Ovarian cysts: Why you should get treatment

Marian, 30, felt stomach ache for some weeks and was diagnosed of ovarian cyst when she went to the hospital. The ovaries are part of the female reproductive system. They are located in the lower abdomen on both sides of the uterus. Women have two ovaries that produce eggs as well as the hormones estrogen […]

Marian, 30, felt stomach ache for some weeks and was diagnosed of ovarian cyst when she went to the hospital.

The ovaries are part of the female reproductive system. They are located in the lower abdomen on both sides of the uterus. Women have two ovaries that produce eggs as well as the hormones estrogen and progesterone.

According to Dr Victor Ohenhen, a Consultant Obstetrician/Gynaecologist, at the Central Hospital, Benin City, a fluid-filled sac called a cyst may develop on one of the ovaries. And most women would develop at least one cyst during their lifetime but in most cases, cysts are painless and cause no symptoms.

He said there are different types of ovarian cysts, and they include, among others, functional cysts, dermoid cysts, endometrioma cysts and Cystadenomas.

However, functional cysts are the most common type. They exist in two types which include follicle and corpus luteum cysts.

Explaining the follicle cyst, the medical expert said during a woman’s menstrual cycle, an egg grows in a sac called a follicle. This sac is located inside the ovaries. In most cases, this follicle or sac breaks open and releases an egg. But if the follicle doesn’t break open, the fluid inside the follicle can form a cyst on the ovary.”

On Corpus luteum cysts, he said follicle sacs typically dissolve after releasing an egg. But if the sac doesn’t dissolve and the opening of the follicle seals, additional fluid can develop inside the sac, and this accumulation of fluid causes a corpus luteum cyst.

For the other types of ovarian cysts, the Dr provides the following explanations:

Dermoid cysts: sac-like growths on the ovaries that can contain hair, fat, and other tissue.

Endometriomas: tissues that normally grow inside the uterus, and can develop outside the uterus and attach to the ovaries, resulting in a cyst.

Cystadenomas: non-cancerous growths that can develop on the outer surface of the ovaries.

Dr Ohenhen said some women develop a condition called polycystic ovary syndrome (PCOS). This condition means the ovaries contain a large number of small cysts. It can cause the ovaries to enlarge. He warned that if left untreated, polycystic ovaries can cause infertility.

He said most times, ovarian cysts are asymptomatic, that is they do not cause any symptom. However, symptoms can appear as the cyst grows. Symptoms may include: abdominal bloating or swelling, painful bowel movements, pelvic pain before or during the menstrual cycle, painful intercourse, pain in the lower back or thighs, breast tenderness, nausea and vomiting.

Severe symptoms of an ovarian cyst that require immediate medical attention include: severe or sharp pelvic pain, fever, faintness or dizziness, and rapid breathing. These symptoms can indicate a ruptured cyst or an ovarian torsion.

Both complications can have serious consequences if not treated early, Ohenhen said.

Dr Ohenhen who is also Chairman, Medical and Dental Consultant’s Association Of Nigeria, Edo State Hospitals Management Board Chapter, said most ovarian cysts are benign, and naturally go away on their own without treatment.

These cysts cause little, if any, symptoms but in rare cases, a cancerous cystic ovarian mass may be detected during routine examination.

“Ovarian torsion is another rare complication of ovarian cysts. This is when a large cyst causes an ovary to twist or move from its original position. Blood supply to the ovary is cut off, and if not treated, it can cause damage or death to the ovarian tissue. Although uncommon, ovarian torsion accounts for nearly 3 percent of emergency gynecologic surgeries.

“Ruptured cysts, which are also rare, can cause intense pain and internal bleeding. This complication increases the risk of an infection and can be life-threatening if left untreated.”

Ovarian cysts could be detected during a routine pelvic examination. An ultrasound test to confirm the presence of a cyst is usually the mainstay of diagnosis. An ultrasound test (ultrasonography) is an imaging test that uses high-frequency sound waves to produce an image of internal organs. Ultrasound test helps to determine the size, location, shape, and composition (solid or fluid filled) of a cyst.

Dr Ohenhen said treatment was rarely needed for ovarian cysts in most cases, as they tend to shrink spontaneously. However, he said when this fails to happen, or if it keeps growing larger or if the cyst is symptomatic, treatment is then commenced.

He said if ovarian cysts are recurrent, oral contraceptives pills (OCPs) could be prescribed to stop ovulation and prevent the development of new cysts. “Oral contraceptive pills can also reduce the risk of ovarian cancer. However, it is worthy to mention that the risk of ovarian cancer is higher in postmenopausal women.”

The medical expert said laparoscopy and laparotomy could also be used. “If the cyst is small and results from imaging tests rule out cancer, a laparoscopy can be performed to surgically remove the cyst. The procedure involves doctors making a tiny incision around the umbilicus and then inserting a small instrument into the abdomen to remove the cyst.

“Laparotomy-If the cyst is very large (>50mm in diameter), it could be removed surgically through a large incision in the abdomen to be taken for an immediate biopsy, and if it is determined that the cyst is cancerous, there may be need to perform a hysterectomy to remove the ovaries and uterus completely.”

Medical experts said ovarian cysts could not be prevented. However, routine gynecologic examinations can detect ovarian cysts early.

Dr Ohenhen said, however, that symptoms of ovarian cancer could mimic symptoms of an ovarian cyst, “Thus it is important to visit your doctor and receive a correct diagnosis. Alert your doctor to symptoms that may indicate a problem, functional changes in your menstrual cycle, ongoing pelvic pain, loss of appetite, unexplained weight loss, abdominal fullness etc.”

He said that the outlook for premenopausal women with ovarian cysts was good. “Most cysts disappear within a few months. However, recurrent ovarian cysts can occur in premenopausal women and women with hormone imbalances.

If left untreated, some cysts could decrease fertility. This is common with endometriomas (a type of cyst formed when endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) grows in the ovaries. It affects women during the reproductive years and may cause chronic pelvic pain associated with menstruation and polycystic ovarian syndrome. To improve fertility, your doctor can remove or shrink the cyst. Functional cysts, cystadenomas, and dermoid cysts are not associated with infertility.”

He said although some doctors take a “wait and see” approach with ovarian cysts, surgery may be recommended to remove and examine any cyst or growth that develops on the ovaries after menopause. This is because the risk of developing a cancerous cyst or ovarian cancer increases after menopause. However, ovarian cysts don’t increase the risk of ovarian cancer. Some doctors will remove a cyst if it is larger than 50mm in diameter.

A better health-seeking behavior and health awareness campaign is most desirable as part of strategies to improve women’s health, Dr Ohenhen advised.