Ovarian cysts 101
EVERY week I see women who come in concerned about a cyst or cysts found on their ovaries. It’s often a source of great anxiety and stress for these women, as they often start worrying about the possibility of cancer or the cyst affecting their chances of getting pregnant.
But what causes an ovarian cyst? What are they really? The truth is there’s no one answer as there are different types of cysts, and each with a different background. For the most part we really don’t know exactly, though there are a few boring (and complicated) medical explanations around.
So how will you know if you have one? Pelvic pain, bloating or swelling, pain during sex, and pain during your period are some of the more common symptoms. There may be no symptoms at all, and your doctor may find it during a routine annual pelvic exam. Sometimes they are found on ultrasound while you’re looking for something else.
Thankfully most of them are simple — just a sac of clear fluid. These you’ll see show up on your ultrasound as a “simple cyst” or “follicular cyst”. We tend to leave these alone if they are small and not causing any symptoms. Most times they go away on their own anyway. If they are larger, you run the risk of the cyst rupturing causing intense pain and maybe even internal bleeding. If large it can also twist on itself causing pain and vomiting. The twisting also stops the circulation to the ovary, and if left untreated it can kill the entire ovary!
Where it gets tricky is when the cysts are “complex”. This usually means there’s more to it than just a fluid-filled sac. There may be multiple sacs, solid parts, or even blood within the sac. You are more likely to be offered surgery for a complex mass as the risk of it being a tumour is much increased. If this is found, further investigations such as blood tests to screen for cancer and higher-level imaging such as MRIs are usually required.
One of the more interesting cyst types is the dermoid cyst. They aren’t cancerous, but contain actual formed tissue within. Skin, teeth, bone, even active thyroid tissue have all been found within dermoids.
Another important one is the “chocolate cyst” or endometrioma. This is found in women with endometriosis and represents advanced stages of that disease. In this case, a cyst is formed from endometriosis and has blood inside it. After a while the blood stays there and turns into a thick brown fluid — resembling chocolate. These always require surgery.
Cancer in ovarian cysts are rare, and usually present in older women. However, with a complex cyst it’s impossible to be absolutely sure without doing surgery. If you have a family history of cancer, especially ovarian and breast cancer, you shouldn’t delay having surgery to have it removed. In fact women from high-risk backgrounds should ensure they have regular check-ups with their gynaecologists.
Thankfully, most of these cysts can be managed by laparoscopy, which in most cases allow you to have the cyst or even the entire ovary removed and go home the same day. If cancer is suspected then an open procedure will likely be required.
On a side note, in the common disorder causing irregular periods called Polycystic Ovarian Syndrome, there are no real cysts. It’s probably one of the most misleading disease names I’ve encountered. In these patients, their ovaries contain a lot of smaller eggs that failed to mature and which look like tiny cysts but are actually follicles. But these follicles are not significant, and we don’t treat them.
So if you’re having any of the symptoms of a cyst as mentioned above, you should get them evaluated by your family doctor or gynaecologist without delay. The best outcomes with surgery come with early identification and intervention before any complications occur.
Dr Ryan Halsall is a gynaecologist at Island Laparoscopy. To schedule a consultation send e-mails to info@islandlaparoscopy.com or call 876-455-4527. Facebook page is www.Facebook.com/ilapjamaica.
