Gynaecology Ovarian Cysts

What are ovaries?

Ovaries are the parts of a woman’s reproductive organs that make female hormones and release an egg from a follicle (a small fluid-filled sac) each month. The follicle is usually about 2-3cm when measured across (diameter) but sometimes can be a little larger.

What is an ovarian cyst?

An ovarian cyst is a larger fluid-filled sac (more than 3cm in diameter) that develops on or in an ovary. A cyst can vary in size from a few centimeters to the size of a large melon. Ovarian cysts may be thin-walled and only contain clear fluid (known as a simple cyst) or they may be more complex, containing thick fluid, mucous, blood or solid tissue.

There are many different types of ovarian cyst that occur before the menopause, examples include:

  • A simple cyst, which is usually a large follicle that has continued to grow after an egg has been released, simple cysts are the most common cysts to occur before the menopause and most disappear within a few months if they are small. Larger simple cysts >4cms in size may need removed surgically
  • An endometrioma– where cells of the lining of the womb are found outside the womb, sometimes causes ovarian cysts and these are called endometriomas. They tend to have a complex appearance on scan and sometimes go by the name ‘Chocolate cyst’ as the old blood they contain looks remarkably like chocolate sauce.
  • A dermoid cyst is probably the commonest type of cyst seen. The dermoid gets its name from skin as the cysts can contain any of the substances that the body can produce from skin such as hair and fat and even rudimentary teeth. These cysts can vary greatly in size and can cause very sudden pain as they can twist on themselves occluding their blood supply (ovarian torsion)
  • Other types of cyst on the ovary are less common.
  • Almost all ovarian cysts that occur before the menopause are benign. Cancer of the ovary before the menopause is uncommon.

Ovarian Cyst

How common are ovarian cysts?

Ovarian cysts are common. Some women will be unaware that they have a cyst as they often cause no symptoms as they grow gradually over time. Some do cause pain which may be chronic or cause pain with sexual intercourse. If there is bleeding into the cyst, the cyst ruptures or torsion occurs (the cyst twists and stops its own blood supply) the woman may experience severe pain localised to the site of the ovary. These scenarios are often referred to as cyst accidents. Over a lifetime 1 in 10 women may need surgery for an ovarian cyst.

What symptoms might I have?

Most cysts are diagnosed by chance, for example during a routine examination or if you have an ultrasound scan for another reason. Therefore you may have no symptoms at all. However, you may experience one or more of the following:

  • Lower abdominal pain or pelvic pain
  • Painful periods, or a change in the pattern of your periods
  • Pain during intercourse
  • Pain related to your bowels
  • A feeling that you want to pass urine urgently and more frequently
  • A change in appetite or feeling full quickly
  • A distended (swollen) abdomen
  • Sudden onset heartburn
  • Difficulty in becoming pregnant which may be linked to endometriosis.

What happens if my GP suspects I have an ovarian cyst

  • Your GP may choose to organise and abdominal ultrasound scan and or take some blood tests.
  • If you are referred to see Dr McMurray he will take a history to see if you have any significant symptoms and perform a pelvic ultrasound scan to assess the pelvis.  If it is not possible to do a pelvic scan an abdominal scan will be arranged and this is usually done on the day of your consultation.
  • If your scan suggests that you have a complex cyst, you might be offered blood tests, which can help to determine what type of cyst it is. You do not need blood tests if a simple cyst is diagnosed. Sometimes additional imaging may be requested (either a CT or MRI scan).

What happens next?

If your scan is reassuring and you have no symptoms, you may not need any treatment further investigation or follow up.

However if you are symptomatic and the ultrasound scan has shown a large or a complex cyst, you are likely to require surgery to remove the cyst.

What Treatment will I be offered?

Treatment options include ‘watching and waiting’ or an operation to remove the cyst if it is getting bigger or complex. Your choice depends on your symptoms, the appearance and the size, and the results of any blood tests. You should be given information about the choices in your individual situation, including information about the risks and benefits of each option.

I have a simple cyst on my ovary that causes no pain- what are my options?

  • A simple cyst that measures less than 5cm in diameter.

Normally, treatment is not necessary. These cysts usually disappear on their own after a few months. You would need a follow up appointment/scan

  • A simple cysts that measures > 6cm in diameter/complex cyst

You will usually be offered laparoscopic (keyhole) surgery, which is less painful afterwards than a laparotomy (open surgery) and usually means that you can leave hospital earlier and will recover more quickly with reduced risk of complications. A laparotomy may be recommended if the cyst is very large or if there is a suspicion of cancer.

Will my ovaries be removed if I have an Operation?

In women who wish to have children your ovaries are unlikely to be removed. The ovaries produce important hormones before the menopause and therefore in most cases only the cyst is removed.

However, there are some circumstances where the ovary may need to be removed, for example, if the cyst is very large or has completely replaced the entire ovary. The ovary may also need to be removed if the cyst has twisted so much that the ovary’s blood supply has been cut off or if there is a suspicion that the cyst may be cancerous.

What if I am pregnant and my ultrasound scan has shown that I have a cyst?

Simple ovarian cysts are often found on the ultrasound scan during pregnancy and most will disappear as pregnancy progresses. If the cyst is large or complex, you may be offered further scans during pregnancy and a scan after your baby is born.

Is there anything else I need to know?

Taking the combined oral contraceptive pill will not help a simple cyst disappear although taking the pill may stop further cysts developing in the future.

Removing fluid from a simple cyst (aspiration) is of little benefit as the cyst is likely to fill up again, although this may be done to help determine what type of cyst it is.

Key Points

  • Ovarian cysts are common in women before the menopause
  • Ovarian cancer is uncommon in women before the menopause
  • An ultrasound scan should provide reassurance
  • Small simple ovarian cysts usually require no treatment
  • If you have surgery, this will usually be keyhole with removal of the cyst or ovary depending on your own fertility wishes.