Ovarian Cysts

What are ovarian cysts?

Ovarian cysts are fluid-filled cysts commonly seen within ovaries. The cysts can vary in size and range from a few millimetres to tens of centimetres. Many ovarian cysts are asymptomatic but some can produce symptoms such as pain.

How common are ovarian cysts?

Ovarian cysts are very common and probably most women have them at some stage of their life.

What are the common types of ovarian cysts and what causes them?

There are three common types of ovarian cysts:

• Functional ovarian cysts: These cysts are also known as follicular cysts and are common in young women. Function of ovaries is to produce eggs every month and it is not uncommon for these eggs to be retained and enlarge in size. These cysts are often self-limiting and can be monitored. Usually, these cysts will resolve spontaneously without any treatment.
• Benign ovarian cysts: These cysts are not cancerous but do not resolve spontaneously. Tumour marker (CA125) levels are often normal and surgery can be performed as a key-hole (laparoscopic) procedure. Dermoid cyst or teratoma is a common benign ovarian cyst.
• Malignant ovarian cysts (ovarian cancer): These cysts are often seen in older women and the tumour marker (CA125) level may be raised. Even though ovarian cancer may be suspected on tests, it is confirmed after removal and histological analysis. Treatment is often (but not always) by open surgery. In some cases of advanced ovarian cancer, further treatment may be required after surgery in the form of chemotherapy.

What are the symptoms of ovarian cysts?

Many ovarian cysts are asymptomatic but some may cause symptoms such as abdominal pain, fullness of abdomen, lump and occasionally sharp pain. Sharp pain could be a sign of a complication such as torsion, bleeding or rupture.

Cancerous ovarian cysts in early stages may not produce any symptoms at all or the symptoms may be vague or appear unrelated. In addition to above symptoms, abdominal distension, indigestion, dyspepsia or altered bowel habits may be associated with malignant ovarian cysts. New onset of pelvic pain after the age of 50 is also a significant symptom. These symptoms often imitate irritable bowel syndrome (IBS) and you should see your GP urgently if you are older than 50 and have these symptoms.

For more information regarding ovarian cancer symptoms please read the Early Recognition of Ovarian Cancer leaflet published by NICE.

How are ovarian cysts diagnosed?

Ultrasound scan (vaginal or abdominal) is used to make this diagnosis. An MRI scan may be advised to obtain further information about the nature of an ovarian cyst. CA125 blood test (also known as the tumour marker test) may be performed. This test is often raised in cancerous cysts but may also be raised in other benign conditions such as endometriosis, fibroids, infection, during monthly periods and after surgery.

Do the ovarian cysts always need removal?

Not all ovarian cysts need removal. Functional (follicular) cysts often will resolve spontaneously. Surgery may be needed if the cysts are persistent or if there are symptoms (see above). If there is a suspicion of cancer, urgent surgery is indicated to make a diagnosis and also as treatment.

How are ovarian cysts treated?

Most of the ovarian cysts can be removed as a key-hole (laparoscopic procedure). Three or four small (5-10mm) incisions are made on the tummy wall. Camera and special surgical instruments are then inserted to remove the cyst and healthy ovarian tissue is conserved. The cyst is then put in a plastic bag, decompressed and removed with no spillage inside the tummy. Key-hole surgery avoids the need for a big cut and has the advantage of reduced hospital stay and quick recovery and return to normal life.

Will I lose my ovary?

The ovary containing the cyst does not need to be removed unless the cyst is suspected to be cancerous or too large. If the cyst is suspected to be cancerous, the ovary may be removed to avoid inadvertent rupture and spillage of contents. In other situations the ovary can almost always be conserved.

How can you prevent recurrent ovarian cysts?

It may not be always possible to prevent ovarian cysts, but going on the contraceptive pill may prevent cyst-formation to some degree.

Where can I find out more information or access any useful support services?