More About Ovarian Cysts

The eggs (or ova) form and then mature in clear, fluid-filled cysts. When they reach the size of a large cherry, they "pop" to release the egg into the fallopian tube - a process called ovulation. If the ova is fertilized, then it will implant and pregnancy occurs. If it doesn't, it will pass from the body or dissolve. Once ovulation has occurred, all the remaining developing ova shrivel up, and within 14 days our period comes and the entire process will repeat itself.

But sometimes the developing ova do not shrivel up and will continue to grow and fill with clear or straw-colored fluid until they are the size of a tennis ball or even as large as a soccer ball!!

Mucinous cyst adenomas are similar to the enlarged follicular cysts and behave the same, but do not originate from ovulation. Both of these types of cysts are rarely painful unless they "pop", causing many women to pass out and end up at the emergency room. This is usually not life threatening unless a blood vessel is torn during the rupture, causing internal bleeding.

Torsion is another complication of these benign cysts, which is most likely to happen when they are no larger than the size of a golf ball. Torsion is when the ovary literally flips over on itself, twisting off the blood flow. This is an emergency because not only is it extremely painful, but will cause the ovary to die from lack of blood flow if not surgically corrected as quickly as possible.

'Benign' cysts means they are not cancerous. Benign cysts do not change to 'malignant' (meaning cancerous) cysts, and women with benign cysts are not at a higher risk for making malignant cysts.

There are other forms of benign cysts like Dermoid cysts, also known as mature teratomas. These cysts are known for the hair, fat, muscle, bone and teeth that can be found in them. Hemorrhagic cysts are cysts that have clear fluid and blood clots in them. Women with endometriosis are at risk for making cysts called Endometriomas or "Chocolate cysts". These are cysts filled with old, brownish appearing blood and endometrium that has come from the back flow of period blood into the Fallopian tubes and onto the ovaries. When they rupture it looks like chocolate syrup pouring out and that is why they were nicknamed Chocolate cysts.

Most cysts are identified by ultrasound. Ultrasound is very good at characterizing cysts as benign or malignant, and can identify simple fluid filled cysts from the other types. If simple, fluid filled cysts are 5 cm or less in size they can resolve on their own and you may never need surgery.

Sometimes women notice an increase in discharge when small cysts rupture or leak. This is usually a thin, watery, odorless fluid.

It is always best to see your doctor if you notice changes in your menstruation, pain with sex or when using the restroom, walking or exercising, increase in need to urinate, or a feeling of fullness in your abdomen or pressure on your bladder.

I hope this helps answer your worries and questions about ovarian cysts. There is so much more on this subject but I wanted to simplify it for you a little bit.

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Why Do Our Ovaries Make Cysts…..and Are They OK?

Why do the ovaries make cysts? What do they mean? Does it mean cancer, or that you can get cancer easier than someone who never gets them?

Well, we have two ovaries and two Fallopian tubes that transport the egg or embryo from the ovaries to the uterus. Ovaries are small - about the size and shape of a pecan. Every single month, the eggs (or ova) start maturing and are released at ovulation. But, our hormones stimulate both ovaries, and they both start developing eggs. So, they race each other until one of the follicular cysts holding an egg pops, and the egg is released. At that moment, all the other follicular cysts carrying eggs shrivel up and go away. For example, there could be five cysts on your right ovary and four on your left ovary during any month. We can ovulate on our right ovary four months in a row and then maybe an egg on the left 'wins', so we ovulate on the left. That might happen three months in a row on the left, or it could switch back and the right ovary pops out the egg.

We may think, "Ohh, the ovaries switch back and forth every month from right to left; they take turns." But that's not how it really happens. It's a race, and our body doesn't care which wins, because the ovaries are identical and are both affected each month by the same hormones. They work like one organ even though they are two.

The follicular cysts, when mature, are about the size of a cherry just before the egg is released. They have an egg in them and are filled with clear, water-like fluid. As mentioned, once one ruptures, all the remaining ones shrivel and dissolve. The cyst that popped out the egg transforms into a Corpus Luteum cyst. This cyst then produces our female hormone called progesterone. Without progesterone, we would all miscarry every pregnancy. Progesterone has the job of keeping the uterine lining in place for exactly 14 days. At that point, if there is no pregnancy hormone in our blood stream, the Corpus Luteum cyst dissolves and our period comes as the uterine lining is released.

If there is pregnancy hormone present in the blood, the Corpus Luteum will stay to produce progesterone for about 13 weeks - the entire first trimester of pregnancy - so we don't miscarry. After 13 weeks, the placenta takes over this job, so the Corpus Luteum will dissolve. Some women never make this cyst or it will only stay for 14 days despite being pregnant, and they will, therefore, miscarry every pregnancy. Once we know this, we can supplement progesterone to make up for the absent Corpus Luteum.

Now the reason I took the time here to explain this to all of you is because I have so many patients who come into my office after having an ultrasound at the ER or primary care doctors office and have been told, "You have cysts on your ovaries." Then are instructed to go see their gynecologist. Some women were told this 10 years ago and come in for the exam and tell me they have a cyst but never went back to a doctor to follow-up. So they worry it is still there and getting bigger.

Remember, we form multiple cysts every single month, and as I explained above, these cysts form, and as we ovulate, they all dissolve away. Then it repeats the next month until we arrive at menopause. So all cysts are not bad, they are normal.

I hope this explains and helps you to understand why cysts are supposed to be there and come and go. I will continue this teaching with next blog because I'm not done. Okay?

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Ovarian Cysts

Nothing seems to scare women more than hearing that they have a cyst on their ovary.

It is rare for a cyst to be found at a regular, annual pelvic exam with Pap Smear because the ovaries and uterus can be difficult to feel on Bimanual exam, as the ovaries can be pushed and moved around. Most women do not even know they have a cyst unless it causes pain or abnormal bleeding. Most ovarian cysts are found on a routine ultrasound or CT scan ordered by the Emergency Room, Internal Medicine or Primary Care doctors to evaluate a medical condition. When the results show an ovarian cyst, most of these care providers do not have the expertise in women's care to counsel patients properly. So, women come to their OB/GYN feeling worried that any cyst is harmful or cancerous.

Most ovarian cysts start during the normal function of your menstrual cycle. These are known as functional cysts. The 2 types are Corpus Luteal and Follicular cysts. They are the most common type of benign cysts, they usually go away on their own, they are usually harmless, and they rarely cause pain. A positive pregnancy test usually indicates the presence of a Corpus Luteal cyst. They develop at the sight of ovulation on the ovary. They remain for the first 3 months of pregnancy and produce the hormone progesterone to keep the lining of the uterus from releasing. If not pregnant, they will stay for only 2 weeks and then dissolve, which then causes the period to start.

Your ovaries normally grow small, cyst-like structure called follicles each month. Follicles are about the size of a marble and produce the female hormones estrogen and progesterone. The follicles house the developing eggs which grow and mature until the egg is released at ovulation.

Once ovulation occurs all of the remaining follicles dissolve, leaving only the newly formed Corpus Luteum from the follicle where ovulation took place. But, sometimes one of the other follicles won't dissolve and instead keeps growing and filling with fluid. These can grow very large, even to the size of cantaloupe, with the largest know to be the size of a watermelon! Of course these must be drained or removed in surgery. Thankfully, most can be removed without damaging the ovary.

Sometimes the Corpus Luteal cyst bleeds into itself after ovulation and grows large - becoming painful. These can be watched, but if they become too painful, they will also usually be removed surgically.

Some cysts are not related to the normal function of your menstrual cycle. They are usually complex and not fluid-filled. For example:

• Dermoid cysts are benign and the most common, yet unusual, of these complex cysts. These cysts may contain tissue such as hair, skin, muscle, fat or teeth. They form from out-of-control growth of ovarian tissue. They are rarely cancerous.
• Cystadenomas are benign cysts that develop from ovarian tissue and may be filled with a watery liquid or a mucous material.
• Endometriomas are benign cysts that develop from endometriosis, a condition where uterine endometrial cells grow outside your uterus. Some of that tissue may attach to your ovary, forming a growth.
• Serous cystadenocarcinoma is a cancerous tumor. Other malignant tumors are named malignant teratomas, and metastatic from other organs.

Diagnosis can be obtained by ultrasound, blood work, and through surgical biopsy. Most of you have had an ultrasound at some point and know that it is a painless procedure where a small transducer is used to send and receive high-frequency sound waves to a screen which forms an image of what is being looked at. The transducer can be moved over your abdomen or a smaller one can be placed inside your vagina, to create an image of your uterus and ovaries in order see and measure ovarian cysts.

If a cyst looks suspicious the next step would be blood work and surgery. The type of surgery would depend on the size and location. A Laproscope is a slim camera with a light that can be inserted into your abdomen through a small incision below your belly button. This makes it very easy to see your uterus and ovaries, take pictures and remove the cyst if needed.

The radiologists will report cysts as fluid-filled, solid, complex or mixed. Those that are solid or mixed and filled with fluid, solid tissue or blood clots usually require further evaluation. Your age, size of the cyst and the possibility of pregnancy also have to be considered.

It is important to be alert to changes in your monthly cycle, including symptoms that may accompany menstruation that aren't typical for you (or that persist over more than a few cycles). If a cyst ruptures, it can cause severe pain and lead to internal bleeding.

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, but only if you have no symptoms and an ultrasound shows you have a small, fluid-filled, not a complex cyst.

Blood levels of tumor markers like Cancer Antigen-125 or CA -125, Alpha-feta protein, HCG (Human Chorionic Gonadatropin) can be elevated in women with ovarian cancer. Non-cancerous conditions like endometriosis, uterine fibroids and pelvic inflammatory disease can cause CA-125 to be elevated, so without an ultrasound, comparison is not complete or specific.

It is important that you get follow-up pelvic ultrasounds at periodic intervals to see if you have recurrent cysts, or if your cyst has changed in size.

Birth control pills can 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 and the risk decreases the longer you take birth control pills. This is because it prevents ovulation and can reduce your risk by 80% if taken for one year.

So next time you have a cyst found on ultrasound, be sure you know the size and character of it and be sure the ultrasound wasn't done at time of ovulation.

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Ovarian Cysts

Today I want to help all of you understand what it means when you are told you have a cyst on your ovary. I think this is one of the scariest things to hear after having an ultrasound or CT scan, because most of us think of cysts relating to cancer and don't understand what it could mean. Hopefully, you have a wonderful gynecologist who will explain your tests to you.

Functional ovarian cysts are the most common type of benign cyst on the ovary. It is a clear bubble that forms on the surface of a woman’s ovary during ovulation. Inside is a maturing egg, and there are usually several of these on both ovaries each month that race each other to mature first, rupture and pop out the mature egg into the fallopian tube. Once this bubble pops, and one of the eggs is ovulated, that cyst and all the rest go away. If an egg is not released, or if the sac closes up after the egg is released, the sac can swell up with fluid or blood and begin to enlarge. The bubble can then fill up with a pale yellowish fluid. It is still called a "functional" cyst at this point, or a "hemorrhagic" cyst if it bleeds into itself after ovulation. Both are benign and have no relationship to growths on the ovary related to cancer.

Functional cysts are different from ovarian growths caused by other problems, such as cancer, and most of these are harmless and will go away on their own. Because they do not cause symptoms, and can go away without treatment, most of us may not even know we have one. But if a cyst becomes larger, it can twist (called torsion) and cut off the blood flow to the ovary, rupture, or bleed. If this happens, it is EXTREMELY PAINFUL, and I have seen women pass out or fall on the floor crying due to the pain.

Most of the time, functional cysts will form when the ovary doesn't release the egg and the bubble keeps growing and growing, waiting for the egg to release. Sometimes it is formed after the egg releases, when the bubble seals over and blocks the drainage of fluid, bleeds into itself and fills with blood and clots.

The larger a functional cyst is, the more likely it is to cause symptoms such as back/side pain, delayed/irregular menstrual cycles, constant bleeding/spotting and pain with sex.

These cysts can be seen with ultrasound or CT scan and sometimes can be felt during a pelvic exam. Once you know you have one, then it can be watched to see if it goes away on its own. But, if it is larger than normal and causing pain or bleeding, it can be easily removed by laparoscopic surgery.

I hope this helps your understanding so you know what to ask if you get one.

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Can Ovarian Cysts Cause Vaginal Discharge?

Vaginal discharge can be a perplexing problem. Especially when you know something has changed, but all your tests at the doctor's office are negative for an infection. It's not always explained or even obvious why we are having changes, and most of the time the symptoms come and go - so it can be confusing.

Many women know that ovarian cysts can cause pain but do not realize that they can cause all sorts of other symptoms. Not sure why you're having low pelvic pain and pressure? Suffering an increase in vaginal discharge? Maybe you are experiencing symptoms of ovarian cysts.

Ovarian cysts are fluid-filled sacs on the ovary that are a result of ovulation. Each month, a woman produces many follicles, which are fluid-filled cysts that the egg matures in. These (and most ovarian cysts) are benign and harmless. Most cysts are a direct result of ovulation, and therefore very common. Thankfully, most cysts resolve themselves without intervention.

Once a single ovarian follicle ruptures and "pops" out the egg, all the rest of the maturing follicles from that cycle should shrink back and dissolve. But, sometimes one or more do not do this and, in fact, they keep growing. They have been known to get larger than a baseball! If this ruptures, it can cause internal bleeding and extreme pain. When a cyst ruptures, the pain can be so severe that many women pass out.

Most women will have an ovarian cyst at some point, but won't even know it exists because most of them are painless. They simply swell up, then leak the fluid back into your bloodstream on their own. There are other types of benign cyst that occur but it is impossible to know whether a cyst is benign or cancerous by how you feel. That is why it is important to see your doctor for blood tests and an ultrasound to determine if it needs to be removed or has malignant qualities.

The following symptoms could indicate the presence of ovarian cysts:

• Constant pain. Take note of when you experience pain. Is it cyclical? Are you experiencing pain during the first half of your menstrual cycle, but it goes away just after the time you should be ovulating? If so, you may have a follicular cyst, which is considered a harmless, functional cyst. Do you experience pain in the latter half of your cycle? You may have a corpus luteum cyst, which is also related to ovulation, is also benign and is considered functional. But, if the pain is persistent and not cyclical, it's a good idea to get it checked out sooner rather than later.

• Both benign and malignant cysts can grow to be very large. They may place pressure on internal organs and cause you discomfort and pain with sex.

• Larger cysts can also place pressure on your bladder or colon. This leads to frequent trips to the bathroom. Large cysts can also obstruct the colon, causing narrow stools. Hormone-producing cysts can cause an increase in vaginal discharge and menstrual irregularities, such as spotting. Because cysts sit very close to the opening of the fallopian tube, they can discharge blood or fluid as they drain, and it will run down through the intrauterine cavity, through the cervix and into the vagina.

Most ovarian cysts resolve on their own with little or no pain and will go undetected. But it is always best to have your doctor check you if you are having any of these symptoms. Vaginal discharge can disrupt the normal vaginal flora and actually bring on more bacterial and yeast infections. WaterWorks is a great system to use to maintain feminine hygiene and clear any abnormal discharge or odor. It works best when added to you regular hygiene regime and used at least 3-4 times a week.

I hope this helps you understand your body better. Take care and be safe. Thanks for all your questions. It helps others when you ask your questions, because we are all learning and experiencing the same things.

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I Have an Ovarian Cyst. Should I Be Worried?

We 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.

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What is Ovarian Torsion?

Ovarian torsion is when the ovary and fallopian tube flip and twist over on themselves. Rotation of the ovary causes obstruction to venous and arterial flow. Ovarian torsion is usually associated with a cyst or benign type tumor on the ovary. These cysts or benign tumors cannot be larger than 5 cm, because, once they get larger than that, they would be stuck in one place in the pelvis, wedged next to the uterus and unable to move about.

The reason I mention this is to follow-up on our discussion on ovarian cysts and also because so many of you are worrying about this happening to you. I really want to let you know more about it, so no matter what you read on the internet, you can have some sound medical information.

Ovarian torsion is an uncommon cause of acute abdominal pain at any age, but it is a gynecologic emergency - diagnostic delay can result in loss of the ovary. The ovary, and often the fallopian tube as well (adnexal torsion) become twisted around themselves. This twisting initially obstructs venous flow, which causes engorgement and edema. The engorgement can progress until arterial flow is also compromised, leading to the death of that ovary. The engorgement can be confusing and appear to be a cyst or tumor on ultrasound. An ovary with a mass or cyst is more prone to twisting by virtue of its asymmetry.

The classic presentation of adnexal torsion is sudden onset of one-sided lower abdominal pain which may actually radiate over to the other side and make it hard to actually know, without an ultrasound, which side is actually affected. It may even radiate to the groin or upper thighs and down legs.

There are other things that can cause severe pain and confuse the diagnosis, such as ovarian cysts, tubo-ovarian abscesses, ectopic pregnancy (a pregnancy test can easily rule this out), appendicitis, or kidney stones. The scariest condition in the differential diagnosis for adnexal torsion is an ectopic pregnancy. Any female of reproductive age presenting to the emergency department should have a pregnancy test. There are no laboratory tests which are helpful in establishing the diagnosis of adnexal torsion.

Some tests may be helpful in pointing you toward an alternative diagnosis. A urinalysis may reveal blood - consistent with kidney stones, or it may show bacteria - more consistent with a urinary tract infection. A fever or flu-like symptoms may mean there is a severe pelvic infection like PID and a tubo-ovarian abscess over torsion.

Even though there are fancier scans like CT scans and MRIs, ultrasound is the best way to detect ovarian torsion and determine if there is still good blood flow to the ovary. If the twisting is too tight, it can completely cut off blood flow to the ovary and the ovary will die. As the flow is stopped, the ovary swells and the blood can clot; this is intensely painful. This is why, even though not life threatening, it is still considered a medical emergency - we always want to save the ovary if possible. Keep in mind, a woman can reproduce and live a normal life, and go through menopause at the normal time (49-54 years) with just one ovary. So, if the ovary does die and has to be removed, all will still be okay.

The presence of blood flow on color Doppler imaging does not allow exclusion of torsion, but instead suggests that the ovary may be viable, especially if flow is present centrally. Absence of flow in the twisted vascular pedicle may indicate that the ovary has already died and needs to be removed.

Outpatient care has no role in the treatment of ovarian torsion. So you can't treat it with pain medications and waiting. Ovaries don't flip back on their own once they have twisted. The ovary must be untwisted surgically as soon as possible to restore blood flow. Patients with either a suspected or confirmed diagnosis of ovarian torsion should be admitted and operated on as soon as possible. Laparoscopic surgery can work, or the doctors may opt for an open procedure for confirmation of the diagnosis and treatment.

So, I hope this helps all of you with understanding this. The internet is so informative, but it is still important to know where and who the information is coming from.

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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.

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