Ovarian cysts: When to be worried

AT least once in a woman’s life she will develop gynaecological cysts — fluid-filled sacs — on at least one of her two ovaries. In most cases, these cysts not only resolve on their own but present little or no discomfort. However, obstetrician-gynaecologist at ICON Medical Centre Dr Keisha Buchanan said that there are instances when they can be potentially dangerous, particularly when they have ruptured.

“Gynaecological cysts are common diagnoses and the most significant and common are ovarian cysts. Ovarian cysts are either simple or complex; they are most likely non-cancerous but can rarely be cancerous. Most are functional cysts, which form as a natural part of ovulation or after ovulation. Some may be non-functional and may develop, for example, as a result of endometriosis or dermoid cysts which you are born with or in some instances cancers may present as cysts with abnormal solid components,” Dr Buchanan explained.

She pointed out that ovarian cysts are usually asymptomatic but can rupture, presenting with pain and internal bleeding. The internal bleeding tends to be self-limited and resolves within a few hours with minimal blood loss and the blood is naturally reabsorbed by the body.

“While most ruptured ovarian cysts resolve and only painkillers are needed as treatment, sometimes when cysts rupture [a patient] can present with significant internal bleeding and shock and require emergency surgery to stop the bleeding by removal of the cyst or rarely removal of the ovary depending on the severity of the condition or to prevent haemorrhaging in cases where there is excessive bleeding,” Dr Buchanan underscored.

The ObGyn outlined that while a cyst can rupture for any number of reasons, including its large size, there are a number of factors most linked to vigorous activities that affect the pelvis, which increases the risk of ruptures, such as vaginal intercourse, strenuous physical activities and abdominal trauma.

“When a cyst ruptures a patient usually complains of a sudden onset of pelvic pain and oftentimes bleeding during or just after the physical activity. Other accompanying symptoms include nausea, vomiting, diarrhoea, passing the urine often, and another telltale sign is that ruptured cysts are more likely to happen at the time of the period,” Dr Buchanan shared.

Diagnosing an ovarian cyst is usually done by way of ultrasound, not only because it is the least expensive and most readily available method, but because it is one of the most accurate. However, methods including CT scan and MRIs are also utilised. Dr Buchanan said once ovarian cysts are confirmed, decreasing physical activity and abstaining from sex can reduce the likelihood of rupture since there is no guarantee that it will not.

“If the ovarian cyst is cancerous, a rupture of the cyst can cause cancer to spread. If the cyst is accidentally ruptured at surgery this can be corrected and the contents that spill cleared up quickly preventing the chance of spread. If the cyst ruptures prior to surgery the duration that the cyst has been ruptured for and the type of cancer (aggressive or less aggressive) will determine the extent of the spread. Spread tends to extend to the Fallopian tubes, the womb, and the bladder initially,” Dr Buchanan explained.

There are other instances in which some ovarian cysts can undergo twisting or torsion and so once this is identified equal care should be taken to prevent or reduce the possibility of rupture. Torsions, Dr Buchanan explained, often present with sudden lower abdominal pain, nausea and vomiting, and fever, and usually requires surgery to untwist the ovary, or if the ovarian tissue has been damaged due to prolonged torsion the ovary may need to be removed.

“Keep in mind that while rupture of some gynaecological cysts can be dangerous, at times it can be the way in which the cyst naturally resolves, healing itself. Therefore, sudden onset of pelvic pain which is persistent needs to be assessed, not only to check if a cyst is the culprit, but to also rule out conditions such as an ectopic pregnancy and pelvic inflammatory disease,” Dr Buchanan advised.

She recommends routine pelvic examinations since these will give the doctor a better opportunity to act on cysts that have the potential to be especially dangerous, as well as the use of oral contraceptives as a way of preventing ovarian cysts, which Dr Buchanan said will decline with the onset of menopause.