Ovarian cysts are sacs containing fluid or semisolid material that develop in or on the surface of an ovary.
Ovarian cysts are common and the vast majority are harmless. Because they cause symptoms that may be the same as ovarian tumors that may be cancerous, ovarian cysts should always be checked out. The most common types of ovarian cysts are follicular and corpus luteum, which are related to the menstrual cycle. Follicular cysts occur when the cyst-like follicle on the ovary in which the egg develops does not burst and release the egg. They are usually small and harmless, disappearing within two to three menstrual cycles. Corpus luteum cysts occur when the corpus luteum—a small, yellow body that secretes hormones—does not dissolve after the egg is released. They usually disappear in a few weeks but can grow to more than 4 in (10 cm) in diameter and may twist the ovary.
Ovarian cysts can develop at any time in a female's life from infancy to puberty
to menopause, including during pregnancy
. Follicular cysts occur frequently during the years when a woman is menstruating, and are nonexistent in postmenopausal women or any woman who is not ovulating. Corpus luteum cysts occur occasionally during the menstrual years and during early pregnancy. (Dermoid cysts, which may contain hair, teeth, or skin derived from the outer layer of cells of an embryo, are also occasionally found in the ovary.)
Causes and symptoms
Follicular cysts are caused by the formation of too much fluid around a developing egg. Corpus luteum cysts are caused by excessive accumulation of blood during the menstrual cycle, hormone therapy, or other types of ovarian tumors.
There is also a condition known as polycystic ovary syndrome
(PCOS) in which the eggs and follicles are not released from the ovaries and instead form multiple cysts. Obesity
is linked to this condition, as 50% of women with PCOS are also obese. Hormonal imbalances play a major role in this condition, including high levels of the hormone androgen and low levels of progesterone, the female hormone necessary for egg release. High levels of insulin, the hormone that regulates blood sugar, are often found in women with PCOS. PCOS is also characterized by irregular menstrual periods, infertility
, and hirsutism
(excessive hair growth on the body and face). Although PCOS was formerly thought to be an adult-onset condition, more recent research indicates that it begins in childhood, possibly even during fetal development.
PCOS is also known to run in families, which suggests that genetic factors contribute to its development. As of 2002, the specific gene or genes responsible for PCOS have not yet been identified; however, several groups of researchers in different countries have been investigating genetic variations associated with increased risk of type 2 diabetes in order to determine whether the same genetic variations may be involved in PCOS.
In adolescent girls, ovarian cysts may be associated with a genetic disorder known as McCune-Albright syndrome, which is characterized by abnormal bone growth, discoloration of the skin, and early onset of puberty. The ovarian cysts are responsible for the early sexual maturation.
As of early 2003, McCune-Albright syndrome is known to be associated with mutations in the GNAS1 gene. The mutation is sporadic, which means that it occurs during the child's development in the womb and that the syndrome is not inherited.
Many ovarian cysts have no symptoms. When the growth is large or there are multiple cysts, the patient may experience any of the following symptoms:
- Fullness or heaviness in the abdomen.
- Pressure on the rectum or bladder.
- Pelvic pain that is a constant dull ache and may spread to the lower back and thighs, occurs shortly before the beginning or end of menstruation, or occurs during intercourse.
Non-symptomatic ovarian cysts are often felt by a doctor examining the ovaries during a routine pelvic exam
. Symptomatic ovarian cysts are diagnosed through a pelvic exam and ultrasound. Ultrasonography is a painless test that uses a hand-held wand to send and receive sound waves to create images of the ovaries on a computer screen. The images are photographed for later analysis. It takes about 15 minutes and is usually done in a hospital or a physician's office.
Ovarian cysts can be diagnosed in female fetuses by transabdominal ultrasound during the mother's pregnancy.
Many follicular and corpus luteum cysts require no treatment and disappear on their own. Often the physician will wait and re-examine the patient in four to six weeks before taking any action. Follicular cysts do not require treatment, but birth control pills may be taken if the cysts interfere with the patient's daily activities.
Most uncomplicated ovarian cysts in female infants resolve on their own shortly after delivery. Complicated cysts are treated by laparoscopy
or laparotomy after the baby is born.
McCune-Albright syndrome is treated with testolactone (Teslac), an anti-estrogen drug that corrects the hormonal imbalance caused by the ovarian cysts.
Long-term management of PCOS has been complicated in the past by lack of a clear understanding of the causes of the disorder. Most commonly, hormonal therapy has been recommended, including estrogen and progesterone and such other hormone-regulating drugs as ganirelix (Antagon). Birth control pills have also been prescribed by doctors to regulate the menstrual cycle and to shrink functional cysts.
More recent studies have shown that increasing sensitivity to insulin in women with PCOS leads to improvement in both the hormonal and metabolic symptoms of the disorder. As of 2002, this sensitivity is increased by either weight loss and exercise
programs or by medications. Metformin (Glucophage), a drug originally developed to treat type 2 diabetes, has been shown to be effective in reducing the symptoms of hyperandrogenism as well as insulin resistance
in women with PCOS.
Another strategy that is being tried with PCOS is administration of flutamide (Eulexin), a drug normally used to treat prostate cancer
in men. Preliminary results indicate that the antiandrogenic effects of flutamide benefit patients with PCOS by increasing blood flow to the uterus and ovaries.
Surgery is usually indicated for patients who have not reached puberty and have an ovarian mass and in postmenopausal patients. Surgery is also indicated if the growth is larger than 4 in (10 cm), complex, growing, persistent, solid and irregularly shaped, on both ovaries, or causes pain or other symptoms. Ovarian cysts are curable with surgery but often recur without it.
Surgical options include removal of the cyst or removal of one or both ovaries. More than 90% of benign ovarian cysts can be removed using laparoscopy, a minimally invasive outpatient procedure. In laparoscopic cystectomy
, the patient receives a general or local anesthetic, then a small incision is made in the abdomen. The laparoscope is inserted into the incision and the cyst or the entire ovary is removed. Laparoscopic cystectomy enables the patient to return to normal activities within two weeks. Surgical cystectomy to remove cysts and/or ovaries is performed under general anesthesia in a hospital and requires a stay of five to seven days. After an incision is made in the abdomen, the muscles are separated and the membrane surrounding the abdominal cavity (peritoneum) is opened. Blood vessels to the ovaries are clamped and tied. The cyst is located and removed. The peritoneum is closed, and the abdominal muscles and skin
(Illustration by Argosy Inc.)
are closed with sutures or clips. Recovery takes four weeks.
A surgical procedure known as ovarian wedge resection appears to improve fertility in women with PCOS who have not responded to drug treatments. In an ovarian wedge resection, the surgeon removes a portion of the polycystic ovary in order to induce ovulation.
Alternative treatments for ovarian problems—herbal therapies, nutrition
and diet, and homeopathy—should be used to supplement, not replace, conventional treatment. General herbal tonics for female reproductive organs that can be taken in tea or tincture (an alcohol-based herbal extract) form include blue cohosh (Caulophylum thalictroides
) and false unicorn root (Chamaelirium luteum
). Recommendations to help prevent and treat ovarian cysts include a vegan diet (no dairy or animal products) that includes beets, carrots, dark-green leafy vegetables, and lemons; anitoxidant supplements including zinc and vitamins
A, E, and C; as well as black currant oil, borage oil, and evening primrose oil (Oenothera biennis
) supplements. Homeopathic treatments—tablets, powders, and liquids prepared from plant, mineral, and animal extracts—may also be effective in treating ovarian cysts. Castor oil packs can help reduce inflammation. Hydrotherapy applied to the abdomen can help prevent rupture of the cyst and assist its reabsorption.
The prognosis for non-cancerous ovarian cysts is excellent.
Ovarian cysts cannot be prevented.
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American College of Obstetricians and Gynecologists (ACOG). 409 12th Street, SW, P. O. Box 96920, Washington, DC 20090-6920. http://www.acog.org.
The Health Resource. 209 Katherine Drive. Conway, AR 72032. (501) 329-5272.
Polycystic Ovarian Syndrome Association. P. O. Box 80517, Portland, OR 97280. (877) 775-PCOS. www.pcosupport.org.
— A small, yellow structure that forms in the ovary after an egg has been released.
— A skin-like benign growth that may appear on the ovary and resemble a cyst.
— Internal secretions, usually in the systemic circulation.
— Relating to one of the round cells in the ovary that contain an ovum.
— A benign cyst that forms on the ovary and resolves on its own without treatment.
— A condition marked by excessive hair growth on the face and body.
McCune-Albright syndrome (MCAS)
— A genetic syndrome characterized in girls by the development of ovarian cysts and puberty before the age of 8, together with abnormalities of bone structure and skin pigmentation.
— The phase of the female monthly cycle when a developed egg is released from the ovary into the fallopian tube for possible fertilization.