Ovarian Cysts

An ovarian cyst refers to a fluid-filled sac formed in one or both the ovaries. The primary functions of the ovaries, which are a part of the female reproductive system, are to produce and release eggs as well as hormones. When the eggs are not released during the monthly cycle, the follicles enclosing the eggs may form into a cyst. Ovarian cysts are quite common, particularly in premenopausal women. About 8% of premenopausal women develop larger cysts that require treatment.

There are two types of ovarian cysts:

Functional Ovarian Cysts

Functional ovarian cysts are very common and are associated with a normal menstrual cycle. An egg is released by the ovaries during every menstrual cycle. This egg travels through the fallopian tube connected to the ovary from where the egg is released. The egg then exits the fallopian tube and enter the womb. The uterus is usually the site of fertilisation of this egg. When these eggs are formed inside the ovary, they are enclosed in a follicle that bursts when the egg has to be released. However, if the egg is not released, the follicle can swell and turn into a cyst. Besides this, the ruptured follicle may also seal back and get filled with fluid to form a cyst. This is also known as a corpus luteum cyst. Functional cysts do not cause any trouble or complications and are non-cancerous in nature.

Pathological Cysts

Pathological cysts develop irrespective of a woman’s menstrual cycle or menopause stage as opposed to the functional cysts that develop before menopause only. They are formed due to abnormal growth of the cells but are not always cancerous.

Functional cysts do not tend to produce any symptoms. However,  in pathological cysts, some of the commonly experienced symptoms include

• Pain in the lower belly that may be of a sharp or dull nature.
• Bloating.
• Nausea.
• Vomiting.
• Reduced appetite.
• Constipation.
• Irregular menstrual cycles.
• Swelling and tenderness in the lower abdomen.

The less common symptoms of ovarian cysts include:

• Pain in the pelvic region.
• Pain during intercourse.
• Unexplained vaginal bleeding.
• Tenderness or mild pain in the breasts. (Read more - Breast pain causes)
• Frequent urination.
• Pain in the thighs and lower back.
• Sudden weight gain.

Although fertility remains unaffected due to ovarian cysts in most women, some women may experience difficulty in getting pregnant.

The prevention of ovarian cysts is difficult. The doctor may prescribe medications that will prevent ovulation. This will prevent the formation of new cysts. In addition, maintaining a healthy weight and being active is important to prevent conditions like PCOS from occurring.

In many cases, ovarian cysts may not produce any symptoms. Hence, the diagnosis may be delayed. However, when you contact the health care provider, they may first rule out pregnancy as the cause of the symptoms. The following tests may be conducted to diagnose ovarian cysts:

• Pelvic Examination
  A pelvic examination allows the doctor to assess the status and the presence of any abnormalities in the vagina, cervix, and uterus.
• Ultrasound
  An ultrasound makes use of sound waves to acquire the images of the ovaries. An ultrasound is commonly used for detecting the ovarian cysts. It also enables the doctor to assess the size, shape, and location of the cyst and to determine if the cyst is solid or filled with fluid.
• Blood Tests
  Blood tests allow the doctor to assess the hormone levels in the blood e.g., thyroid hormones, prolactin, testosterone, estrogen, progesterone and more.
• Laparoscopy
  In laparoscopy, a small camera-fitted tube is inserted into the belly through a tiny incision to diagnose an ovarian cyst.

Diagnostic tests can also help in identifying conditions that may result in ovarian cysts, such as:

• Endometriosis
  Abnormal growth of the lining of the womb at abnormal places, such as the ovaries or the fallopian tubes.
• Pelvic infections
  Infections of the female upper genital tract, womb, and ovaries.
• Fibroids
  Fibroids are benign or non-cancerous growths in and around the womb.

Most often, ovarian cysts tend to resolve in a few months without any treatment. In such cases, no symptoms may be noted.

The need for therapy or treatment will depend upon:

• The size of the cyst.
• The symptoms it produces.
• Whether the woman has had menopause.

Observing the cysts for some time

In most cases, the doctor may recommend that you do not receive any immediate treatment but keep undergoing medical tests, such as ultrasounds, to check whether the cyst is healing. Women who have reached menopause may be advised to have ultrasound scans every four months for at least a year, as they are at a higher risk of developing ovarian cancer. If the ultrasounds reveal that the cyst does not exist, no further treatment may be needed.

Medications

The healthcare provider may prescribe medications containing hormones (birth control pills) to stop ovulation. This would prevent the formation of any functional cysts.

Surgery

Large-sized cysts that manifest symptoms, such as pain and inflammation or swelling, may have to be removed surgically. The surgery can be performed in two different ways:

• Laparoscopy
  A laparoscopic surgery may be performed for smaller cysts that are non-cancerous. In this surgery, the doctor extracts the cyst using a device inserted through a small incision near the belly button.
• Laparotomy
  Laparotomy is the surgical method used for removing the cyst that is larger in size or may be cancerous. This surgery also allows the doctor to remove the cyst and send it for further testing. If the cyst is determined to be cancerous, then an oncologist will provide further treatment. Depending on its severity, the removal of the ovary may also be necessary.

After surgery, you may experience slight discomfort in the abdominal area. However, the pain due to surgery gets better within a few days. The recovery time for laparoscopy is two weeks, while that for a laparotomy may be eight weeks.

Following the surgery, the presence of any of the following symptoms, which are indicative of an infection, must be immediately reported:

• Bleeding at the surgical site.
• Severe pain in the abdomen.
• Swelling in the operated area.
• Fever.
• Unusual vaginal discharge.

Lifestyle management

There are several helpful steps that can help immensely in dealing with ovarian cysts. These include a list of do’s and don’ts as part of health management:

• Quit smoking
  There are studies that have shown that women who smoke are more prone to developing ovarian cysts. Hence, excessive smoking and intake of alcohol must be avoided at all costs.
• Limit caffeine intake
  Caffeine may act as a trigger for the development of ovarian cysts. Hence, it must be consumed only in moderation.
• Limit sugar intake
  The consumption of excessive sugar can lead to inflammation and swelling. Sugar and other sources of refined carbohydrates can also lead to more pain if you are already suffering from cysts. Hence, sugar intake must be restricted. The consumption of processed foods should also be avoided.
• Reduce oestrogen intake
  Food sources, such as soy and food additives, contain high amounts of oestrogen and xenoestrogens. Excessive oestrogen levels in the body can lead to hormonal imbalance, which can, in turn, lead to ovarian cysts.
• Avoid steroid medications
  Steroid medications can result in hormonal imbalances as well, which initiate the formation of ovarian cysts, and hence must be avoided. For pain relief, paracetamol can be used instead of regular painkillers.
• Eat a balanced diet
  If you are already dealing with ovarian cysts, special care should be taken in terms of having a healthy and balanced diet. The diet must be inclusive of fruits, vegetables, and pulses to prevent the cysts from recurring. These foods are also rich in fibre, which helps in naturally healing the cysts and reducing their recurrence as well.
• Making an exercise routine
  Practising yoga and other stretching exercises will not only help in healing the ovarian cysts but will also reduce the menstrual discomfort, such as period pain and cramps in the stomach and back. Regular exercises also reduce stress levels and increase blood circulation throughout the body, which in turn has a positive effect in terms of reducing ovarian cysts.
• Wear comfortable clothing during menstruation
  Wearing tight and uncomfortable clothing while on your periods can put pressure on the abdomen and trigger pain. Hence, it is advisable to wear comfortable and loose clothes.
• Drink plenty of water
  Consuming 7-8 glasses of water a day will help in flushing out the toxins from the body and reducing inflammation as well. Hence, it is important to keep yourself hydrated.
• Practice relaxation techniques
  Stress and anxiety have a detrimental effect on health as they contribute to an imbalance of hormone levels. Stress is also a common cause of functional ovarian cysts. Hence, practising relaxation techniques, such as deep breathing, meditation, exercising, or even getting a therapy, can bring the body and mind back to a balanced state.

Prognosis

Outcomes of ovarian cysts are generally good, especially where lifestyle is a contributor and it can be changed, as in PCOS and infections. Timely treatment can help manage the symptoms adequately enough to live a healthy and active life. 

Complications

An ovarian cyst can be treated easily. However, rarely, complications may arise. Life-threatening complications are extremely rare. Some complications of an ovarian cyst are:

• Torsion
  Torsion occurs when the stem of the ovary that attaches it to the uterus twists due to the growth of the cyst on it. Torsion can produce severe pain in the abdomen and is a medical emergency.
• Bursting of the cyst
  In some cases, the formed cyst may burst and lead to bleeding. This will lead to severe lower abdominal pain and may get infected as well.
• Ovarian cancer
  A cyst may sometimes be an early form of cancer.

One must also see the doctor immediately if experiencing the following symptoms, knowing that they have an ovarian cyst:

• Pain with fever and vomiting.
• Dizziness.
• Breathing problems.
• Severe abdominal pain.