Ovarian Cysts: Causes, Signs & Treatment

Ovarian cysts are common occurrences in women of all ages, but despite their prevalence, they can sometimes cause concern and confusion. Whether you've recently been diagnosed or are experiencing symptoms that cause concerns, it's essential to understand the basics of ovarian cysts, including their causes, signs and available treatments. At CHI Saint Joseph Health, we believe in empowering patients with knowledge, so let's delve into this topic together.

What are Ovarian Cysts?

Ovarian cysts are fluid-filled sacs that develop on the ovaries, the small organs on either side of the uterus that play a crucial role in the reproductive system. These cysts can vary in size, from as small as a pea to as large as a grapefruit, and they typically form during the menstrual cycle.

There are two main types of ovarian cysts:

1. Functional Ovarian Cysts: These are the most common type of ovarian cysts and typically form as a result of the menstrual cycle. They are often harmless and usually resolve on their own within a few menstrual cycles. Functional ovarian cysts can be further categorized into:

• Follicular cysts: These develop when the follicle, which contains the egg, fails to rupture and release the egg during ovulation. Instead, it continues to grow and forms a cyst.
• Corpus luteum cysts: These develop after the follicle releases the egg during ovulation. If the follicle fails to shrink after releasing the egg, fluid accumulates inside, forming a cyst.

2. Pathological Ovarian Cysts: Unlike functional cysts, pathological cysts are less common and may be associated with abnormal cell growth or other underlying conditions. Examples of pathological ovarian cysts include:

• Dermoid cysts: These cysts contain tissue such as hair, skin or teeth because they form from cells that produce human eggs.
• Endometriomas: These cysts develop as a result of endometriosis, a condition where tissue similar to the lining of the uterus grows outside the uterus.
• Cystadenomas: These cysts develop from ovarian tissue and are filled with a watery or mucous-like fluid. They can become large and cause discomfort.
• Malignancy: There are certain features which may suggest ovarian cancer rather than a more common kind of cyst. If these features are seen, further testing and treatment may be recommended. 

Causes of Ovarian Cysts

Ovarian cysts can develop for various reasons, often related to hormonal changes, the menstrual cycle, or underlying health conditions. Understanding these causes can help shed light on why ovarian cysts form and how they can be managed:

1. Menstrual Cycle: Ovarian cysts often form as a natural part of the menstrual cycle. During each menstrual cycle, the ovaries produce follicles that contain eggs. In some cases, these follicles may fail to release the egg during ovulation or may not dissolve after the egg is released, leading to the formation of cysts. These types of cysts, known as functional cysts, are typically harmless and resolve on their own.
2. Endometriosis: Endometriosis is a condition in which tissue similar to the lining of the uterus grows outside the uterus, such as on the ovaries or fallopian tubes. This displaced tissue can form cysts called endometriomas, which can cause pain and other symptoms.
3. Pregnancy: During pregnancy, the ovaries continue to produce hormones to support the pregnancy. Occasionally, cysts called corpus luteum cysts can form on the ovaries after ovulation. These cysts develop from the empty follicle that released the egg and typically resolve on their own without causing harm to the pregnancy.
4. Polycystic Ovary Syndrome (PCOS): PCOS is a hormonal disorder characterized by enlarged ovaries containing multiple small cysts. Women with PCOS often have irregular menstrual cycles, excessive hair growth, acne and obesity. The exact cause of PCOS is not fully understood, but it is believed to involve a combination of genetic and environmental factors.
5. Hormonal Imbalances: Fluctuations in hormone levels, particularly estrogen and progesterone, can disrupt the normal ovarian cycle, leading to the development of cysts. Hormonal imbalances may occur due to factors such as puberty, pregnancy, perimenopause or certain medical conditions like polycystic ovary syndrome (PCOS).
6. Other Factors: Certain lifestyle factors, such as obesity and smoking, may also increase the risk of developing ovarian cysts. Additionally, medical treatments such as fertility medications, hormone therapy or tamoxifen (used to treat breast cancer) may predispose some women to ovarian cysts.

Ovarian Cyst Symptoms

Ovarian cysts often do not cause any symptoms and may be discovered incidentally during a routine pelvic exam or imaging test. However, some women may experience:

• Pelvic pain: Dull or sharp pain in the lower abdomen or pelvis.
• Bloating: A sensation of fullness or swelling in the abdomen.
• Changes in menstrual cycle: Irregular periods or abnormal bleeding.
• Pain during intercourse: Discomfort or pain during sexual activity.
• Urinary symptoms: Increased frequency or urgency to urinate.

Treatment for Ovarian Cysts

If you're experiencing symptoms suggestive of ovarian cysts, it's crucial to consult with your healthcare provider. Diagnosis typically involves a combination of pelvic exams, imaging tests (such as ultrasound) and sometimes blood tests to evaluate hormone levels.

The treatment approach for ovarian cysts depends on various factors, including the size of the cyst, your age, symptoms and whether you're premenopausal or postmenopausal. Options may include:

• Watchful waiting: If the cyst is small and not causing symptoms, your doctor may recommend monitoring it over time to see if it resolves on its own.
• Medications: Hormonal birth control pills or other hormonal medications may help regulate your menstrual cycle and prevent the formation of new cysts.
• Surgery: If the cyst is large, causing severe symptoms or suspicious for cancer, your doctor may recommend surgical removal (cystectomy) either laparoscopically or through traditional surgery.

When to See a Doctor

While many ovarian cysts are harmless and resolve on their own, certain symptoms may indicate a need for medical attention. It's essential to be aware of these signs and seek prompt evaluation by a health care provider if you experience any of the following:

• Severe or persistent pelvic pain: If you experience intense or prolonged pelvic pain, especially on one side of your abdomen, it could indicate a ruptured cyst, ovarian torsion (twisting of the ovary) or another complication that requires medical intervention.
• Sudden or worsening symptoms: If you notice a sudden onset of symptoms such as pelvic pain, bloating, getting full quickly, or changes in bowel or bladder habits, or if existing symptoms worsen over time, it's essential to seek medical evaluation.
• Irregular menstrual bleeding: Unusual bleeding patterns, such as heavy or prolonged menstrual bleeding, bleeding between periods or postmenopausal bleeding, should be evaluated by a health care provider to rule out underlying causes, including ovarian cysts.
• Difficulty eating or feeling full quickly: Ovarian cysts, particularly larger ones, can exert pressure on the surrounding organs, leading to feelings of fullness, bloating or difficulty eating.
• Pain during intercourse: Pain or discomfort during sexual intercourse can be a symptom of various gynecological issues, including ovarian cysts. It's essential to discuss this symptom with your health care provider for proper evaluation and management.
• Urinary symptoms: Frequent urination, urgency to urinate or difficulty emptying the bladder may occur if an ovarian cyst presses on the bladder or urethra. These symptoms should be evaluated to rule out urinary tract infections or other underlying conditions.
• Symptoms in postmenopausal women: While ovarian cysts are less common after menopause, any pelvic pain, bloating or other symptoms in postmenopausal women should be promptly evaluated by a health care provider to rule out potential concerns such as ovarian cancer.
• Family history of ovarian cancer or genetic mutations: Women with a family history of ovarian cancer or certain genetic mutations, such as BRCA1 or BRCA2 mutations, may have a higher risk of developing ovarian cysts or ovarian cancer. If you have a family history of these conditions, it's essential to discuss screening and preventive measures with your health care provider.

If you experience any of these symptoms or have concerns about ovarian cysts, don't hesitate to schedule an appointment with your healthcare provider. Early detection and proper management can help ensure the best possible outcomes and peace of mind.

How are Ovarian Cysts Diagnosed?

Diagnosing ovarian cysts typically involves a combination of medical history review, physical examination and diagnostic tests. Here's what you can expect during the diagnostic process:

• Medical history review: Your health care provider will ask about your symptoms, menstrual cycle patterns and any relevant medical history, including past gynecological issues or surgeries. Providing detailed information can help guide the diagnostic process.
• Physical examination: During a pelvic exam, your health care provider will manually palpate your abdomen and pelvis to feel for any abnormalities, such as swelling, tenderness or masses. While a pelvic exam alone cannot definitively diagnose ovarian cysts, it can provide valuable clues and help guide further testing.
• Imaging tests: Diagnostic imaging tests, such as transvaginal ultrasound or pelvic ultrasound, are commonly used to visualize the ovaries and identify the presence of cysts. These non-invasive imaging techniques use sound waves to create detailed images of the pelvic organs, allowing health care providers to assess the size, shape, and characteristics of any cysts present.
• Blood tests: In some cases, blood tests may be ordered to measure levels of certain hormones, such as estrogen, progesterone or cancer markers like CA-125. While these tests alone cannot diagnose ovarian cysts, they can provide additional information to help evaluate ovarian function and rule out other potential causes of symptoms.
• Further evaluation: Depending on your symptoms, medical history and imaging findings, your health care provider may recommend additional tests or procedures, such as MRI (magnetic resonance imaging), CT (computed tomography) scan or laparoscopy (a minimally invasive surgical procedure), to further evaluate the cyst or rule out other conditions.
• Monitoring and follow-up: In cases where ovarian cysts are detected but are not causing symptoms, your health care provider may recommend a watchful waiting approach with regular monitoring through imaging tests. This approach allows health care providers to track any changes in the size or characteristics of the cyst over time and intervene if necessary.

By combining these diagnostic approaches, health care providers can accurately diagnose ovarian cysts, assess their size and characteristics, and develop an appropriate treatment plan tailored to your individual needs and circumstances. If you have concerns about ovarian cysts or are experiencing symptoms, don't hesitate to discuss them with your health care provider for timely evaluation and management.

Do Ovarian Cysts Affect Fertility?

Ovarian cysts typically do not directly affect fertility, especially if they are small and functional. However, certain types of cysts, such as endometriomas or cysts associated with polycystic ovary syndrome (PCOS), may impact fertility. Additionally, large cysts or those that cause complications such as ovarian torsion (twisting) can sometimes require surgical intervention, which may affect ovarian function or fertility. 

If you have concerns about ovarian cysts and their potential impact on fertility, it's essential to discuss them with your health care provider, who can provide personalized guidance and recommendations based on your individual circumstances.

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