An ovary can frequently become enlarged by a cyst – a fluid-filled compartment or sac formed by an envelope of ovarian tissue. These enlargements distinguish cysts from solid tumors that may also cause an increase in ovarian size. A cyst in an ovary may be part of the ovary's normal function, or it may be part of a tumor. These cysts may cause pain and pressure symptoms, or may be completely 'silent'. Those cysts that have not caused pain are usually found during gynecologic exam or ultrasound.
A follicular cyst is one in which the egg-making follicle of the ovary enlarges and fills with fluid. A corpus luteum cyst is a yellow mass of tissue that forms from the follicle after ovulation. These types of cysts come and go each month and are associated with normal ovarian function.
Types of Cyst
Abnormal or neoplastic cysts – result from cell growth and are mostly benign. In rare cases, they can be cancerous. Abnormal cysts require medical treatment by your doctor. Examples include:
Women with healthy ovaries normally release an egg from a small ovarian cyst each month. The small cyst becomes a corpus luteum cyst and then lasts for two to three weeks waiting to support a new pregnancy. If pregnancy does not occur, the woman will experience a menstrual period as part of the process of the disappearing corpus luteum cyst. These normal cysts, also called functional cysts, are usually only 2-3cm in size but may reach 6-8cm if filled with blood or lots of fluid. Functional cysts resolve within one to two menstrual cycles and so can be identified by their disappearing behavior. Their presence explains why women of reproductive age have small cysts in the ovary all the time. What is not as common are functional cysts that grow so fast as to cause pain, or so large as to be easily felt on exam.
They are most common between the ages of 20 and 35 and in women who have endometriosis, pelvic inflammatory disease (PID) or the eating disorder bulimia. Those who take a drug for epilepsy called Valporate are also at increased risk.
Your doctor may order a pelvic ultrasound if a mass is found during the pelvic exam. The ultrasound will evaluate the ovaries and any suspected cysts. Functional cysts are characterized by being fluid-filled and composed of one single sac or chamber. The ultrasound can identify the cyst as being single-chambered. Confirming a functional cyst means it will not likely need treatment and should simply be observed. If that cyst does persist over two to three months, then it should be re-evaluated and treated.
When an ovarian cyst is found, the first important decision to be made is whether this cyst will go away without treatment. Spontaneous resolution is expected and normal for the functional cysts related to ovulation.
Any ovarian growth with multiple cystic areas or mixed solid and cystic features should be considered a tumor and possibly a malignancy. These should be surgically removed to determine the exact diagnosis. When a functional cyst or simple benign tumor is identified, the ovary can be preserved for younger women because only the cyst is removed in those cases.
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