FOR every ovulating woman, the possibility of an ovarian cyst around the time of menstruation is quite high, but most women will never actually realise this. And while in most instances cysts are harmless, obstetrician-gynaecologist Dr Keisha Buchanan says that they can often lead to serious complications, most commonly indicated by pelvic pains.

“The ovaries are the organs that produce the egg that is essential for reproduction. During the reproductive years — that is, from the onset of the first period to menopause — the ovaries are more likely to form cysts,” Dr Buchanan said.

Cysts, she explained, are fluid-filled sacs (and at times solid-filled sacs) that can form in the ovary. These are usually benign (non-cancerous), are transient, and will resolve on their own.

“The ultrasound appearance of a cyst can indicate whether the cyst is serious or not. A simple cyst is one that is fluid-filled; these are usually not serious and will resolve naturally. However, a complex cyst has components called septations and may have solid masses inside. These cysts need to be followed carefully, as they are more likely to persist and require surgical removal,” Dr Buchanan advised.

She noted, however, that sometimes even complex cysts can resolve on their own. She cautions that in menopausal women, complex cysts are usually removed immediately.

Dr Buchanan maintains that most cysts trigger very few symptoms, but when they do they often present with pressure, bloating, swelling, or pain in the lower abdomen on the side of the cyst, as well as on and off pain. These symptoms should be taken very seriously. Additionally, cysts in the instances listed below should also be of great concern:

• Cysts that occur in women who have either not started to ovulate or who no longer ovulate. “The concern is greater for cysts that develop before the onset of the menses — hence ovarian cysts in girls and in women in menopause,” Dr Buchanan said. She explained that there is a greater likelihood that these may be serious, as the possibility exists that they could be cancerous.

•Ovarian cysts that are associated with abdominal bloating, fever, weight loss, vaginal bleeding, lower abdominal pain, or those that persist for longer than two to three months, are a cause for concern. “A cyst associated with fever may be an abscess. For the menopausal woman, the observation period for ovarian cysts is shorter than two months, and in many cases, as soon as ovarian cysts are seen they have to be removed promptly,” Dr Buchanan advised. Also, Dr Buchanan cautions that abdominal bloating and weight loss may be a sign of cancer.

•Ovarian cysts in pregnancy are also a great cause for concern. Ovarian cysts are common in pregnancy and detected on the prenatal ultrasound. “These usually resolve later in the pregnancy but can rupture or twist in pregnancy (called torsion). Rarely is surgery needed in pregnancy, and this is done if there is worsening pain or if there are signs that the ovary is cancerous,” Dr Buchanan said.

• Ovarian cysts that continue to increase in size or simply won’t go away should be taken seriously. “Ovarian cysts that measure more than 5-6cm or that persist above that size may need to be surgically removed. Not only do they often become painful, but they sometimes press on the bladder, causing a reduction in its capacity,” Dr Buchanan explained. This means that you will find that you want to urinate more frequently. You may also experience some abdominal discomfort. There is also a rare chance of cancer in this case.

•A sudden onset of pain during sex in the presence of a known ovarian cyst, Dr Buchanan said, may be a sign that the cyst has ruptured or twisted (torsion). “It’s best to ask your doctor if it’s safe to have sex in the presence of an ovarian cyst; often we advise patients to abstain, as sex may affect the cyst,” Dr Buchanan advised.

According to Dr Buchanan, cysts are generally harmless. However, if any of the symptoms or groups of symptoms are experienced, medical attention must be sought.