Ovarian Cyst

An ovarian cyst is a fluid-filled sac within the ovary, often causing no symptoms but sometimes leading to bloating, lower abdominal pain, or lower back pain. Most cysts are harmless, but complications such as rupture or ovarian torsion can cause severe pain and require medical attention.

Signs and Symptoms

Ovarian cysts frequently produce non-specific symptoms. These may include:

• Abdominal pain: Dull aching in the abdomen or pelvis, especially during intercourse.
• Uterine bleeding: Irregular periods or abnormal uterine bleeding.
• Fullness and bloating: A sense of heaviness, pressure, or swelling in the abdomen.
• Sudden sharp pain: Particularly when a cyst ruptures.
• Urinary and bowel issues: Changes in frequency or ease of urination and difficulty with bowel movements.
• Constitutional symptoms: Fatigue, headaches, nausea, or vomiting.
• Weight gain

Complications

Cyst Rupture

A ruptured cyst can leak its contents, causing abdominal pain that may last from a few days to several weeks. While most cases are self-limiting, large cysts can lead to significant internal bleeding, potentially requiring surgical intervention.

Ovarian Torsion

This is a painful condition requiring urgent surgery, where a cyst causes the ovary to twist, cutting off its blood supply. It is more common in women of reproductive age and can also occur during pregnancy.

Types

Functional Cysts

These form as part of the menstrual cycle:

• Follicular cysts: The most common type, forming when an ovarian follicle fails to release an egg.
• Luteal cysts: Form from the corpus luteum after ovulation and usually resolve by the end of the menstrual cycle.

Non-functional Cysts

These may include:

• Dermoid cysts: Benign and common in women under 30.
• Endometriomas: Cysts caused by endometriosis.
• Cystadenomas: Can be serous or mucinous, often large and benign.
• Hemorrhagic cysts: Contain blood and often resolve on their own.

Diagnosis

Imaging

Ovarian cysts are typically diagnosed via pelvic ultrasound, CT scan, or MRI. Ultrasound is the primary imaging tool, allowing for detailed evaluation of cyst characteristics.

Histopathology

A definitive diagnosis can be made by examining the cyst tissue under a microscope if surgically removed.

Treatment

Most ovarian cysts resolve naturally within a few months. Treatment options include:

Expectant Management

If asymptomatic and benign-appearing, cysts may be monitored via follow-up ultrasounds.

Symptom Management

Pain can be managed with pain relievers such as acetaminophen or ibuprofen. Hormonal birth control may prevent new cysts but is not effective for treating existing ones.

Surgery

Indications for surgery include ovarian torsion, ruptured cysts, suspected malignancy, and persistent pain. Surgical options range from minimally invasive laparoscopic procedures to open laparotomy for large or suspicious cysts.

Frequency

Ovarian cysts are common, particularly in women of reproductive age. Large cysts cause problems in about 8% of premenopausal women and 16% of postmenopausal women, with a higher risk of cancer in the latter group.

In Pregnancy

Ovarian cysts are often detected during pregnancy and are usually benign, resolving on their own. Large cysts can cause complications such as obstructed labour.

Historical Context

The first successful removal of an ovarian cyst was performed by Ephraim McDowell in 1809. Benign ovarian tumours have been identified in ancient Egyptian mummies, showcasing the long history of this condition.

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Self-assessment MCQs (single best answer)

What is an ovarian cyst?

Which of the following is NOT a common symptom of an ovarian cyst?

What is a potential complication of a ruptured ovarian cyst?

Which imaging modality is primarily used for diagnosing ovarian cysts?

Which type of ovarian cyst is most commonly associated with the menstrual cycle?

What is the recommended management for asymptomatic and benign-appearing ovarian cysts?

Which type of cyst is caused by endometriosis?

What is the primary concern with ovarian torsion?

How are most ovarian cysts managed if they do not cause symptoms?

Who performed the first successful removal of an ovarian cyst?