What is an ovarian cyst?
Suspecting that you have an ovarian cyst may well be a cause for concern. Yet in many cases, an ovarian cyst is perfectly normal. Certainly in pre-menopausal women it is part of the body’s normal function to produce cysts each month. Only if it does not disappear at the end of the monthly cycle, in which case it often causes symptoms, is it something you may need to get looked at.
Similarly, in post-menopausal women, it is not unusual for the ovaries to briefly spring back into action and produce ovarian cysts. These can be of various types – many of which are benign – and can cause various symptoms. However, it is important to realise that if you are a post-menopausal woman, the risk of an ovarian cyst being malignant (ovarian cancer) is significantly greater.
In pre-menopausal women, the ovaries are active and it is a normal part of their function to produce a number of ovarian cysts each month. One cyst becomes larger than the others and at about the mid part of the monthly cycle it releases an egg (ovulation) which enters the fallopian tube and heads towards the uterus (womb). This process of ovulation sometimes causes mild pain for around 24-48 hours. Following ovulation, the remainder of the cyst disappears at the end of the monthly cycle and, unless the egg becomes fertilised (pregnancy), the process begins again.
Ovarian cysts in pre-menopausal women
Because of the above natural process, and because they are part of normal (functional) activity, ovarian cysts will often show up on ultrasound pictures taken of healthy women. Ovarian cysts in pre-menopausal women are only important if they persist, in which case they usually cause symptoms.
Ovarian cysts in post-menopausal women
In post-menopausal women, the ovaries are inactive and therefore the presence of any ovarian cyst is an abnormality. However many of these cysts are benign (not cancer). In the early years following the last menstrual period, it is not uncommon for the ovaries to have a late episode of functional activity, just as in younger women, and these cysts can cause similar symptoms. As in younger women, there is a wide range of other possible types of benign ovarian cyst and they can cause the same sort of symptoms (swelling, pressure, bleeding, dyspareunia, pain). Nevertheless, in post-menopausal women, the possibility that any ovarian cyst is malignant (ovarian cancer) becomes a much more significant concern.
At your assessment
At your consultation, the symptoms you describe along with the findings of your gynaecological examination will give your gynaecologist a good idea of the likely cause of your cyst. However, some simple additional investigations are required. These will include a blood test and an ultrasound scan. In most cases these are all that is needed, but sometimes other types of scan are also helpful and it may be necessary for you to have a CT scan or MRI scan.
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Symptoms of ovarian cysts
Symptoms of ovarian cysts vary considerably, according to the size and type of ovarian cyst. A large cyst may cause few symptoms other than a feeling of abdominal swelling (bloating) or the effects of pressure on the bladder (either difficulty passing urine or more frequency) or bowel (either constipation or diarrhoea). Other cysts may be the cause of irregular bleeding, pelvic discomfort during sex (dyspareunia) or pelvic pain. Ovarian cancer is rare in pre-menopausal women and very rare in women under 40 years, unless there is a history of ovarian cancer in the family.
Treatment for ovarian cysts
Where an ovarian cyst is small and causing few symptoms, provided the blood tests and scan show no cause for concern, it may well be reasonable to wait for the cyst to disappear without treatment. In many such cases, a follow up scan in 8-12 weeks will show that the cyst has gone.
For larger cysts or where there are more significant symptoms, a decision on the best treatment will usually depend on whether the tests show any significant risk of the cyst being malignant. For most, this will not be the case, and there is a wide range of possible surgery options. Laparoscopic (keyhole) surgery is often the best choice and it may be possible to remove the cyst in this way, leaving the normal ovary behind (laparoscopic ovarian cystectomy). Sometimes the cyst cannot be separated from the ovary, which therefore has to be removed completely (laparoscopic oophorectomy).
Where the ovarian cyst is very large, where there are potential difficulties for a laparoscopic approach, or where the cyst shows possible signs of malignancy, then surgical treatment would be recommended via an abdominal incision. The type of incision used will depend upon the precise circumstances and is very much an individual matter. You will, of course, be able to discuss this aspect in detail with your surgeon before surgery.