Many women have ovarian cysts at some time in their lives. While the majority of ovarian cysts in women of reproductive age are benign, this is not the case in post-menopausal women when some cysts might be cancerous and require specialist evaluation.
Who gets an ovarian cyst?
Ovarian cysts are fluid-filled sacs that can form in the ovaries. They are very common. They are particularly common during the childbearing years. Ovarian cysts are benign in most cases. It is estimated that a pelvic ultrasound scan will reveal abnormal ovarian morphology in 21% of asymptomatic postmenopausal women, with this number being even higher for younger women.
What are the causes of ovarian cysts?
There are many different causes and types of ovarian cysts. Some cysts might be associated with the following:
• Ovulation (functional)
• Pregnancy-related (corpus luteal)
• Endometriosis ( endometriomas)
• Dermoid cysts
• Polycystic ovary syndrome.
• Cancer of the ovary
It is obviously important to be vigilant and maintain a high index of suspicion for ovarian cancer in all women, but it should be highlighted that less than 1% of ovarian cysts are malignant. Longitudinal studies have consistently shown that small, simple ovarian cysts, with no suspicious sonographic features, are usually benign.
What are the symptoms of ovarian cysts?
Very often ovarian cysts do not cause any symptoms. You may not realize you have one until you visit your healthcare provider for a routine pelvic exam. Ovarian cysts can, however, cause problems if they twist, bleed or rupture.
If you have any of the symptoms below, it is important to have them checked out. That is because they can also be symptoms of ovarian tumours. Ovarian cancer often spreads before it is detected.
Symptoms of ovarian cysts include the following:
• Pain or bloating in the abdomen
• Difficulty urinating, or frequent need to urinate
• Dull ache in the lower back
• Pain during sexual intercourse
• Painful menstruation and abnormal bleeding
• Weight gain
• Nausea or vomiting
• Loss of appetite, feeling full quickly
Diagnosis
If you have signs and symptoms suggestive of an ovarian cyst, you should see your doctor or gynaecologist. Postmenopausal women with signs and symptoms in particular should get examined. That is because they face a higher risk of ovarian cancer. Your gynecologist or your regular doctor may feel a lump while doing a routine pelvic exam, but today most cysts are diagnosed following an ultrasound scan of the pelvis. Other tests and investigations might be used to confirm the diagnosis.
Management of ovarian cysts
Ovarian cysts will be managed differently depending on many factors, specifically:
• Age and menopausal status
• Personal and family medical history
• Ultrasound appearance of the cyst
• +/- tumour markers (specifically CA-125 in post-menopausal women)
Ovarian cysts in young women
The majority of ovarian masses found in women of reproductive age will be functional (benign), and the overall risk of malignancy in this group is low. Most of these cysts (70%) will resolve spontaneously and thus are best managed by repeating the ultrasound, usually in 6-12 weeks, to ensure resolution. Cysts or masses that continue to enlarge, become symptomatic, or attain a more worrisome sonographic appearance would managed by a gynaecologist.
Ovarian cysts in pregnant women
Many ovarian cysts are found incidentally on routine antenatal ultrasound scan. The vast majority of these will be benign (often corpus luteal cysts) and can be managed expectantly as they are likely to resolve.
Referral to a gynaecologist would be warranted in the case of suspected malignancy, acute complication such as torsion or if the size of the cyst is sufficient to cause obstetric complication.
Ovarian cysts in the peri- or post-menopausal woman
The risk of malignancy is higher in this group, but it is important to remember that the majority of these cysts will be benign. The management of ovarian cysts in this age group will depend on the individual risk of malignancy, which is determined by a thorough history, physical exam, CA-125 concentration and the sonographic appearance of the cyst.
Ovarian cysts will be managed differently depending on many factors, specifically:
• Age and menopausal status
• Personal and family medical history
• Ultrasound appearance of the cyst
• +/- tumour markers (specifically CA-125 in post-menopausal women)
Complications of ovarian cysts
The main complications of ovarian cysts are haemorrhage, rupture and ovarian torsion. All these can cause severe abdominal pain and other symptoms. These complications should be discussed with all individuals having ovarian cysts.
Conclusion
Ovarian cysts are very common in women and, fortunately, the vast majority are benign. In a few women, especially in the peri and postmenopausal age group, ovarian cysts might be associated with cancer. Women in this age group if they are having signs and symptoms suggestive of ovarian cysts, should be examined by a gynaecologist for a complete evaluation.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor who has over thirty two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
