Ovarian Cysts

Ovarian cysts are sacs containing fluid or semisolid material that develop in or on the surface of an ovary.

An ovarian cyst is being surgically removed from a 25-year-old female patient. (Photograph by Art Siegel, Custom Medical Stock Photo. Reproduced by permission.)

Description

Ovarian cysts are common and the vast majority are harmless. Because they cause symptoms that may be the same as ovarian tumors that may be cancerous, ovarian cysts should always be checked out. The most common types of ovarian cysts are follicular and corpus luteum, which are related to the menstrual cycle. Follicular cysts occur when the cyst-like follicle on the ovary in which the egg develops does not burst and release the egg. They are usually small and harmless, disappearing within two to three menstrual cycles. Corpus luteum cysts occur when the corpus luteum—a small, yellow body that secretes hormones—doesn't dissolve after the egg is released. They usually disappear in a few weeks but can grow to more than 4 in (10 cm) in diameter and may twist the ovary.

Ovarian cysts can develop any time from puberty to menopause, including during pregnancy. Follicular cysts occur frequently during the years when a woman is menstruating, and are non-existent in postmenopausal women or any woman who is not ovulating. Corpus luteum cysts occur occasionally during the menstrual years and during early pregnancy. (Dermoid cysts, which may contain hair, teeth, or skin derived from the outer layer of cells of an embryo, are also occasionally found in the ovary.)

Causes and symptoms

Follicular cysts are caused by the formation of too much fluid around a developing egg. Corpus luteum cysts are caused by excessive accumulation of blood during the menstrual cycle, hormone therapy, or other types of ovarian tumors.

Many ovarian cysts have no symptoms. When the growth is large or there are multiple cysts, the patient may experience any of the following symptoms:

(Illustration by Argosy Inc.)

• Fullness or heaviness in the abdomen.
• Pressure on the rectum or bladder.
• Pelvic pain that is a constant dull ache and may spread to the lower back and thighs, occurs shortly before the beginning or end of menstruation, or occurs during intercourse.

Diagnosis

Non-symptomatic ovarian cysts are often felt by a doctor examining the ovaries during a routine pelvic exam. Symptomatic ovarian cysts are diagnosed through a pelvic exam and ultrasound. Ultrasonography is a painless test that uses a hand-held wand to send and receive sound waves to create images of the ovaries on a computer screen. The images are photographed for later analysis. It takes about 15 minutes and is usually done in a hospital or a physician's office.

Treatment

Many follicular and corpus luteum cysts require no treatment and disappear on their own. Often the physician will wait and re-examine the patient in four to six weeks before taking any action. Follicular cysts don't require treatment, but birth control pills may be taken if the cysts interfere with the patient's daily activities.

Surgery is usually indicated for patients who haven't reached puberty and have an ovarian mass and in post-menopausal patients. Surgery is also indicated if the growth is larger than 4 in (10 cm), complex, growing, persistent, solid and irregularly shaped, on both ovaries, or causes pain or other symptoms. Ovarian cysts are curable with surgery but often recur without it.

Surgical options include removal of the cyst or removal of one or both ovaries. More than 90% of benign ovarian cysts can be removed using laparoscopy, a minimally invasive outpatient procedure. In laparoscopic cystectomy, the patient receives a general or local anesthetic, then a small incision is made in the abdomen. The laparoscope is inserted into the incision and the cyst or the entire ovary is removed. Laparoscopic cystectomy enables the patient to return to normal activities within two weeks. Surgical cystectomy to remove cysts and/or ovaries is performed under general anesthesia in a hospital and requires a stay of five to seven days. After an incision is made in the abdomen, the muscles are separated and the membrane surrounding the abdominal cavity (peritoneum) is opened. Blood vessels to the ovaries are clamped and tied. The cyst is located and removed. The peritoneum is closed, and the abdominal muscles and skin are closed with sutures or clips. Recovery takes four weeks.

Alternative treatment

Alternative treatments for ovarian problems—herbal therapies, nutrition and diet, and homeopathy—should be used to supplement, not replace, conventional treatment General herbal tonics for female reproductive organs that can be taken in tea or tincture (an alcoholbased herbal extract) form include blue cohosh (Caulophylum thalictroides) and false unicorn root (Chamaelirium luteum). Recommendations to help prevent and treat ovarian cysts include a vegan diet (no dairy or animal products) that includes beets, carrots, dark-green leafy vegetables, and lemons; anitoxidant supplements including zinc and vitamins A, E, and C; as well as black currant oil, borage oil, and evening primrose oil (Oenothera biennis) supplements. Homeopathic treatments—tablets, powders, and liquids prepared from plant, mineral, and animal extracts—may also be effective in treating ovarian cysts. Castor oil packs can help reduce inflammation. Hydrotherapy applied to the abdomen can help prevent rupture of the cyst and assist its reabsorption.

Prognosis

The prognosis for non-cancerous ovarian cysts is excellent.

Prevention

Ovarian cysts cannot be prevented.