What are ovarian cysts?
A cyst is like a balloon filled with fluid. The majority of cysts in the ovary are physiological (natural or functional). As ova (eggs) start to mature they develop in follicular cysts. These generally reach up to 2.5 cms diameter. Occasionally they can reach 4 or 5 cms diameter. The vast majority of small cysts will disappear without treatment. Sometimes these cysts continue to release hormones delaying the onset of the next period. the Question of pregnancy then arises. If there is associated pain, the possibility of an ectopic pregnancy (Q12.23) needs to be considered. Modern pregnancy tests are very sensitive and a negative result excludes this diagnosis.
Endometriosis may result in chocolate filled cysts of the ovaries (18). In polycystic ovary syndrome (Q7. 2) the cysts are small varying from 2-8 mm. They are not cysts that need to be removed and they do not seem to cause pain.
True ovarian cysts may continue to increase in size. Every sort of tissue within an organ has the potential to form a tumour, which can be benign or malignant. As the ovaries contain most tissue types including eggs that have the potential to produce every tissue, there is a greater variety of tumours of the ovaries than for any other organ. With increasing age of the patient there is a greater chance of an ovarian cyst proving to be malignant. When there is concern that an ovarian cyst could be malignant a blood test for a tumour marker (Ca-125) may provide guidance (Q32.25).
How do ovarian cysts cause pelvic pain?
Moderate sized cysts may undergo torsion (twisting) and this cuts off their blood supply causing acute pain. Bleeding into an ovarian cyst, even a physiological cyst, can be the cause of pain. A cyst may rupture (burst) releasing blood or fluid that irritates the peritoneum (peritonism 6). Some of the clinical manifestations of peritonism, notably pain and tenderness may be similar to those found in peritonitis (inflammation of the peritoneum). Peritonitis, which is a dangerous condition, has the additional evidence of infection including an elevated temperature and a high white blood cell count. An endometrioma (a collection of old blood associated with endometriosis - 18) can be associated with pain, although at times even large collections may be pain free.
How are ovarian cysts diagnosed?
Ovarian cysts can cause discomfort and occasionally pain in the pelvis or bladder pressure symptoms including increased Frequency of micturition (bladder emptying -Q 29.9). An ovarian cyst may be recognised during a routine pelvic examination or if it is particularly large it can be felt on examination of the abdomen. The majority of patients referred to me with an ovarian cyst have had the diagnosis made from an ultrasound examination that was re quested to investigate pelvic pain. Most of these cysts will prove to be physiological and will resolve without treatment.
How are ovarian cysts treated?
If the cyst is physiological, it will disappear spontaneously within a few weeks or months. If the cyst seems to be simple (no structures within the cyst), it can be drained through a fine needle under ultrasound guidance or at laparoscopy (laparoscopy). Aspiration of a cyst, however, has been shown to be no better than observation alone1996-01. There may be an occasional indication for aspiration in those who would be at risk from surgery1993-01. Larger cysts may need surgical removal. Many can be treatedlaparoscopically.
For young women, the aim of treatment is to be as conservative as possible. When there is acute severe pelvic pain associated with an ovarian cyst in a young woman emergency surgery may be required. The objective is to remove the cyst and conserve the remainder of the ovary. When a woman in her forties or beyond presents with pain associated with an ovarian cyst serious consideration would need to be given to removing both ovaries and the uterus (Q32.33A). Ultrasound examination is required to provide further details of the swelling. Areas of solid tissue associated with the cyst(s) reduce the chance of the cyst being innocent. An exact diagnosis can only be provided by full detailed microscopic assessment (histopathology) of the cyst.
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Related Medical Abstracts - Click on the paper title.
- Transvaginal aspiration of ovarian cysts: long-term follow-up. (2006-01)
- Clinical management of functional ovarian cysts: a prospective and randomized study (2000)
- Follow up of women with simple ovarian cysts detected by transvaginal sonography in the Tokyo metropolitan area. (1999)
- Role of puncture and aspiration in expectant management of simple ovarian cysts: A randomised study (1996).
- The management of ovarian cysts by sono-guided transvaginal cyst aspiration. (1993-01)
- 1 Pelvic Pain. Is this a common problem?
- 2 What are the common causes of pelvic pain in women?
- 3 What are the more common gynaecological causes of pelvic pain?
- 4 What are the more common non-gynaecological causes of pelvic pain?
- 5 What are primary and secondary dysmenorrhoea - painful periods?
- 6 What is retrograde menstruation?
- 7 How can dysmenorrhoea - painful periods be treated?
- 8 What are ovarian cysts?
- 9 How do ovarian cysts cause pain?
- 10 How are ovarian cysts diagnosed?
- 11 How are ovarian cysts treated?
- 12 I think I may be pregnant and I have some pelvic pain. What should I do?
- 13 What is pelvic inflammatory disease and how can it be treated?
- Mittelschmertz
- What are fibroids?
- I have fibroids. What difficulties might they cause for me?
- How are fibroids diagnosed?
- How could my fibroids be treated?
ENDOMETRIOSIS
- What is endometriosis?
- How prevalent is endometriosis?
- What causes endometriosis?
- How can my endometriosis be treated?
- How can my doctor determine the cause of my pelvic pain?
- What investigations might be recommended by my gynaecologist to investigate my pelvic pain?
- What is laparoscopy?
- What are pelvic adhesions?
- I have chronic pelvic pain. Could this be related to adhesions?
- What is uterine retroversion (retroverted uterus)
- Does a retroverted uterus (backward tilted uterus) cause symptoms?
- How is a retroverted uterus - backward tilted uterus - treated?
- What is pelvic congestion?
- What causes pain associated with sexual intercourse (dyspareunia)
- How can painful sexual intercourse (dyspareunia) be treated?
- What is a pelvic mass?
IRRITABLE BOWEL SYNDROME - IBS
- What is irritable bowel syndrome?
- How can we find out if I have irritable bowel syndrome?
- Is irritable bowel syndrome (IBS) a common condition?
- What causes IBS?
- What is the pain associated with IBS like?
- Can IBS be mistaken for gynaecological problems?
- How can my IBS be treated?
- What other treatments are available for IBS?
- What can be done to reduce the amount of bowel gas(flatus)
- What is constipation?
- What causes constipation?
- How can constipation be treated?
- How could we summarise the treatments that are available for my pelvic pain?
- Where can I obtain more information?
- Pelvic Pain Support Groups.
- Endometriosis Support Groups.
- IBS Support Groups.
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This is the personal website of David A Viniker MD FRCOG, retired Consultant Obstetrician and Gynaecologist - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
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