What is Ovarian Cyst?
An ovarian cyst is a fluid-filled sac that forms on the ovary, commonly occurring during a woman’s reproductive years or menstruation.
Each woman has two ovaries, one on each side of the uterus. These walnut-sized organs are part of the female reproductive system.
The ovaries have the main function of producing eggs every month (from puberty to menopause) and producing hormones such as estrogen and progesterone. Ovarian function can be disrupted, with cysts being a common occurrence.
Symptoms of Ovarian Cysts
When cysts are small, individuals usually do not experience symptoms. However, as cysts grow larger, symptoms may develop. This is because cysts can interfere with blood flow to the ovaries. Common symptoms of ovarian cysts include:
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Pain or discomfort
Pain or discomfort typically occurs in the lower abdomen. The severity varies, ranging from mild to severe. Additionally, the pain may come and go, occurring on either the right or left side. Pain may also arise during sexual intercourse.
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Changes in menstruation
During menstruation, individuals with ovarian cysts may experience heavier or lighter bleeding than usual. Additionally, menstrual cycles may become irregular.
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Digestive issues
Individuals with ovarian cysts may feel excessively full even after eating a small amount and experience bloating. Other digestive disturbances may include difficulty with bowel movements and increased frequency of urination.
Causes of Ovarian Cysts
What causes ovarian cysts? These cysts occur due to processes within the menstrual cycle itself (functional cysts) or abnormal cell growth (pathological cysts). Here are some types of ovarian cysts based on their classification:
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Functional Cysts
These cysts occur when the ovaries release eggs for fertilization (ovulation). If the size of the egg increases each month, it can lead to functional cysts.
Functional cysts are the most common type experienced by women. They are typically harmless and can disappear within 2-3 menstrual cycles. Functional cysts are further divided into two types:
a. Follicular cysts
Normally, eggs are surrounded by follicles and rupture during ovulation. Follicular cysts occur when the follicle fails to rupture, trapping the egg. As a result, the follicle swells with fluid, forming a cyst.
b. Corpus luteum cysts
After the follicle ruptures and releases the egg, it forms the corpus luteum, which produces fluid. These cysts occur when the opening of the corpus luteum becomes blocked, leading to fluid accumulation. Consequently, the corpus luteum enlarges, forming a cyst.
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Pathological Cysts
Pathological cysts are not related to the menstrual cycle and occur due to abnormal cell growth. These cysts can be benign or malignant ovarian tumors, although pathological cysts are usually benign. They include several types:
a. Dermoid cysts
These cysts originate from embryonic cells present since birth and develop during a woman’s reproductive years. While usually benign, dermoid cysts can develop into cancer.
b. Adenoma cysts
Adenoma cysts appear on the surface of the ovary and can contain fluid or mucus. They may enlarge and cause ovarian torsion, reducing or stopping blood flow to the ovary.
c. Endometriomas
Endometriomas occur when cells from the uterine lining or endometrium grow on the ovary.
In addition to these cyst causes, several conditions can increase a person’s risk of developing ovarian cysts, including:
- Taking fertility medications.
- Pregnancy.
- Previous history of ovarian cysts.
- Severe pelvic infections, endometriosis, or PCOS.
Diagnosis of Ovarian Cysts
Ovarian cysts can be detected through pelvic ultrasound scans. In addition to ultrasound, doctors may recommend pregnancy tests to ensure the individual is not pregnant. However, if the individual is pregnant, the detected cyst is likely a corpus luteum cyst.
Next, doctors will perform blood tests, including hormone level tests, to detect any hormonal imbalances. Additionally, for individuals in menopause with cysts containing solid material, doctors will conduct a CA 125 blood test for cancer antigen.
A high CA 125 test result may indicate that the lump on the individual’s ovary is malignant. However, a high CA 125 test result does not always indicate ovarian cancer, especially in premenopausal women.
If necessary, doctors may perform laparoscopy to examine ovarian cysts in more detail. This procedure involves inserting a thin tube with a camera at its tip into the individual’s abdomen through a small incision in the abdominal wall to observe the ovary’s condition.
Treatment of Ovarian Cysts
Cysts usually disappear on their own without requiring specific treatment. The treatment approach depends on the type and size of the cyst and the individual’s age. Treatment options include:
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Regular monitoring
Regular monitoring is done if the cyst is still small and asymptomatic. Monitoring involves performing ultrasound scans several weeks or months after the cyst diagnosis to determine if the cyst has disappeared or persists.
Meanwhile, in postmenopausal women, ultrasound and blood tests should be performed every 4 months because they are at higher risk of ovarian cancer.
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Birth control pills
Doctors may prescribe birth control pills to prevent the recurrence of cysts. However, birth control pills cannot shrink existing cysts.
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Surgical procedures
Surgery is performed if the cyst continues to grow, persists after more than 3 menstrual cycles, or causes pain. The surgical procedure aims to remove the cyst. However, for severe cases, doctors may also remove the ovary.
Surgery to remove small cysts is performed using laparoscopic methods, involving small incisions assisted by laparoscopic instruments. However, for larger or malignant cysts, doctors may perform open abdominal surgery or laparotomy.
All surgical procedures carry risks. Complications that may occur after ovarian cyst surgery include infection at the surgical site characterized by bleeding, abdominal pain or swelling, fever, and foul-smelling dark discharge.
Impact of Treatment on Fertility
Removing both ovaries surgically will render the individual unable to conceive. Therefore, in managing cysts, doctors will strive to preserve the fertility of individuals who have not reached menopause.
If doctors must remove an ovary, the procedure typically only affects one ovary. The other ovary is left intact, allowing the individual to still conceive.
Complications of Ovarian Cysts
Complications that can occur due to ovarian cysts include:
- Ovarian torsion. Enlarged cysts can cause the ovary to move and twist, causing painful ovarian torsion.
- Ruptured cysts. Ruptured cysts can cause severe pain and internal bleeding.
Prevention of Ovarian Cysts
Although there is no way to prevent ovarian cysts, regular pelvic examinations can help detect changes in the ovaries early, allowing ovarian cysts to be detected as early as possible.
Additionally, women are advised to be vigilant about changes in their monthly cycles, including unusual menstrual symptoms, especially if these conditions persist for more than a few cycles.
