An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. Ovarian cysts are very common in women during their reproductive years. There are multiple types of ovarian cysts and most are noncancerous. The most common type of cyst is a functional cyst, which may form on a monthly basis as a result of ovulation. These cysts will almost always disappear on their own in about 6-8 weeks. These cysts most commonly do not cause any symptoms, and if any, they are very mild.
Sometimes, however, they may continue to get bigger and start collecting fluid or blood inside them. If they get really big (more than 7-8 cm) then there may be a risk for rupture (burst cyst) or torsion (twisting around the base of the cyst). In that case, you may suffer from severe sharp shooting pain in the abdomen associated with nausea, vomiting, sweating etc.
The pain may be constant or may be intermittent. Sometimes, the pain is so severe that you need to go to the emergency room. In the ER, you will be checked out by a sonogram and blood tests to see if you are losing blood. In most situations, if your blood pressure and heart rate is stable, you will be observed for a few hours and then discharged to follow up with your doctor. Your gynecologist may prescribe birth control pills to prevent the cyst from coming back in the next menstrual cycle.
Polycystic ovaries are also a commonly seen finding. Women with polycystic ovaries may present with symptoms of irregular periods. They may also have a tendency to gain weight, have excessive hair growth and have a pre-disposition to developing diabetes during pregnancy or later on in life. For women who are not ovulating, the ovaries may be enlarged and contain a large number of small cysts. About 4-7% of all women may present with polycystic ovaries.
Polycystic ovarian syndrome (PCOS) is a more complex condition, which includes hormonal imbalance and other symptoms. Your gynecologist can help you diagnose and manage the condition on an ongoing basis.
Another common type of cyst is an “endometrioma, or “chocolate cyst”. These types of cysts result from endometriosis. With endometriosis, endometrial tissue that is usually seen in the uterus grows outside the uterus, in places such as the ovaries. These cysts form as the tissue bleeds with each menstrual cycle, therefore filling the cyst with dark, reddish brown blood. Endometriosis is a complex condition with varying severity and presenting symptoms (Watch out for a more detailed blog coming up on endometriosis!).
Many women are not even aware that they have a cyst and don’t experience any symptoms. If they do experience symptoms of endometriosis, they may include abdominal or pelvic pain. More concerning signs may include bloating, constipation, extreme abdominal or pelvic pain, early satiety, nausea or vomiting.
Ovarian cysts may be found during a routine pelvic exam. If one is found, your provider will likely do an ultrasound of the uterus and ovaries to look closer at the cyst. You will also need sonogram if are experiencing abdominal pain or any other symptoms to rule out any other conditions in the lower abdomen that may be causing pain.
The treatment depends on the size and type of cyst found on ultrasound and your symptoms. With small functional cysts that are not causing the patient symptoms, watching and waiting is the usual course.
If the cysts are bothersome and growing, some treatment options may be birth control pills, which will help new cysts from forming. Your gynecologist may recommend removal by laparoscopic surgery if the cyst is getting bigger, painful or looks concerning on certain ultrasound findings.
Adeeti Gupta MD, FACOG