Ovarian Cyst: Symptoms, Treatment & Common Doubts

What is it:

An ovarian cyst is a fluid-filled sac that forms on the inside or outside of the ovary. It can cause pain in the pelvic region, irregular periods, and difficulty in getting pregnant.

Generally, ovarian cysts are benign and disappear after a few months without needing treatment. However, if you present symptoms, you may need medical treatment.

Ovarian cysts are usually not a concern as they are common in women between the ages of 15 and 35. They may form several times throughout life.

Symptoms of ovarian cysts

It is very rare for an ovarian cyst to cause symptoms, but when it is very large (ie. more than 3 cm in diameter), you may notice symptoms such as:

• Pain in the ovary, on the side where the cyst is;
• Pain during ovulation;
• Pain during intimate contact;
• Irregular period;
• Increased breast tenderness;
• Vaginal bleeding outside your menstrual period;
• Weight gain, due to the hormonal changes;
• Difficulty getting pregnant.

To diagnose an ovarian cyst, the doctor will first assess you by palpating you pelvic region. He or she may then order transvaginal ultrasound, a CT scan, or an MRI.  

The doctor may also order a pregnancy test to check for the presence of beta HCG to rule out the possibility of an ectopic pregnancy. This condition may present with similar symptoms. Learn more about the symptoms, causes and treatment of ectopic pregnancy. 

After confirming an ovarian cyst, if the doctor suspects malignancy, he or she may also request blood tests, such as CA-125. Blood levels should be under 35 mUL.

Warning signs

Warning signs that may indicate a possible ovarian torsion, which requires urgent surgery are:

• Intense pain on one side of the abdomen, which decreases when you put hot compresses on the region;
• Nausea and vomiting, which can be confused with appendicitis or bowel obstruction.

If you experience these symptoms, you should go to the emergency room as soon as possible.

Cysts over 8cm in size are more likely to rupture or twist. In addition, for a woman who gets pregnant and has a large cyst, there is a greater chance of torsion between 10 and 12 weeks of pregnancy due to the growth of the uterus. During this time, the uterus pushes on the ovary, which can lead to a torsion.

Types of ovarian cysts

The main types of ovarian cysts include:

• Follicular cyst: this is formed when there is no ovulation or when the ovum does not leave the ovary during your fertile phase. Usually you do not have any symptoms and it does not require treatment. Its size can vary from 2.5 cm to 10 cm, although it usually decreases in size within 4 to 8 weeks. It is not considered to be a type of cancer.
• Corpus luteum cyst: this may form after the release of an ovum and usually disappears without treatment. Its size varies between 3 and 4 cm. Although it may rupture during intimate contact, no specific treatment is necessary. However, if you experience severe pain, a drop in blood pressure and an accelerated heartbeat as a result of the cyst, removal through laparoscopic surgery may be considered.
• Theca-lutein cyst: it occurs rarely, and is more common in women who take medication to get pregnant;
• Hemorrhagic cyst: it happens when there bleeding along the cyst wall and can cause pelvic pain;
• Dermoid cyst: also known as a mature cystic teratoma, this can be found in infants or later in life. It contains hair, tooth or bone fragments, and requires laparoscopic removal;
• Ovarian fibroma: this is a type of neoplasm that is more common in menopause. It can range from microcysts to a total weight of up to 23 kg, and it should be removed with surgery.
• Ovarian endometrioma: it arises in cases of endometriosis in the ovaries, and requires treatment with medication or removal with surgery;
• Cystadenoma: a benign ovarian cyst, which must be removed through laparoscopy.

Because these cysts are filled with fluid, they are referred to as anechoic cysts. This means that they do not reflect the ultrasound waves used in diagnostic tests. The term anechoic is not related to their severity.

The type of cyst can be determined by a doctor through examinations such as ultrasound, laparoscopy or blood tests. 

Treatment options

Having an ovarian cyst is not always dangerous, and it is expected to decrease in size on its own, without the need for treatment.

Painkillers such as acetaminophen can be used in cases of pain. Oral contraceptives are often prescribed in cases of follicular cysts to suppress ovulation Placing a warm compress over the painful region may also relieve the discomfort, but whenever the pain is very intense you should go to the doctor or emergency room for immediate assessment. The pain can be caused by a cyst that has grown, or a rupture, which requires surgery.

If symptoms are intense or if the cyst impedes with ovarian function, surgery may be recommended to remove the cyst. In more severe cases, where the cyst is very big, has signs of cancer or there is ovary torsion, it may be necessary to completely remove the ovary.

Is it still possible to get pregnant?

An ovarian cyst does not cause total infertility, but it may make getting pregnant more difficult. There are hormonal changes that occurred which led to the original cyst, and these changes can impede with conceiving. However, with proper treatment, the cyst will decrease in size or disappear, allowing the body to go back to its normal hormonal rhythm. This will facilitate fertilization.

If you have an ovarian cyst and become pregnant, you should make regular visits to your obstetrician because there is a greater risk of complications such as ectopic pregnancy.

Can a cyst be ovarian cancer?

An ovarian cyst is usually not cancer, as it is typically a benign lesion that disappears on its own. It is surgically removed when it is large in size, as their is a larger risk for rupture and can cause significant pain or discomfort. Ovarian cancer is more common in women over the age of 50, and is very rare in women under 30.

Cysts that are suspicious for cancer are those large in size, with a thick septum and a solid area. If these characteristics are present. the doctor may request a CA-125 blood test to check for high levels. High levels may be a sign of a carcinogenic lesion. It is important to note that, women with ovarian endometrioma may have elevated CA-125 without having cancer.