Cysts: When growths develop inside the ovaries

Many women experience lower abdominal pains at some point, and one common cause is ovarian cysts. However, some women may have the cysts even if they don’t feel lower abdominal pain.

What are ovarian cysts?

Ovarian cysts are fluid-filled sacs that can develop in or on the ovary. Ovaries are where the eggs develop, mature and are released once a month during ovulation (roughly mid-menstrual cycle). Occasionally, you might feel pain, notice slight body changes, or experience vaginal spotting during ovulation. However, there are times when ovulation happens without any noticeable signs. Ovarian cysts are common and can occur at any age.

What causes ovarian cysts in people who still have monthly periods?

Ovulation, dermoid cysts, polycystic ovary syndrome (PCOS), endometriosis, pregnancy, severe pelvic infections, noncancerous growths, and, rarely, cancer.

What causes ovarian cysts in people who no longer have monthly periods?

 Non-cancerous growths and, more rarely, cancer.

Are there risk factors for ovarian cysts? Some conditions put one at risk of developing ovarian cysts such as ovulation induction for infertility treatment, endometriosis, PCOS, pregnancy, genetics and high risk sexual behaviour that can lead to infection in the reproductive system (pelvic inflammatory disease).

What are the symptoms of ovarian cysts?

Ovarian cysts may cause pain or pressure in the lower abdomen. The pain can be dull or sharp, constant, or on and off. Symptoms may also include sudden severe pain if a cyst ruptures, especially following a strenuous physical activity like exercise or sexual intercourse. The pain may be one sided and thereafter spread out in the abdomen. Symptoms of shock may be present if significant bleeding results from the rupture such as dizziness, headache, fainting and weakness. Nausea and vomiting may also be present if the ovary twists.

Other symptoms are pelvic discomfort, a feeling of fullness or pain during sexual intercourse. Some people with ovarian cysts may not show any symptoms. In such women, the diagnosis of is usually made incidentally while checking for something else.

How can I know if I have ovarian cancer?

While it's natural to worry, most ovarian cysts are not cancerous. Factors that may increase the risk of cancer include genetic predisposition, older age, previous breast or digestive tract cancer, complex cyst characteristics on ultrasound examination (your doctor should clarify this for you), and fluid collection in the pelvis or abdomen. Further testing is usually recommended to assess the likelihood of cancer.

How are ovarian cysts diagnosed?

Ovarian cysts may be found during a pelvic examination, but imaging tests like pelvic ultrasound are necessary for confirmation. Blood tests, including pregnancy testing and some tumour markers, may also be done to determine the nature of the cyst. Tumor markers are signals in the body indicating certain cancers, produced in response to or found on cancer cells. Elevated levels don’t always mean cancer, and doctors consider them along with other factors when managing the disease

Do all ovarian cysts need treatment?

No, ovarian cysts do not always require treatment. For those still having monthly periods, watchful waiting may be recommended, involving monitoring for symptoms and repeating ultrasounds. Surgery may be considered if the cyst is large, causing pain, is at risk of rupture or twisting, is associated with endometriosis, is large (>5cm), appears suspicious for cancer, or does not resolve after repeated ultrasounds.

What is the treatment for ovarian cysts after menopause?

Watchful waiting may be an option, involving regular monitoring through pelvic ultrasound and tumour markers tests. Surgery may be recommended if the cyst shows signs of potential cancer or if it grows or changes in appearance.

What does surgery for ovarian cysts involve?

Surgery may be needed if the cyst causes persistent pain, is associated with endometriosis, or appears suspicious for cancer. The procedure could involve removing the cyst, part of the ovary, or the entire ovary, depending on factors like size and characteristics.

What happens after an ovarian cyst resolves?

After resolution, further imaging tests are not needed if there are no symptoms. Some types of cysts, like endometriomas and ovulation ovarian cysts, are more likely to recur. Taking birth control pills may help prevent recurrence in those with monthly periods.

What is watchful waiting?

Watchful waiting involves monitoring symptoms and repeating pelvic ultrasound after about six weeks. In some cases, birth control pills may be recommended to prevent new cysts. For postmenopausal individuals, watchful waiting includes regular ultrasound and tumor markers measurements.

When is surgery recommended for ovarian cysts?

Surgery may be recommended if a cyst causes persistent pain, is at risk of rupture or twisting, is associated with endometriosis, is large (>5cm), appears suspicious for cancer, or does not resolve after repeated ultrasounds.

What happens during surgery to remove ovarian cysts?

The procedure is usually done in a hospital or surgical centre. The extent of surgery depends on factors like cyst size and characteristics. It may involve laparoscopic removal through small incisions or a larger incision (laparotomy) for more complex cases.

What are the complications of ovarian cyst?

Sometimes ovarian cysts can cause problems like twisting (ovarian torsion) or breaking open (rupture). If a cyst twists, it can bring sudden and strong pelvic pain, nausea, vomiting and might reduce blood flow to the ovary. If a cyst breaks open, it can lead to serious pain and pelvic bleeding. The chances of these issues increase with the size of the cyst and activities like intense pelvic movements or vaginal sex can make complications more likely.

What can be done to prevent ovarian cysts?

Adopt healthy habits such as regular gynaecological check-ups, using hormonal contraceptives, maintaining a balanced diet and engaging in regular exercise. Managing conditions like PCOS, being cautious with fertility treatments, avoiding smoking, and maintaining a healthy weight are also important preventive measures. Awareness of pelvic health and prompt reporting of any unusual symptoms to a healthcare provider contribute to reducing the risk of ovarian cysts. Personalized advice from a healthcare professional is recommended based on individual health factors.

Dr Okemo is a consultant obstetrician gynaecologist at Aga Khan University Hospital, Nairobi