysts usually do not experience any symptoms. In most cases, cysts are not harmful. Ovarian cysts, particularly those that have ruptured, may, however cause severe symptoms; it may cause intense discomfort and internal bleeding. It is important to get routine pelvic checks to gain awareness of the signs that could indicate a serious medical condition.
The incidence of ovarian cysts varies considerably, with reports indicating ovarian cysts in between 8% and 18% in both premenopausal and postmenopausal women.
The most common endocrine disorder in women of reproductive age is Poly Cystic Ovary Syndrome (PCOS), where it affects one out of four women in India, according to studies conducted by AIIMS. About 25% of women in the country have PCOS, which is higher than in the United States and many European countries. Further, regardless of age, benign ovarian tumours are more common than malignant ones.
Causes of Ovarian Cysts
It can be noted that depending on the type of cyst, the causal factor differs.
Types of Ovarian Cysts
They are the most common form of cysts, that develop during the menstrual cycle. They are usually harmless. The following are the two forms of functional cysts:
- Follicular Cysts: A follicle opens to free the egg during the menstrual cycle. When the follicle does not open to release the egg, it causes a follicular cyst which continues to grow. Follicular cysts are usually painless and they disappear in one to three months. A follicular cyst can grow upto a diameter of 2.3 inches. It has a thin wall and is infused with clear fluid. Its rupture can cause excruciating pain on the side of the ovary where the cyst is located.
- Corpus luteum cysts: The follicle sac shrinks into a lump of cells called corpus luteum after the follicle releases the egg. The corpus luteum produces estrogen and progesterone to prepare for the next egg. If the sac does not shrink corpus luteum cysts grow instead. In most cases, the egg is released, the sac then reseals itself and fluid accumulates inside. It may expand to nearly 4 inches in diameter and bleed into itself or twist the ovary, resulting in pelvic or abdominal pain. The cyst can burst if it is filled with blood, causing internal bleeding and sharp pain. Clomiphene citrate, a fertility drug used to promote ovulation, raises the risk of corpus luteum cyst forming after ovulation.
These are cysts caused by endometriosis, which is a condition in which the lining of the uterus expands outside of the uterus. Some of the uterine tissue may attach to the ovary develop into a tumour. Endometriosis affects one out of ten women during their reproductive years (usually between 15 and 49 years), a total of 176 million women worldwide. Approximately 17-44% of women who have been diagnosed with endometriosis will experience endometriomas. They are also called chocolate cysts because they are filled with a brown liquid. They form when a tiny uterine membrane bleeds, falls off and attaches itself inside the ovaries. Overtime the blood builds up and turns brown.
They are also called teratomas, and they develop from embryonic cells, as they contain tissue like hair, skin or teeth. They normally are not cancerous and they do not cause any signs and symptoms. Dermoids occur in both ovaries up to an estimate of 15% of women. These cysts can twist the ovary, jeopardising its blood supply. The bigger the dermoid cyst, the greater the chance of it rupturing and spilling its greasy contents which can cause discomfort and other issues. While the vast majority of these tumors are benign (98%) a small ratio (2%) become cancerous.
These cysts form on the ovary’s surface and are filled with a watery or mucus-like substance or fluid. At times they grow large. Ovarian cystadenomas are the most common form of benign ovarian tumor, accounting for 50-80% of all benign epithelial ovarian tumors. Its incidence ranges between the ages of 60 and 70 years.
Symptoms of Ovarian Cysts
The vast majority of ovarian cysts are tiny and do not show any signs or symptoms. Bloating, discomfort, swelling and pain in the lower abdomen are common among women. When a cyst ruptures the pain it causes is unbearable. The following are less common symptoms:
- Dull, aching, extreme, sudden, sharp pain or discomfort in the pelvis or lower abdomen , vagina, thighs, lower back; this pain may be continuous or irregular.
- Pressure, bloating in the lower abdomen.
- Pain at the start or at the end of a menstrual cycle.
- Periods that are irregular, or abnormal bleeding or spotting.
- Changes in urination frequency or ease, such as inability to fully clear the bladder, or bowel movement difficulty due to pressure on pelvic.
- Nausea and vomiting
- Fatigue
- Infertility
- Increased hair growth, and increased growth or facial and body hair.
- Pain during intercourse
- Weight gain
- Breast tenderness
- Urinating frequently
Treatment of Ovarian Cysts
Cyst treatment is determined by the cyst’s size and symptoms. The wait-and-see approach with frequent check-ups would most likely be recommended for small, asymptomatic cysts. Functional cysts are the most common ovarian cysts in women of childbearing age, and they usually disappear in one to three months, but when they rupture suddenly they can cause discomfort. They are usually harmless and have no long-term medical complications. The ideal treatment option for ovarian cysts is determined by the cysts’ possible cause and whether or not they are causing symptoms. Treatment depends on the woman’s age, size of the cyst, and the cyst’s appearance in ultrasound.
In case the cysts burst and cause serious bleeding, then surgery is required. Tumors, both benign and malignant, require surgery. Treatment can range from observation to assessing blood tests like the CA-125 to help assess the likelihood of cancer.
Ovarian cyst pain can be relieved with the following:
- Pain reliever such as acetaminophen, and anti-inflammatory drugs like Ibuprofen , can help to alleviate pelvic pain.
- A warm bath, heating pad, or hot water bottle placed on the lower abdomen near the ovaries can relax strained muscles and alleviate cramping, as well as improve circulation and healing.
- Chamomile herbal tea can help to relieve ovarian cyst pain and relax tight muscles.
- Urinate whenever the urge strikes.
- Avoid constipation, even if it does not cause ovarian cysts it may cause additional pelvic pain.
- Caffeine and alcohol should be avoided in a diet, and carbohydrates should be reduced. Instead opt for foods rich in vitamin A and carotenoids (carrots, tomatoes, and greens) and vitamin B, as well as whole grain foods.
Cysts that last longer than two or three menstrual cycles or occur in postmenopausal women suggest a more serious condition that should be examined with ultrasonography and laparascopy, particularly if there is a history of ovarian cancer cases in the family.
While ovarian cysts cannot be prevented, routine pelvic examinations will help ensure that changes in your ovaries are detected as soon as possible. Awareness of any changes in your monthly cycle, especially irregular menstrual symptoms that last longer than a few cycles, is useful. Consult a doctor if you notice any changes that worry you.
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