When people hear about cysts and swellings their initial instinct is often to panic and think…cancer. It’s natural to worry, but the good news is that most ovarian cysts are harmless. This is especially true before the menopause, when cysts are pretty common, affecting as many as 7% of women.
What are ovarian cysts?
Ovarian cysts are growths, like little sacs, that develop within the ovary. A normal ovary is the size and shape of an almond. Cysts can dwarf this, sometimes growing to the size of an orange or even a watermelon and taking up much of the space in the abdomen.
Cysts should always be taken seriously. They can indicate another condition like endometriosis and sadly, some can be cancerous. It’s vital to investigate thoroughly, this is especially important if they’re large, getting bigger or affecting a woman who has had her menopause.
What causes ovarian cysts?
There are many types of ovarian cysts, each caused by different things:
Functional cyst: These grow as a result of the ovary doing its normal job. Every month an ovary creates fluid-filled follicles, containing an egg. Sometimes ovulation doesn’t happen and a follicular cyst remains. Corpus Luteum cysts are formed after ovulation, the escape opening of the egg seals off and fluid accumulates.
Pathological cysts: The name sounds scary, but most of these aren’t cancerous. They’re known by this name because they develop because of disease, not due to normal function. They include:
Dermoid cysts: These grow because of the existence of developmental tissue. They often contain weird materials like teeth, bone or hair.
Haemorrhagic cyst: The name is the clue here, with cysts formed due to bleeding.
Endometriomas: These are caused by endometriosis on the ovaries. Patches of tissue similar to the lining of the womb can grow and bleed making a blood-filled cyst. This old blood is brown, so they’re known as ‘Chocolate Cysts’-but they’re anything but sweet. They’re a sign of severe endometriosis and can be very painful.
Cancerous cysts: Cancer is thankfully rare, and usually affects women after the menopause. It is often known as the silent killer because the symptoms can be vague and are often missed, so it’s essential to properly investigate any concerns.
What are the symptoms of ovarian cysts?
Many ovarian cysts go unnoticed. If they’re small, there may be no symptoms. The notable exception is endometriomas, which punch above their size and can be agonising, even when tiny.
Large cysts of all types can cause pain and abdominal swelling. The cyst may also press on pelvic structures, leading to problems like constipation or needing to wee frequently.
What are the risks of ovarian cysts?
Cysts can burst, bleed and twist. This can cause severe pain and bleeding and usually needs emergency surgery. The cyst can also affect the ovary, making it twist. This can cut off the blood supply and cause severe pain. This is called torsion of the ovary. There’s a danger of the ovary becoming damaged or dying, an emergency operation is needed to save the organ and maintain function.
How are cysts diagnosed?
Your gynaecologist will take a full history and examine you, to identify the problems you’re experiencing and pinpoint any swellings and sore spots.
The best way to diagnose a cyst is by ultrasound. A small probe is placed inside the vagina to scan the pelvis. This may sound intrusive but although uncomfortable, it is not usually painful. This technique gets the best possible view of the ovaries so that the size, position and some idea of the content of the cysts can be seen.
General blood tests may be arranged as well as a CA125 test. This measures a protein that goes up in women with ovarian cancer. It’s not always reliable, so don’t panic if yours is high, it simply means we need to investigate a little more.
Further tests including MRI and CT scans may be needed for a little extra information.
Functional cysts often disappear on their own, so Mr Khazali may watch, wait and monitor, some may not even need monitoring.
Other cysts may need treatment, the best option depends on your symptoms, cyst size, the appearance on ultrasound, your age and the results of the CA125 test. Read more about the nitty gritty of treatment for ovarian cysts here.