Ovarian Cysts

Ovarian Cysts: Overview

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.

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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

  • Functional cysts – are the most common type.  These cysts are related to variations in the normal function of the ovaries.  For example, they form when an egg fails to release as it should during normal ovulation.  They can last 4-6 weeks.  Rarely do they secrete hormones.
  • 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:

    • Dermoid cyst – which consists of a growth filled with various types of tissue such as fatty material, hair, teeth, bits of bone and cartilage.
    • Polycystic ovaries – caused by a buildup of multiple small cysts which cause hormonal imbalances that can result in irregular periods, body hair growth and infertility.  Polycystic Ovary Syndrome, a separate condition, causes follicular cysts to develop as a result of pituitary overproduction of luteinizing hormone in an attempt to initiate ovulation.

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.

Causes and Development; Contributing Risk Factors

Ovarian cysts may result from corpus luteum cysts, malignancy or dermoid cysts.

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.

Signs and Symptoms

Symptoms include:

  • A feeling of fullness or swelling of the abdomen.
  • Weight gain.
  • A dull constant ache on either or both sides of the pelvis.
  • Pain during intercourse.
  • Delayed, irregular or painful menstrual periods.
  • Increased facial hair.
  • Sharp, severe abdominal pain, fever and/or vomiting.  This may be caused by a bleeding cyst or one that breaks or twists.

Diagnosis and Tests

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.

Treatment and Prevention

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.

Prognosis

Ovarian cysts are common and will resolve over time, thus confirming that they were functional cysts instead of something more serious.

Signs, symptoms & indicators of Ovarian Cysts:

Symptoms - Abdomen

Moderate/severe/significant right iliac pain or mild right iliac discomfort

The most common symptom of ovarian cyst is pain in the lower right or left side of the pelvis, right where the ovaries are.  The side will depend on which ovary contains the cyst.  Specific pain in the right iliac can be a caused by ovarian torsion, which usually occurs when the ovary is enlarged by a cyst.

Moderate/severe/significant left iliac pain or mild left iliac discomfort

The most common symptom of ovarian cyst is pain in the lower right or left side of the pelvis, right where the ovaries are.  The side will depend on which ovary contains the cyst.  Specific pain in the left iliac can be a caused by ovarian torsion, which usually occurs when the ovary is enlarged by a cyst.

Moderate/severe/significant hypogastric pain or mild hypogastric discomfort

Due to the location of the ovaries, a growing cysts can cause pain in the lower abdomen.

Slight/intermittent/constant abdominal fullness

Fluid in an ovarian cyst can irritate the lining of the abdomen, creating inflammation which in turn can cause bloating or fullness.

Symptoms - Gas-Int - General

Recent onset/chronic vomiting or vomiting for 1-3 months

There are three different ways in which ovarian cysts can cause chronic vomiting: 1) When an ovarian cyst ruptures, fluid and sometimes blood are released into the ovary or surrounding tissues; 2) In some women the cause can be severe pain from a cyst; 3) Irritation of tissues in the abdomen.

Occasional/regular/frequent unexplained vomiting

There are three different ways in which ovarian cysts can cause vomiting: 1) When an ovarian cyst ruptures, fluid and sometimes blood are released into the ovary or surrounding tissues; 2) In some women the cause can be severe pain from a cyst; 3) Irritation of tissues in the abdomen.

Symptoms - Metabolic

Occasional/frequent unexplained fevers

When an ovarian cyst becomes twisted or ruptures it can cause fever.

Symptoms - Reproductive - Female Cycle

Painful menstrual cramps

Ovarian cysts can cause symptoms resembling painful menstrual periods when the cyst grows to a larger size.

Conditions that suggest Ovarian Cysts:

Female-Specific

Hirsutism

A study by the Royal College of Obstetricians and Gynaecologists, reported by the BBC in April of 2009, found that 70-80% of cases of female Hirsutism are caused by polycystic ovarian syndrome, an abnormality of the ovaries where many small cysts appear due to elevated testosterone levels.

Irregular Periods

In some cases ovarian cysts can cause problems with menstrual periods such as abnormal or irregular bleeding, especially in women with endometriosis.

Metabolic

Bulimic Tendency

Polycystic or multifollicular ovarian cysts are common in bulimics.

Symptoms - Reproductive - General

Ovarian cysts (confirmed)

The presence of ovarian cysts can only be confirmed by having a medical professional perform the recommended diagnostic tests.

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Risk factors for Ovarian Cysts:

Symptoms - Reproductive - Female Cycle

History of painful menstrual cramps

A history of painful menstrual cramps can indicate hormonal problems or imbalances which can increase the risk of ovarian cysts.

Symptoms - Reproductive - General

Unusual vaginal bleeding

Dysfunctional uterine bleeding is commonly associated with an 'anovulatory cycle' – a menstrual cycle that does not result in the release of an egg from one of the ovaries.  If a follicle does not release an egg, it can swell and become a cyst.

Ovarian Cysts can lead to:

Female-Specific

Metrorrhagia

Ovarian cysts may cause a variety of menstrual abnormalities, including Metrorrhagia, depending on the hormone produced by the cyst.  Metrorrhagia can also be a result of an ovarian cyst being unusually large, blocking the blood supply or rupturing.

Recommendations for Ovarian Cysts:

Botanical / Herbal

Castor Oil

Castor oil packs can help reduce inflammation.

Wild Yam

Wild Yam root (Dioscorea villosa) promotes a healthy menstrual cycle, hormonal balance and can help reduce ovarian pain.  Wild Yam contains 'saponin aglycone diosin' which can be converted to diosgenin in the body.  Once released, diosgenin is absorbed through the mucous membranes of the intestines into the bloodstream.  This allows diosgenin to act on estrogen receptor sites in the hypothalamus, which in turn can help regulate production of estrogen and promote estrogen balance.  This support allows for better function of the uterus while working to prevent uterine cramping or spasms.  This has a positive effect on the ovaries, toning them and relieving ovarian cyst pain.

Squawvine

Squaw vine (also known as Partridgeberry) is a medicinal herb known for being useful for adenomyosis, endometriosis, uterine fibroids and ovarian cysts.  It has astringent properties and can therefore cause toning and support the tissues of the body, including the uterus and ovaries.

Hormone

Natural Progesterone

Intravaginal application of progesterone cream provides higher doses where needed in cases of endometriosis, fibroids and ovarian cysts.

Physical Medicine

Hydrotherapy

Hydrotherapy applied to the abdomen may help prevent a cyst from rupturing.  It increases circulation in the pelvic area which in turn promotes healing and reduces pain during the treatment of ovarian cysts.

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