OVARIAN CYSTS (PART 2)

Dr. Kemi Ailoje

Last week, we started a topic on ovarian cyst. We defined and discussed the causes and types of ovarian cyst. This week, we will conclude with its symptoms, diagnosis and treatment.

SYMPTOMS OF OVARIAN CYST

Women with ovarian cysts typically experience little to no discomfort and may go about their daily lives without interruption. Women with cancerous or large cysts, on the other hand, may experience noticeable and even life-threatening symptoms. Among the most common symptoms are:

·       Lower tummy (abdomen) pain or discomfort.

·       Feelings of fullness or pressure in the abdomen.

·       Menstrual irregularities, such as menstrual bleeding absence (amenorrhea), heavy bleeding (menorrhagia), and painful periods (dysmenorrhea).

·       Pelvic pain in general.

·       If a cyst twists or ruptures, it causes severe abdominal pain, fever, and nausea.

·       Lower back or thigh aches and pains.

·       Painful, frequent urination or urinary retention, if a cyst presses against the bladder.

Even though symptoms vary depending on the individual, women with endometriosis cysts are more likely to experience the following:

·       Menstrual cramps that cause pain in the lower back or abdomen

·       Exceptionally heavy menstrual flow

·       Discomfort during intercourse

·       Urination or bowel movements that are painful

Those suffering from polycystic ovary syndrome (PCOS), which causes an abundance of small, unruptured follicles or cysts on the ovaries, may also experience the following symptoms:

·       Missed or irregular periods 

·       Excessive hair growth on the face and body as a result of an increase in the production of masculinizing hormones (hirsutism).

·       Acne complications

·       Increased weight

If you have experienced any of the above symptoms or have been diagnosed with an ovarian cyst, it may be a good time to consult with a clinician to determine a diagnosis and next line of treatment.

DIAGNOSIS OF OVARIAN CYSTS

A gynecological examination is required to diagnose an ovarian cyst. If an ovarian lump or mass is found, additional tests are required to rule out the possibility of ovarian cancer.

To diagnose a benign ovarian cyst, the clinician may use one or more of the following tests:

·       Pelvic Examination

Ovarian cysts are frequently detected when symptoms suggestive of an ovarian cyst are mentioned or during a routine pelvic exam, in which the clinician examines the abdomen for an abnormal swelling that may be a cyst. However, if the pelvic examination does not yield a definitive diagnosis, a vaginal sonogram is performed.

·       Vaginal sonogram

This imaging test provides the clinician with the most precise picture of the ovary and cyst. A small instrument is inserted into the vagina and sound waves are bounced off the uterus, fallopian tubes and ovaries, forming a picture on a monitor. This image allows the clinician to accurately determine the size of the cyst as well as see inside it and determine whether it is solid or fluid-filled. While a vaginal sonogram may detect the presence of a cyst, it cannot tell if it is benign or malignant. If the sonogram reveals a cyst, the next step may be surgical removal of the cyst to determine whether it is malignant or benign.

·       Laparoscopy

The surgeon can see and remove the cyst with this minimally invasive surgical procedure by making a small incision in the abdomen rather than a long cut. The laparoscope, a thin lighted telescope, is inserted into the abdomen through a small incision. The cyst is then removed using small instruments placed near the pubic bone by the surgeon.

TREATMENT OF OVARIAN CYSTS

Treatment is determined by the age, size, and type of cyst. It may also be determined by the symptoms. The clinician may recommend the following steps:

·       Watchful waiting:  In many cases, it is preferable to wait and be reexamined to see if the cyst disappears after a few months. If you have no symptoms and an ultrasound shows a small, fluid-filled cyst, this is usually an option regardless of age. You may need several follow-up pelvic ultrasounds to see if the cyst’s size or appearance changes.

·       Medication: Ovulation is prevented by hormonal contraceptives such as birth control pills. This may help to prevent future ovarian cysts. However, birth control pills will not shrink an existing cyst.

·       Surgery: A cyst that is large, does not appear to be a functional cyst, continues to grow, or causes pain may be removed by the surgeon. Some cysts may be removed without removing the ovary (cystectomy). In some cases, the cystic ovary is removed (oophorectomy). Minimally invasive surgery (laparoscopy) with a laparoscope and instruments inserted through small cuts in the abdomen may be performed. If the cyst is large or there is a risk of cancer, an open procedure with a larger cut may be required.

An ovarian cyst that appears after menopause is occasionally diagnosed as cancer. In this case, you should consult with a gynecologic cancer specialist (gynecologic oncologist). The uterus, cervix, fallopian tubes, and ovaries may need to be removed surgically. You might also require chemotherapy or radiation.

CONCLUSION

Ovarian cysts are benign growths that form on or within the ovaries. Cysts come in a variety of shapes and sizes. The most common type is harmless, does not cause symptoms, and eventually goes away on its own after a few months without treatment. Regular pelvic exams to help reduce the chances of having a cyst and be aware of the symptoms that may indicate a serious problem requiring specialist review.