I Have an Ovarian Cyst. Should I Be Worried?

>> Tuesday, January 29, 2013

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Good morning.

I hope you are all having a wonderful New Year. I hear many of you worrying because you were told you have a cyst on your ovary, and feel like it is a defect that will always be there. I am always amazed at the lack of information provided about the normal function of the female body. In this context, we can better discuss what ovarian cysts are, why they are there, and what can be done about them.

There are different types of cysts, many of which are normal and harmless (benign). Functional cysts, which are not disease related, occur as a result of ovulation (the release of an egg from the ovary). These are relatively common, and should not be confused with other types of cysts that are disease- or cancer-related.

Most ovarian cysts are functional, not dangerous and form for the purpose of ovulation. A functional ovarian cyst is a sac that forms on the surface of a woman’s ovary during ovulation. It holds a maturing egg. Usually the sac goes away after the egg is released.

Usually there are several cysts on both ovaries during the menstrual cycle just before ovulation. These functional cysts, or follicles, race each other to be the first to ovulate. Once ovulation occurs, all the cysts regress (go away) and a new cyst is formed in the same place ovulation occurred – this is called a Corpus Luteum cyst. This cyst has the important function of making progesterone the last half of our menstrual cycle. Progesterone is the 'secondary' female hormone that works synergistically with Estrogen, the 'primary' female hormone.

Estrogen builds the lining of the uterus (the endometrium) and progesterone stabilizes the lining so it doesn't come out prematurely. If no pregnancy occurs, the Corpus Luteum will dissolve and progesterone levels, along with Estrogen levels, will decline. This causes the uterine lining to release, and within 14 days our period will come. However, if the body gets the message that pregnancy occurred, the Corpus Luteum will not dissolve, but rather continue to make progesterone for another 12 weeks (the entire first trimester). Once the first trimester is completed, the placenta takes over this job.

When the Corpus Luteum fails, women will have a miscarriage as the loss of progesterone signals the body to release the uterine lining. Some women have what is known as Corpus Luteal Defect (CLD) and have recurrent pregnancy losses. Once CLD is recognized, progesterone can be given through the first trimester to maintain their pregnancy.

Functional ovarian cysts are different from ovarian growths caused by other problems, such as cancer. As mentioned, most of these cysts are harmless. They do not cause symptoms, and they go away without treatment. If an egg is not released, or if the sac closes up after the egg is released, the sac can swell up with fluid. If this happens, the cyst can keep growing larger and larger as it keeps filling with fluid, and it can then twist, rupture, or bleed. This can be very painful. These cysts have been known to get as large as cantaloupes or even a small watermelon without rupturing.

Most cysts do not cause symptoms unless they continue to grow after ovulation. The common symptoms are pain and aching with pressure in the lower pelvis, severe pain with sex (dysparunea), painful menstruation (dysmenorrhea), a dull ache in your back, and a feeling of fullness & bloating.

Cysts have the ability to twist over on themselves. This is called torsion. Torsion is extremely painful and usually happens with cysts no larger than 4-5 cm, as once they are larger they have no room to twist. Torsion cuts off the blood flow to the ovary and can increase the risk of it bursting, causing internal bleeding. A ruptured ovarian cyst can be a medical and surgical emergency when internal bleeding occurs, and it causes sudden, severe pain, often with nausea and vomiting.

Most ovarian cysts can be identified by ultrasound, and this is the best way to determine if they are enlarging or changing in any way. If it is around 3 cm with no pain, generally no follow up is needed. Once they are larger (4-5 cm) with no pain or discomfort, then it is usually followed with a repeat ultrasound in 6-8 wks. The cyst is likely to go away on its own during this time, as most functional cysts do without treatment.

Birth control pills or injections prevent ovulation and actually rest the ovaries. Because of this, no follicles or functional cysts form, and the current cyst can actually shrink, preventing the need for surgery.

The use of heat or ice and special pain medicine and muscle relaxers for mild to moderate pain may help while the cyst is shrinking. If at any time the cyst bleeds, causes severe pain or continues to increase in size, you may need to have surgery to remove it.

It is important to see your doctor if you think you may have a cyst to determine what type and the size, so it can be treated and followed for your safety. Ovarian cysts cannot be evaluated by a blood test, but if there is cancer present, the blood will have certain bio-chemicals or hormones in it from the tumor. A blood test can be done when there is a cyst to help determine whether it is cancer.

Again, not all cysts are bad or life threatening. In fact, many are normal and should be there if you are a woman in your reproductive years and still having regular menstrual cycles. I hope this helps some of you to ask questions and investigate - so you are not left thinking you have a cyst on your ovary, and it will be there permanently.

Hope you have a fun, happy and safe week.

Dr. Susan Boyd, MD
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