OVARIAN CYSTS. Types of Ovarian Cysts There are many types of ovarian cysts and these can be categorized into functional and nonfunctional

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1 OVARIAN CYSTS Follicular Cyst Ovarian cysts are fluid-filled sacs that form within or on the ovary. The majority of these cysts are functional meaning they usually form during a normal menstrual cycle. Most of these cysts are harmless. Many cause no symptoms and are only discovered during routine pelvic exams. Functional cysts usually resolve on their own within one week to three months and are noncancerous. Almost every woman will experience an ovarian cyst some time in her childbearing years. Most are non-cancerous in this age group. Women who are past menopause are at a greater risk of developing ovarian cancer. Whatever your age, if you think you have an ovarian cyst, see your healthcare provider. Female Reproductive System To have a better understanding of what ovarian cysts are, let us review the female reproductive system. Most women have two ovaries that store and release eggs and produce the female hormones estrogen and progesterone. These hormones affect breast, body type and body hair development. Each ovary is about the size of a walnut. Every month, one ovary releases an egg during the normal menstrual cycle. Within the ovary, the egg is enclosed in a sac called a follicle. The follicle bursts as it releases the egg. This is called ovulation. The fallopian tubes then carry the egg from the ovary toward the uterus or womb. If the egg is fertilized, the uterus is home for the growing baby. If the egg is not fertilized, the lining of the uterus, which is responsible for the vaginal bleeding occurring during menses and is known as a period, sheds through the cervix. The cervix is the lower, narrow part of the uterus connecting the uterus to the vagina. Types of Ovarian Cysts There are many types of ovarian cysts and these can be categorized into functional and nonfunctional cysts. Functional ovarian cysts are almost never associated with cancer. A follicular cyst is a functional cyst that forms when ovulation does not occur or if a mature follicle collapses on itself. The sac can grow to over two inches in size and it usually disappears in one to three months. If this cyst ruptures, it can cause a sharp pain noticed at the time of ovulation in the middle of the menstrual cycle. A follicular cyst is pictured above.

2 A corpus luteum cyst is a functional cyst that forms after the egg is released from the follicle but the sac does not dissolve. The sac seals off and can sometimes fill with fluid or blood. These cysts are usually painless and resolve on their own after a few weeks. A hemorrhagic cyst is a functional cyst that occurs when bleeding occurs within a cyst. The cause of non-functional cysts varies according to the type of cyst. An endometrioma The dark area against the normal white ovary represents the endometriosis. Also seen is an adhesion or scarring of the tube to the ovary. is a cyst that develops because of endometriosis. Endometriosis is an abnormal growth of cells similar to the lining of the uterus outside the uterus. It may attach itself to the ovary and grow causing pain during sex and at menstruation. A cystadenoma develops on the surface of the ovary. Often filled with a watery fluid or a thick, sticky gel, it can grow and cause pain. There are two varieties: mucinous cystadenomas (thick mucous) and serous cystadenoma (thin fluid). A cystadenoma contains multiple septa. They can be quite large. Teratomas or Dermoid cysts develop from cells within the ovary that are able to make teeth, hair and other tissues. The cyst can grow large, inflame, twist and cause pain. Teratomas often occur in younger women and can involve both ovaries.

3 Dermoid cyst cut in half to demonstrate yellow fatty/sebaceous material. Some will contain hair and calcified material like teeth. Polycystic ovaries occur when the eggs mature within the sacs or follicles but the follicles do not release the eggs. Ovulation does not occur. This cycle repeats, follicles grow within the ovary and cysts form. Features of Polycystic ovaries are their larger size and multiple bluish fluid filled follicles seen to cover most of the surface of the ovaries. Best seen on the right ovary being held by the grasper. Signs and Symptoms of Ovarian Cysts Most ovarian cysts go unnoticed, cause no problems and go away spontaneously. If symptoms occur, pain in the abdomen or pelvis is the most common one. Depending on the reason for the cyst, the pain can be at ovulation time, menstruation, during sex or related to bowel movements. It may be constant or intermittent; appear suddenly or gradually. Other symptoms of ovarian cysts may include: Pressure or fullness in the abdomen Irregular periods or bleeding between periods Dull ache in the lower back and thighs Breast tenderness Nausea or vomiting You should seek immediate medical help if you have any of the following symptoms: Pain with fever and vomiting Sudden, severe abdominal pain Faintness, dizziness or weakness Rapid breathing Diagnosis of Ovarian Cysts Because most ovarian cysts cause no symptoms and go away on their own, they are usually found during a routine pelvic exam. Your healthcare provider may feel a swelling or growth on

4 your ovary and order an imaging test called an ultrasound. This will show the size, shape and location of the cyst, and whether it is fluid-filled, solid or mixed. Other tests commonly ordered are pregnancy tests, hormone tests and others depending on the circumstances. Occasionally a CT scan or MRI will be performed to better characterize an ovarian mass. Be certain to tell your healthcare provider if you or a family member has a history of ovarian cancer. Ultrasound images of Ovarian Cysts Polycystic Ovary with multiple small follicles Solid and cystic appearance of Teratoma (Dermoid Cyst)

5 Follicular Cyst demonstrating single dark smooth cystic structure within the ovary Multiseptated Cyst: cystadenoma or carcinoma. The fluid contained within the septa is not completely dark raising suspicion for a mucinous cystadenoma.

6 Treatment for Ovarian Cysts Watchful Waiting Most ovarian cysts are functional and rarely require any treatment other than watchful waiting. This means that you wait and see your healthcare provider in one to three months for a re-examination and/or repeat ultrasound to see if the cyst has changed in size. Surgery Surgical removal of the cyst may be necessary for the following reasons: If the functional cyst grows in size or does not go away If the cyst looks unusual during the ultrasound exam If the cyst causes pain or irregular periods If you are postmenopausal Surgery may be accomplished via Laparoscopy (using small incisions where a fiberoptic scope provides visualization and small instruments perform the surgery) or Laparotomy (open surgery). The choice will depend on the probability of malignancy as well as the size of the lesion. Medications Birth control pills are sometimes prescribed if you have frequent functional cysts. They prevent ovulation and reduce the chance of recurring cysts. Over the counter pain relievers, such as ibuprofen, may be used for menstrual cramps and mild abdominal pain. Prescription pain relievers may be used for acute episodes of a hemorrhagic ovarian cyst. Discuss the dose you should take with your healthcare provider.