Ovarian cysts
Ovarian cysts are fluid-filled sacs that develop on or inside the ovaries. They are common, particularly during a woman’s reproductive years, and most are harmless, resolving on their own without treatment. However, some ovarian cysts can cause pain, discomfort, or complications, especially if they rupture or become twisted.
Key Features of Ovarian Cysts
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Types of Ovarian Cysts:
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Functional Cysts: These are the most common type and form during the normal menstrual cycle. They include:
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Follicular Cysts: Develop when the follicle (a sac in the ovary that contains an egg) doesn’t release the egg and continues to grow.
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Corpus Luteum Cysts: Form after the follicle releases the egg but the sac doesn’t dissolve as it should, instead filling with fluid.
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Pathological Cysts: These can develop due to abnormal cell growth and are less common than functional cysts:
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Dermoid Cysts: Contain tissue, such as hair, skin, or teeth, because they form from embryonic cells.
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Cystadenomas: Develop on the surface of the ovary and may be filled with a watery or mucous material.
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Endometriomas: Result from endometriosis, a condition where uterine lining tissue grows outside the uterus and can attach to the ovaries, forming cysts.
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Size and Growth: Ovarian cysts can vary in size, from as small as a pea to larger than a grapefruit. Larger cysts may cause noticeable symptoms or complications.
Common Symptoms-Complications
While many ovarian cysts cause no symptoms and are only discovered during routine pelvic exams or imaging, others may present with symptoms such as:
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Pelvic Pain: Sudden, sharp, or dull pain in the lower abdomen, especially on one side. The pain may be intermittent or constant.
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Bloating or Fullness: A feeling of heaviness or bloating in the abdomen.
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Pain During Intercourse: Discomfort or pain during sex, particularly with deeper penetration.
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Menstrual Irregularities: Changes in the menstrual cycle, such as heavier or lighter periods or irregular bleeding.
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Frequent Urination: Larger cysts may press on the bladder, leading to frequent urination or difficulty emptying the bladder.
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Pain with Bowel Movements: Depending on the size and location of the cyst, bowel movements may become painful or difficult.
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Ruptured Cyst: If a cyst ruptures, it can cause sudden, severe pain and may lead to internal bleeding, which is a medical emergency.
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Ovarian Torsion: Large cysts can cause the ovary to move or twist (torsion), cutting off its blood supply. This results in severe pain and requires emergency surgery to prevent ovarian damage.
Causes and Risk Factors-Complications of Untreated Cysts
Ovarian cysts develop for various reasons, depending on the type of cyst.
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Hormonal Imbalances: Functional cysts are often linked to hormonal changes during the menstrual cycle. Conditions like polycystic ovary syndrome (PCOS) can cause multiple cysts to develop.
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Pregnancy: Corpus luteum cysts may develop in early pregnancy to support the pregnancy until the placenta forms.
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Endometriosis: Women with endometriosis can develop endometriomas (cysts caused by endometrial tissue).
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Severe Pelvic Infections: If infections spread to the ovaries, they can cause the formation of cysts.
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Previous Ovarian Cysts: Women who have had ovarian cysts in the past are more likely to develop them again.
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Infertility: While most cysts do not affect fertility, certain types, such as endometriomas or those related to PCOS, can impact fertility.
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Cancer: Although rare, some ovarian cysts, particularly in postmenopausal women, can be cancerous. Regular monitoring and evaluation are important.
Diagnosis-Prevention
Ovarian cysts are usually diagnosed during routine pelvic exams or when symptoms prompt further investigation.
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Ultrasound: The most common diagnostic tool for identifying ovarian cysts, ultrasounds can provide images of the cyst’s size, shape, and composition (solid, fluid-filled, or mixed).
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Blood Tests: For certain cysts, especially in postmenopausal women or those with concerns about cancer, doctors may order a blood test to check levels of CA-125, a protein that can be elevated in ovarian cancer.
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Laparoscopy: A minimally invasive surgical procedure where a small camera is inserted into the abdomen to directly view the ovaries and cysts.
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There is no guaranteed way to prevent ovarian cysts, but certain measures can reduce the risk:
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Regular Pelvic Exams: Routine pelvic exams can help detect cysts early, even if they aren’t causing symptoms.
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Hormonal Birth Control: Taking hormonal contraceptives can reduce the likelihood of developing functional ovarian cysts.
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Managing Risk Factors: Women with conditions like PCOS or endometriosis should work with their healthcare providers to manage these conditions and minimize the risk of cysts.
Treatment
Treatment for ovarian cysts depends on the size, type, and symptoms associated with the cyst.
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1. Watchful Waiting:
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For most functional cysts, doctors recommend monitoring the cyst with follow-up ultrasounds, as they often resolve on their own within a few months, particularly if the woman has no symptoms.
2. Medications:
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Hormonal Birth Control: Birth control pills or other hormonal contraceptives can prevent the development of new cysts by regulating the menstrual cycle. However, they do not shrink existing cysts.
3. Surgery:
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Surgery may be required if the cyst is large, persistent, causes symptoms, or appears abnormal (potentially cancerous). The two main types of surgery are:
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Cystectomy: Removal of the cyst, leaving the ovary intact.
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Oophorectomy: Removal of the affected ovary, which may be necessary if the cyst has caused significant damage or is suspected of being cancerous.
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In some cases, laparoscopic surgery is used, which is minimally invasive. For larger cysts or cancer concerns, an open surgery (laparotomy) may be necessary.