Ovarian Cyst: Cyst on the ovary

About seven per cent of women have one or more ovarian cysts, usually discovered by chance during an ultrasound. Fortunately, these fluid-filled cavities are rarely a cause for concern and often go away independently. Ovarian cysts can occur at any age, singly or in large numbers, on one or both ovaries. They do not grow from the proliferation of cells but from the accumulation of tissue fluid. They are the most common benign tumours on the ovary.

Cyst on the ovary: how does an ovarian cyst develop?

The vast majority of cysts develop out of the normal hormonal function of the ovary. They are, therefore, also called functional cysts. They occur predominantly in women of sexual maturity and particularly often during puberty and menopause, i.e. at times when the interplay of hormones is subject to significant changes.

• The most common form is the follicular cyst (cystic cyst). It is more likely to develop in young women during a menstrual cycle when a fertilizable egg develops in the ovary. The sac (follicle) matures but does not rupture to release the egg. So, there is no ovulation, and the follicle continues to grow due to fluid accumulation. In over 90 per cent, follicular cysts spontaneously regress or rupture throughout a menstrual cycle or two.
• Other functional cysts are the yellow body cysts (corpus luteum cysts) caused by bleeding (often during pregnancy),  which usually regress spontaneously.
• Another form is the lutein cysts – which often occur in both ovaries – mainly caused by the increased production of a particular hormone ( HCG ). They can also be the result of hormone treatment when you are unable to have children and usually disappear when the hormone treatment is discontinued.
• Polycystic ovaries ( PCO ) are numerous ovarian cysts that are a significant feature of PCO syndrome (a disease in its own right).

Cysts that grow independently of the function of the ovaries and are caused by secretion retention are less common. They are called organic cysts or retention cysts. They also form a cavity containing, for example, gland secretion or chocolate-coloured thickened blood breakdown products (chocolate cyst), hair, teeth or other body tissue (dermoid cyst). Chocolate cysts develop as part of endometriosis; Dermoid cysts rarely become cancerous.

 

Symptoms of ovarian cysts

Most ovarian cysts are normal and are discovered incidentally during an ultrasound scan. If a cyst becomes noticeable, it is usually quite large, pressing on the surrounding tissue or organs. The symptoms are often only diffuse; there is often a feeling of pressure or unilateral pulling pain in the abdomen. Irregular or heavy menstrual bleeding can also occur.

Complications of ovarian cysts

A particular case is large pedicled cysts, which twist around their pedicle and can suddenly cause severe pain. In addition, cysts can rupture ( ovarian cyst rupture ) and lead to bleeding into the ovary or the free abdominal cavity. The acute abdomen that may result in such cases is a life-threatening complication that requires intensive medical care.

During pregnancy, ovarian cysts larger than 6 cm have an increased risk of such complications and miscarriage; therefore, an operation is usually recommended at the beginning of the second trimester of pregnancy.

 

Diagnosis of the ovarian cyst

First, the doctor will take the patient’s medical history and ask precisely about the symptoms. During the gynaecological examination, he may be able to feel a (painful) enlargement of the ovary. He will use an ultrasound examination through the vagina to see whether the cyst shows any abnormalities. Further examinations, such as an ultrasound of the vessels (Doppler sonography), determination of the tumour markers in the blood and imaging procedures such as computer tomography may follow. In women over 40, cystic changes in the ovary should be precisely clarified. Malignant diseases can also hide behind it.

What therapy is there?

In many cases, it is worthwhile to observe the growth of the cyst first because it will go away on its own in up to 98% of cases. Nevertheless, ultrasound and palpation should regularly monitor even small cysts that do not cause symptoms. Surgical removal is recommended if they grow remarkably quickly, do not respond to medication, cause the woman severe symptoms or appear suspicious in the ultrasound examination.

Regular check-ups for ovarian cysts

In women after menopause, if the cysts are inconspicuous, waiting with regular checks is also justified. Still, the decision to surgically remove them is more likely to be considered since the risk of malignant new growth increases with age.

 

Medication for ovarian cysts

The birth control pill or other hormone preparations with progestin or progestin and estrogen suppress the function of the ovaries. This can stop the cyst from growing or even cause it to regress. They also prevent cysts from forming again. Other drugs that interfere with the hormonal control loop are GnRH analogues and danazol; the last substance is mainly used for endometriosis cysts.

Surgery to remove ovarian cysts

Various surgical procedures are available for surgical intervention, from so-called keyhole surgery to an abdominal incision with an opening of the abdominal wall. The chosen procedure depends on the cyst’s size and the findings. Many cysts can be removed with the help of so-called “keyhole surgery” as part of a laparoscopy (laparoscopy or pelvis-copy).