What are ovarian cysts?

Causes and Symptoms

Ovarian cysts may occur at any age, individually or in numbers, on one or both ovaries. The cyst consists of a thin, transparent outer wall enclosing one or more chambers filled with clear fluids or old blood that presents as thick brownish or jellylike material; in some cases tissue material may be present as well. Such cysts range in size from that of a raisin to that of a large orange. The normal ovary measures 3 centimeters by 2 centimeters; the cystic ovary requiring investigation is one which is enlarged to more than twice its normal size. Large cysts may cause a feeling of fullness in the abdominal area, cramping pain with various levels of severity, or pain during vaginal intercourse. Often, however, there are no apparent symptoms, and the cyst is discovered only during a routine gynecologic examination when the clinician, on bimanual examination, discovers that one ovary is considerably enlarged. At this point, it is important to rule out malignancy, because ovarian cancers in their early stages also have no warning symptoms and can occur at any age.

Polycystic ovaries (ovaries containing multiple cysts) causing significant enlargement occur in a variety of conditions. For example, polycystic ovaries can result from an enzyme deficiency in the ovaries that interferes with the normal biosynthesis of hormones, resulting in the release of an abnormal amount of androgen (a substance producing or stimulating the development of male characteristics).

More than half of all ovarian cysts are functional; that is, they arise out of the normal functions of the ovary during the menstrual cycle. These cysts are relatively common. A cyst can form when a follicle (a small, spherical, secretory structure in the ovary) has grown in preparation for ovulation but fails to rupture and release an egg; this type is called a follicular cyst. Sometimes the structure formed from the follicle after ovulation, the corpus luteum, fails to shrink and forms a cyst; this is called a corpus luteum cyst.

Another type of ovarian cyst, most often found in younger women, is the dermoid cyst, which contains particles of teeth, hair, or calcium-containing tissue that are thought to be an embryologic (developmental) remnant; such cysts usually do not cause menstrual irregularity and are very common. Dermoids are bilateral in 25 percent of cases, making careful examination of both ovaries mandatory. The cyst has a thickened, white, opaque wall and is more buoyant than other types of cysts.

Ovarian cysts cause problems when they become very large, when they rupture and cause severe internal bleeding, or when a cyst’s pedicle (a tail-like appendage) suddenly twists and cuts off its blood supply, creating severe pain and possibly gangrene. Rupture of a cyst is followed by the acute onset of severe lower abdominal pain radiating to the vagina and lower back. The most severe symptoms of pain and collapse are associated with rupture of a dermoid cyst, as the cyst contents are extremely irritating.

Torsion (twisting) of a cyst may occur at any age but most often in the twenties; it may be associated with pregnancy. A twisted dermoid cyst is the most common, probably because of its increased weight. The onset of pain often occurs in the umbilical region and radiates to one or the other side of the pelvis. Pain on the right is frequently confused with appendicitis. Hemorrhage may sometimes occur from a vessel in the wall of the cyst or within the capsule.

Treatment and Therapy

The diagnosis of an ovarian cyst is made with consideration of the patient’s age, medical and family history, symptoms, and the size of the enlarged ovary. In women under the age of thirty, clinicians, after a manual examination, will usually wait to see if the ovary will return to its normal size. If it does not, and pregnancy has been ruled out, a pelvic X-ray or a sonogram (the use of sound to produce an image or photograph of an organ or tissue), or both, can determine the exact size of the ovaries and distinguish between a cyst and a solid tumor. In women age forty and older, X-rays and sonograms may be done sooner. If uncertainty still exists, the physician may recommend laparoscopy, the visual examination of the abdominal cavity using a device consisting of a tube and optical system inserted through a small incision. The physician may also suggest the option of a larger incision and a biopsy.

In the case of the functional ovarian cyst, if no severe pain or swelling is present, the clinician may adopt “watchful waiting” for one or two more menstrual cycles, during the course of which this type of cyst frequently disappears on its own accord. Sometimes this process is hastened by administering oral contraceptives for several months, which establishes a regular menstrual cycle. Women already taking oral contraceptives rarely develop ovarian cysts.

In the case of torsion or rupture, surgical treatment is indicated, preferably the removal of the cyst only and preservation of as much of the normal ovarian tissue as possible. Sometimes, with a very large cyst, the ovary cannot be saved and must be removed, a procedure called oophorectomy or ovariectomy.

Bibliography:

Altcheck, Albert, Liane Deligdisch, and Nathan Kase, eds. Diagnosis and Management of Ovarian Disorders. 2d ed. San Diego, Calif.: Academic Press, 2003.

Ammer, Christine, et al. The New A to Z of Women’s Health: A Concise Encyclopedia. 6th ed. New York: Checkmark Books, 2009.

Berek, Jonathan S., ed. Berek and Novak’s Gynecology. 14th ed. Philadelphia: Lippincott Williams & Wilkins, 2007.

Kovacs, Gabor T., and Robert Norman, eds. Polycystic Ovary Syndrome. 2d ed. New York: Cambridge University Press, 2012.

Leung, Peter C. K., and Eli Y. Adashi, eds. The Ovary. 2d ed. San Diego, Calif.: Academic Press, 2004.

Mahajan, Damodar K., ed. Polycystic Ovarian Disease. Philadelphia: W. B. Saunders, 1988.

"Ovarian Cyst." Family Doctor, August 2010.

Rosenblum, Laurie. "Ovarian Cyst." Health Library, September 10, 2012.

Vorvick, Linda J., Susan Storck, and David Zieve. "Ovarian Cysts." Medline Plus, February 26, 2012.