What Are Ovarian Cysts?

Ovarian cysts just seem to be a confusing subject for most women. There is conflicting information from many different sources. Let me try to help explain the topic. Most ovarian cysts start during the normal function of your menstrual cycle. These are known as functional cysts. Other types of cysts are much less common.

Your ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and progesterone and release an egg when you ovulate. Sometimes a normal monthly follicle just keeps growing. When that happens, it becomes known as a functional cyst.

There are two types of functional cysts:

• Follicular cyst. Around the midpoint of your menstrual cycle, an egg bursts out of its follicle and begins its journey down the fallopian tube in search of sperm and fertilization. A follicular cyst begins when something goes wrong and the follicle doesn't rupture or release its egg. Instead it grows and turns into a cyst.
• Corpus luteum cyst. When a follicle does release its egg, the ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. This changed follicle is now called the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst.

Functional cysts are usually harmless, rarely cause pain, and often disappear on their own within two or three menstrual cycles. The fertility drug clomiphene (Clomid, Serophene), which is used to induce ovulation, increases the risk of a larger than normal corpus luteum cyst developing after ovulation. These cysts don't prevent or threaten a resulting pregnancy.

Other types of cysts are not related to the normal function of your menstrual cycle. They can cause pain when walking (or lying down in certain positions) and painful sexual intercourse.

• Dermoid cysts can appear in two types, mature and immature. These cysts may contain tissue such as hair, skin or teeth because they form from cells that produce human eggs. They are rarely cancerous.
• Cystadenomas - These cysts develop from ovarian tissue and may be filled with a watery liquid or a mucous material.
• Endometriomas - These cysts develop as a result of endometriosis, a condition in which uterine endometrial cells grow outside your uterus. Some of that tissue may attach to your ovary and form a growth.

Dermoid cysts and cystadenomas can become large, causing the ovary to move out of its usual position in the pelvis. The complications that we need to be aware of in benign cysts, especially if we are watching and waiting for it to disappear, include ovarian torsion and rupture that can cause extreme, acute pain. This pain can be so intense that women can pass out from it. A cyst that ruptures may cause severe pain and lead to internal bleeding.

Some women develop less common types of cysts that may not produce symptoms, but that your doctor may find during a pelvic examination. Cystic ovarian masses that develop after menopause may be cancerous (malignant). These factors make regular pelvic examinations important. If a cyst is suspected, doctors often advise further testing to determine its type and whether you need treatment. There are specific things that need to be known about a cyst before treatment recommendations can be made:

• What size is it?
• Composition - Is it filled with fluid, solid or mixed? Fluid-filled cysts aren't likely to be cancerous. Those that are solid or mixed — filled with fluid and solid — may require further evaluation to determine if cancer is present.
• Pregnancy test. A positive pregnancy test may suggest that your cyst is a corpus luteum cyst, which can develop when the ruptured follicle that released your egg reseals and fills with fluid.

A pelvic ultrasound is a painless procedure where a wand-like device (transducer) is used to send and receive high-frequency sound waves (ultrasound). The transducer can be moved over your abdomen and inside your vagina, creating an image of your uterus and ovaries on a video screen. This image can then be photographed and analyzed by your doctor to confirm the presence of a cyst, help identify its location and determine whether it's solid, filled with fluid or mixed.

In another procedure, Laparoscopy, a slim, lighted instrument is inserted into your abdomen through a small incision, allowing your doctor to see your ovaries and remove the ovarian cyst.

The CA 125 blood test may also be used. Blood levels of a protein called cancer antigen 125 (CA 125) are often elevated in women with ovarian cancer. If you develop an ovarian cyst that is partially solid and you are at high risk of ovarian cancer, your doctor may test the level of CA 125 in your blood to determine whether your cyst could be cancerous. Elevated CA 125 levels can also occur in noncancerous conditions, such as endometriosis, uterine fibroids and pelvic inflammatory disease. That is why comparison with ultrasound examination is important.

Cyst treatment depends on your age, the type and size of your cyst, and your symptoms. The different methods of treating known benign cysts (definitely not cancerous) may vary among different practitioners:

• Watchful waiting - In many cases you can wait and be re-examined to see if the cyst goes away on its own within a few months. This is typically an option — regardless of your age — if you have no symptoms and an ultrasound shows you have a small, fluid-filled cyst. Your doctor will likely recommend that you get follow-up pelvic ultrasounds at periodic intervals to see if your cyst has changed in size.
• Birth control pills - Your doctor may recommend birth control pills to reduce the chance of new cysts developing in future menstrual cycles. Oral contraceptives offer the added benefit of significantly reducing your risk of ovarian cancer — the risk decreases the longer you take birth control pills.
• Surgery - Sometimes surgery is the best way to evaluate a cyst to see what it is, such as a functional cyst that is growing, or persists through two or three menstrual cycles. Cysts that cause pain or other symptoms may be removed. Some cysts can be removed without removing the ovary in a procedure known as a cystectomy. If the ovary has been damaged by the cyst, then removing the affected ovary and leaving the other intact in a procedure known as oophorectomy may be the best solution.

Of course cancerous cysts need to be referred and managed by a cancer specialist.

So it is good to know that not all cysts are bad or that something is wrong inside of you. The best thing to do is to go check with your doctor, and if you have always had trouble with cysts, then have them check on a regular basis.