• 07 Oct, 2024
• rahul
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What is an ovarian cyst?

An ovarian cyst is a fluid-filled sac that develops on or inside an ovary. While the majority of ovarian cysts are harmless and may resolve on their own, some can lead to symptoms or complications that require medical attention.

• Types of Ovarian Cysts

1. Functional Cysts: most common type and form during the menstrual cycle. Functional cysts include:-
   • Follicular Cysts: develop when the follicle (which contains the egg) doesn’t rupture as it should during ovulation, causing the follicle to swell with fluid.
   • Corpus Luteum Cysts: After the follicle releases the egg, it forms a structure called the corpus luteum, which can sometimes fill with fluid, creating a cyst.

2. Pathological Cysts: less common and can develop due to underlying pathology. Types include:-
   • Dermoid Cysts: Form from ovarian cells and can contain tissue like hair or teeth.
   • Serous Cystadenomas: Benign growths that can develop on the surface of the ovary.
   • Endometriomas: These develop in women with endometriosis, a condition where endometrial tissue (similar to the uterine lining) grows outside the uterus.
3. Symptoms of Ovarian Cysts

• 60-70% are asymptomatic

However, larger cysts or those that rupture may cause symptoms such as:—–

• Pelvic pain or pressure
• Bloating
• Pain during intercourse
• Irregular periods
• Difficulty emptying the bladder or bowels
• In rare cases, cysts can cause severe pain or complications such as ovarian torsion (twisting of the ovary) or rupture, which requires emergency medical attention.
• Diagnosis:-

• USG –First line investigation 
  • Sensitivity- 94.4% 
  • Specificity- 98.2%

• MRI– 2^ND line modality – characterization of ovarian cysts when USG is inconclusive 

• CT, MRI  and PET CT scans – not recommended for initial evaluations.
• CT scan of abdomen and pelvis – done if malignant disease is suspected on USG and tumor markers.

• Color flow Doppler studies – not essential for routine initial assessment.

• Spectral and pulse Doppler indices – not routinely used .

• 3D USG – does not appear to improve diagnosis of complex ovarian cysts

                routine use is not recommended .

• Don’t Panic

Most cysts are nothing to worry about, &  don’t cause any symptoms

• Management :-

Depends on the patient’s age, menopausal status, the size of the cyst, and whether the cyst has characteristics suspicious of malignancy.

• Watchful waiting – Functional ovarian cysts usually go away without treatment; if the patient is asymptomatic, she can be monitored conservatively with serial transvaginal ultrasound(2-3 monthly).

• If a cyst does not resolve after several menstrual cycles, it is unlikely to be a functional cyst, and further workup is indicated.

• Oral contraceptives –  medications containing hormones (such as birth control pills) stop ovulation and prevent future cysts.

• If a cyst is causing symptoms and/or getting bigger or CA-125 levels are increasing;you may need surgery to remove it either through laparoscopy or laparotomy.

• Dr Monika Rajputrecommends consultation if any of the following occur:—-

• Your periods become irregular/ painful
• Your abdominal pain doesn’t get relieved on oral medicines
• You have trouble urinating or emptying your bladder
• You have pain during intercourse.
• You have feelings of fullness (bloating), pressure, or discomfort in your abdomen.
• You feel generally ill

• Get help immediately if you notice signs of ovarian torsion:

• Severe abdominal pain that comes on suddenly, accompanied by vomiting or fever.
• Feeling light-headed or faint and breathing rapidly.
• Cold, clammy skin.