Cysts in the Ovaries: Definition, Symptoms, Diagnosis, Causes and Treatment

An ovarian cyst is a sac filled with fluid inside the ovary.

They often do not cause symptoms, occasionally they can cause swelling, lower abdominal pain or lower back pain. Most cysts are harmless.

If the cyst ruptures or causes ovarian torsion, it can cause severe pain. This can cause vomiting or fainting.

Most ovarian cysts are related to ovulation , whether they are follicular cysts or corpus luteum cysts. Other types include cysts due to endometriosis , dermoid cysts and cystadenomas.

Many small cysts occur in both ovaries in polycystic ovarian syndrome . Pelvic inflammatory disease can also lead to cysts. Rarely, cysts can be a form of ovarian cancer.

The diagnosis is made by a pelvic exam with an ultrasound or other test used to gather more details.

Often, cysts are simply observed over time. If they cause pain, medications such as acetaminophen (acetaminophen) or ibuprofen may be used.

Hormonal birth control can be used to prevent more cysts in those who are affected frequently. However, the evidence does not support birth control as a treatment for current cysts.

If they do not disappear after several months, they grow, look unusual or cause pain, they can be removed by surgery.

Most women of reproductive age develop small cysts each month. Large cysts that cause problems occur in about 8% of women before menopause.

Ovarian cysts are present in approximately 16% of women after menopause and, if present, are more likely to be cancer.

Signs and symptoms

Some or all of the following symptoms may be present, although it is possible to not experience any symptoms:

Abdominal pain : dull and painful pain inside the abdomen or pelvis, especially during intercourse.

Uterine bleeding : pain during or shortly after the start or end of the menstrual period; irregular periods, or abnormal or spotted uterine bleeding.

Swelling : heaviness, pressure, swelling of the belly or swelling in the abdomen, most of us get swollen from time to time, but if it is not caused by food, it could be a symptom of cysts.

If you have a larger ovarian cyst, it could make your abdomen or pelvic area feel full or heavy. This swelling sensation will not disappear if you use the bathroom.

The Office of Women’s Health explains that ovarian cysts can also cause pain during the period, pain during intercourse and unusual bleeding. And pain in other parts of your body.

Ovarian cysts can cause breast tenderness and pain in the thighs and lower back. It is the difficulty to empty the bowel or bladder completely, you may also feel the need to urinate more often than usual.

When a cyst ruptures from the ovary, there may be a sudden, sharp pain in the lower abdomen on one side.

Change in the frequency or ease of urination (such as the inability to completely empty the bladder) or difficulty passing stools due to pressure on the adjacent pelvic anatomy.

Constitutional symptoms such as fatigue, headaches, nausea or vomiting and weight gain.

Other symptoms may depend on the cause of the cysts.

Symptoms that may occur if the cause of the cysts is polycystic ovary syndrome (PCOS) may include increased facial or body hair, acne , obesity and infertility.

If the cause is endometriosis , periods can be intense and painful relationships. The effect of cysts unrelated to polycystic ovarian syndrome on fertility is unclear.

Rupture of the cyst:

A broken ovarian cyst is usually self-limited, and only requires monitoring the situation and analgesics. The main symptom is abdominal pain, which may last from a few days to several weeks, but may also be asymptomatic.

The rupture of large ovarian cysts can cause hemorrhage within the abdominal cavity and, in some cases, shock.

Ovarian torsion:

Ovarian cysts increase the risk of ovarian torsion; cysts larger than 4 cm are associated with approximately 17% risk. Torsion can cause blockage of blood flow and infarction.

Diagnosis

Ovarian cysts are usually diagnosed by ultrasound, computed tomography or magnetic resonance, and correlate with clinical presentation and endocrinological tests, as appropriate.

Ultrasound:

Follow-up images in women of reproductive age for simple cysts incidentally discovered on ultrasound are not necessary up to 5 cm, since these are normal ovarian follicles.

Simple cysts of 5 to 7 cm in premenopausal women should be followed annually. Simple cysts larger than 7 cm require more magnetic resonance imaging or surgical evaluation.

Because they are large, they can not be reliably evaluated by ultrasound only because it can be difficult to see nodularity of soft tissue or thickened septation in the posterior wall due to limited penetration of the ultrasound beam.

For the corpus luteum, a dominant ovulatory follicle that typically appears as a cyst with circumferentially thickened walls and crenulated internal margins, a follow-up is not necessary if the cyst is less than 3 cm in diameter.

In postmenopausal patients, any simple cyst of more than 1 cm but less than 7 cm needs an annual follow-up, while those larger than 7 cm need magnetic resonance imaging or surgical evaluation, similar to women of reproductive age.

For dermoids discovered incidentally, diagnosed with ultrasound due to pathognomonic echogenic fat, surgical removal or annual follow-up is indicated, regardless of the patient’s age.

For peritoneal inclusion cysts, which have a wrinkled appearance of tissue paper and tend to follow the contour of adjacent organs, follow-up is based on clinical history.

Hydrosalpinx, or dilatation of the fallopian tube, can be confused with an ovarian cyst due to its anechoic appearance. The follow-up of this is also based on the clinical presentation.

For multiloculated cysts with thin septation of less than 3 mm, a surgical evaluation is recommended. The presence of multiloculation suggests a neoplasm , although thin septation implies that the neoplasm is benign.

For any thickened septum, nodularity, or vascular flow in the Doppler evaluation, surgical excision should be considered due to concern for malignancy.

Scoring systems:

There are several systems to evaluate the risk that an ovarian cyst is an ovarian cancer, including MRI (risk of malignancy), LR2 and SR (simple rules). The sensitivity and specificity of these systems are given.

Sensitivity and specificity are statistical measures of the performance of a binary classification test, also known in statistics as a classification function:

Sensitivity : also called true positive rate, recovery or probability of detection in some fields, measures the proportion of positives that are correctly identified as such (for example, the percentage of sick people who are correctly identified as carriers of the condition).

Specificity : also called true negative rate, measures the proportion of negatives that are correctly identified as such (for example, the percentage of healthy people who correctly identify themselves as not having the condition).

Ovarian cysts can be classified according to a variant of the normal menstrual cycle, which is called functional or follicular cyst.

Ovarian cysts are considered large when they are larger than 5 cm and giant when they are larger than 15 cm. In children, ovarian cysts that reach above the level of the umbilicus are considered giants.

Functional:

Functional cysts are formed as a normal part of the menstrual cycle. There are several types of cysts:

Follicular cyst, the most common type of ovarian cyst. In menstruating women, a follicle that contains the egg, an unfertilized egg, will break during ovulation. If this does not occur, a follicular cyst larger than 2.5 cm in diameter may occur.

Cysts of the corpus luteum appear after ovulation. The corpus luteum is the remnant of the follicle after the egg has moved to the fallopian tubes. This usually degrades in 5 to 9 days. A corpus luteum that is more than 3cm is defined as cystic.

Theca lutein cysts are produced within the thecal layer of cells surrounding the developing oocytes. Under the influence of excessive human chorionic gonadotropin, the thecal cells can proliferate and become cystic. This usually is in both ovaries.

Not functional:

Nonfunctioning cysts may include the following:

  • An ovary with many cysts, which can be found in normal women or in the context of polycystic ovarian syndrome.
  • Cysts caused by endometriosis, known as chocolate cysts.
  • Hemorrhagic ovarian cyst.
  • Dermoid cyst.
  • Serous ovarian cystadenoma.
  • Ovarian mucinous cystadenoma.
  • Paraovarian cyst.
  • Cystic adenofibroma
  • Borderline tumor cysts.

Causes

In juvenile hypothyroidism , multicystic ovaries are present in approximately 75% of cases, while large ovarian cysts and elevated ovarian tumor markers are one of the symptoms of Van Wyk and Grumbach syndrome.

The CA-125 marker in children and adolescents can be elevated frequently even in the absence of malignancy and should be considered a conservative treatment.

Polycystic ovarian syndrome involves the development of multiple small cysts in both ovaries due to a high proportion of hormone leutenizing to the follicle stimulating hormone, typically more than 25 cysts in each ovary or an ovarian volume of more than 10 ml.

Larger bilateral cysts may develop as a result of fertility treatment due to elevated levels of human chorionic gonadotropin (hCG), as can be seen with the use of clomiphene for follicular induction, in extreme cases resulting in a condition known as ovarian hyperstimulation syndrome.

Certain malignancies may mimic the effects of clomiphene on the ovaries, also due to the increase of human chorionic gonadotropin (hCG), in particular gestational trophoblastic disease.

Ovarian hyperstimulation occurs more frequently with invasive moles and choriocarcinoma than with complete molar pregnancies.

Cancer risk:

A widely recognized method to estimate the risk of malignant ovarian cancer based on the initial study is the risk of malignancy index (RMI).

It is recommended to refer women with an MRI score higher than 200 to a center with experience in ovarian cancer surgery.

The magnetic resonance is calculated as follows:

  • RMI = ultrasound score x menopause score x CA-125 level in U / ml.

There are two methods to determine the ultrasonography score and the menopause score, and the resulting magnetic resonance imaging (MRI) is called RMI 1 and RMI 2, respectively.

It has been estimated that an IMR2 of more than 200 has a sensitivity of 74 to 80%, a specificity of 89 to 92% and a positive predictive value of about 80% of ovarian cancer. RMI 2 is considered more sensitive than RMI 1.

Treatment

Cysts associated with hypothyroidism or other endocrine problems are treated by treating the underlying condition.

About 95% of ovarian cysts are benign, not cancerous.

Functional cysts and hemorrhagic ovarian cysts usually resolve spontaneously. However, the larger an ovarian cyst is, the less likely it will go away on its own.

Treatment may be required if the cysts persist for several months, grow or cause an increase in pain.

Cysts that persist beyond two or three menstrual cycles, or that occur in postmenopausal women, may indicate more serious disease and should be investigated by ultrasonography and laparoscopy , especially in cases where family members have had ovarian cancer .

Such cysts may require a surgical biopsy.

In addition, a blood test can be performed before surgery to detect elevated CA-125, a tumor marker that is often found at elevated levels in ovarian cancer, although it can also be elevated by other conditions resulting in a large amount of false positives.

Pain:

The pain associated with ovarian cysts can be treated in several ways:

Analgesics such as acetaminophen, non-steroidal anti-inflammatory drugs or opioids, analgesic drugs act in various ways in the peripheral and central nervous systems.

Although hormonal contraceptive control prevents the development of new cysts in those who receive them frequently, it is not useful for the treatment of current cysts.

Contraceptive methods that act on the endocrine system. Almost all methods are composed of steroid hormones.

Surgery:

Although most cases of ovarian cysts involve monitoring, some cases require surgery. This may involve removing the cyst, or one or both ovaries.

The technique is typically laparoscopic, unless the cyst is particularly large, or if preoperative images suggest malignancy or complex anatomy.

In certain situations, the cyst is completely eliminated, whereas with cysts with low recurrence risk, younger patients or those in anatomically eloquent areas of the pelvis may be drained.

Features that may indicate the need for surgery include:

  • Persistent complex ovarian cysts.
  • Persistent cysts that cause symptoms
  • Complex ovarian cysts of more than 5cm.
  • Simple ovarian cysts of 10cm or more than 5cm in postmenopausal patients.
  • Women who are menopausal or perimenopausal.

Most women of reproductive age develop small cysts each month, and large cysts that cause problems occur in about 8% of women before menopause.

Ovarian cysts are present in approximately 16% of women after menopause and, if present, are more likely to be cancer.

Benign ovarian cysts are common in asymptomatic premenarchal girls and are found in approximately 68% of ovaries of girls aged 2 to 12 years and in 84% of ovaries of girls aged 0 to 2 years.

Most of them are smaller than 9 mm, while around 10-20% are larger macrocysts. While the smaller cysts disappear mostly in 6 months, the larger ones seem to be more persistent.

What you can do at home:

The following treatments can help with your symptoms. Some methods may even reduce the size of your cysts or prevent recurrence, but more research is needed.

While you may be able to treat your cysts at home, herbal remedies and other personal care measures are not a replacement for your treatment plan prescribed by a doctor.

Use heat therapy to relieve cramps:

A heating pad is another option that can help relieve the pain of the cyst and menstrual cramps.

Applying a hot water bottle or a heating pad to the lower abdomen can even be as effective as using over-the-counter pain relievers (OTC). You can find electric heating pads online or at your local pharmacy or store.

You can even do yours by dipping a hand towel in water, placing it in a large plastic bag with airtight seal and putting it in the microwave for two minutes. Be sure to leave the bag open while it is in the microwave.

After carefully removing it from the microwave, seal the bag, wrap it in another wet towel and the heat should last a good 20 minutes.

Take an Epsom salt bath to help relax the muscles and relieve cramps:

The same idea applies when taking a hot bath. The heat can relieve the pain of cysts or cramps.

Adding Epsom salts, magnesium sulfate, to your bath can take this relief to the next level. Epsom salts have been used for years to relieve muscle aches and other pains.

You can find Epsom sales packages at your pharmacy, dollar discount stores and online. Just take a bath and add two cups of Epsom salts. Allow it to dissolve completely before submerging in the bath for approximately 20 minutes

Snack almonds, which are high in magnesium:

Almonds have high levels of magnesium, which can help with discomfort. Raw almonds contain around 270 milligrams per 100 gram serving.

You will find this ingredient in many “what to eat during your period” lists for this reason. And in more formal studies, it has been shown that supplementing your diet with magnesium helps with chronic pain.

Most people can eat almonds without interaction. They make a good snack to eat without flavor or they taste good when they are sprinkled over the salad. However, if you are allergic to tree nuts, you will want to skip this suggestion.

Take dong quai supplements to help relieve cramps:

You may have heard that the root dong quai can help with menstrual cramps. This ancient Chinese medicine is often found in supplements or incorporated in teas.

However, studies are mixed on the effectiveness of this herb. Researchers in one study found that the herb is ineffective in combating hot flashes. More research is needed on this root, as well as other complementary and alternative therapies.

Drink chamomile tea to help relax and relieve anxiety:

A cup of hot chamomile tea is another option. Chamomile is an herb that has been used since ancient times.

It has anti-inflammatory properties to help with cramps and can help reduce anxiety. Not only that, but chamomile can also allow you to rest better at night.

The best part? It’s something you can easily find in your local supermarket or online.

For tea purchased at the store, simply boil water and place your tea bag in a cup for a few minutes. Many teas will have instructions on packaging.

You can also make fresh tea with chamomile flowers. For a portion, you will need:

  • 3-4 tablespoons of flowers.
  • A sprig of mint.
  • A cup of boiling water.
Drink ginger tea to help reduce inflammation and relieve pain:

Ginger tea is another herbal option for the natural relief of pain and cramps. It also has antioxidant and anticarcinogenic properties.

In one study, ginger stopped the growth of ovarian cancer cells, which led researchers to conclude that consumption of ginger in the diet can treat and prevent ovarian cancer .

Like chamomile tea, you can find ginger tea on the shelves of a grocery store or online. All you have to do is soak a bag in boiling water for a few minutes and enjoy. If you do not like the taste, consider adding a splash of lemon.

To make fresh ginger tea at home:

  • Peel and cut a 2-inch piece of ginger.
  • Boil the ginger in 2 cups of water for 10 minutes.
  • Then, remove from heat and add flavorings such as lime juice and honey to taste.

Different measures at home can help alleviate any discomfort you have or possibly regulate hormones to help in the long term. However, there is no proven way to prevent the formation of future cysts.

There are other causes of ovarian pain and this feeling can be confused with mittelschmerz, the pain that some women feel during ovulation. It happens once a month and is usually brief.

If you are experiencing severe or otherwise related symptoms, consult your doctor. They can diagnose any cysts or other problems that may be affecting your ovaries, as well as help you develop a treatment plan suited to your needs.