ovarian cysts


Also found in: Dictionary, Thesaurus, Wikipedia.
Related to ovarian cysts: Polycystic Ovarian Syndrome, Ovarian cancer

Ovarian Cysts

 

Definition

Ovarian cysts are sacs containing fluid or semisolid material that develop in or on the surface of an ovary.

Description

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

Causes

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.

Symptoms

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.

Diagnosis

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.

Treatment

Watchful waiting

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.

Medications

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

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
Surgery
Surgery
(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 treatment

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.

Prognosis

The prognosis for non-cancerous ovarian cysts is excellent.

Prevention

Ovarian cysts cannot be prevented.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Pelvic Pain." Section 18, Chapter 237. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
Beers, Mark H., MD, and Robert Berkow, MD., editors. "Physical Conditions in Adolescence." Section 19, Chapter 275. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
Beers, Mark H., MD, and Robert Berkow, MD, editors. "Pregnancy Complicated by Disease: Disorders Requiring Surgery." Section 18, Chapter 251. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Ajossa, S., S. Guerriero, A. M. Paoletti, et al. "The Antiandrogenic Effect of Flutamide Improves Uterine Perfusion in Women with Polycystic Ovary Syndrome." Fertility and Sterility 77 (June 2002): 1136-1140.
de Sanctis, C., R. Lala, P. Matarazzo, et al. "Pubertal Development in Patients with McCune-Albright Syndrome or Pseudohypoparathyroidism." Journal of Pediatric Endocrinology and Metabolism 16, Supplement 2 (March 2003): 293-296.
Ehrmann, D. A., P. E. Schwarz, M. Hara, et al. "Relationship of Calpain-10 Genotype to Phenotypic Features of Polycystic Ovary Syndrome." Journal of Clinical Endocrinology and Metabolism 87 (April 2002): 1669-1673.
Elkind-Hirsch, K. E., B. W. Webster, C. P. Brown, and M. W. Vernon. "Concurrent Ganirelix and Follitropin Beta Therapy is an Effective and Safe Regimen for Ovulation Induction in Women with Polycystic Ovary Syndrome." Fertility and Sterility 79 (March 2003): 603-607.
Franks, S. "Adult Polycystic Ovary Syndrome Begins in Childhood." Best Practice and Research: Clinical Endocrinology and Metabolism 16 (June 2002): 263-272.
Kazerooni, T., and M. Dehghan-Kooshkghazi. "Effects of Metformin Therapy on Hyperandrogenism in Women with Polycystic Ovarian Syndrome." Gynecological Endocrinology 17 (February 2003): 51-56.
Legro, R. S. "Polycystic Ovary Syndrome. Long-Term Sequelae and Management." Minerva ginecologica 54 (April 2002): 97-114.
Marx, T. L., and A. E. Mehta. "Polycystic Ovary Syndrome: Pathogenesis and Treatment Over the Short and Long Term." Cleveland Clinic Journal of Medicine 70 (January 2003): 31-33, 36-41, 45.
Mittermayer, C., W. Blaicher, D. Grassauer, et al. "Fetal Ovarian Cysts: Development and Neonatal Outcome." Ultraschall in der Medizin 24 (February 2003): 21-26.
Ovalle, F., and R. Azziz. "Insulin Resistance, Polycystic Ovary Syndrome, and Type 2 Diabetes Mellitus." Fertility and Sterility 77 (June 2002): 1095-1105.
Vankova, M., J. Vrbikova, M. Hill, et al. "Association of Insulin Gene VNTR Polymorphism with Polycystic Ovary Syndrome." Annual of the New York Academy of Sciences 967 (June 2002): 558-565.
Yildirim, M., V. Noyan, M. Bulent Tiras, et al. "Ovarian Wedge Resection by Minilaparatomy in Infertile Patients with Polycystic Ovarian Syndrome: A New Technique." European Journal of Obstetrics, Gynecology, and Reproductive Biology 107 (March 26, 2003): 85-87.

Organizations

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.

Key terms

Corpus luteum — A small, yellow structure that forms in the ovary after an egg has been released.
Cystectomy — Surgical removal of a cyst.
Dermoid — A skin-like benign growth that may appear on the ovary and resemble a cyst.
Endocrine — Internal secretions, usually in the systemic circulation.
Follicular — Relating to one of the round cells in the ovary that contain an ovum.
Functional cyst — A benign cyst that forms on the ovary and resolves on its own without treatment.
Hirsutism — 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.
Ovulation — The phase of the female monthly cycle when a developed egg is released from the ovary into the fallopian tube for possible fertilization.
Polycystic ovarian syndrome (PCOS) — A condition in which the eggs are not released from the ovaries and instead form multiple cysts.

ovarian cysts

Usually benign, fluid-filled closed sacs growing from an OVARY. They may contain watery fluid or a mucoid material. Some are caused by ENDOMETRIOSIS and may contain altered blood. Ovarian cysts are common and may be symptom-free, but some grow to a considerable size and may simulate obesity or pregnancy. These may lead to varicose veins or piles (haemorrhoids) or may cause breathlessness and abdominal discomfort. Large cysts cause trouble mainly by their bulk, but may cause severe complications if they become twisted and their blood supply is cut off or if they rupture or become infected. In such cases, and when cysts are caused by endometriosis, surgical treatment is usually necessary.

Patient discussion about ovarian cysts

Q. What is ovarian cyst and why is it painful? Is that pathological? Dangerous? Need information please.

A. don’t worry- ovarian cyst is usually a natural thin. It shouldn’t be of a problem. And if you need to hear it from a gynecologist:
http://www.5min.com/Video/Menstrual-Pains-and-Cysts-2374793

Q. my little sister have her periode badly.it stay for a months somethimes what can cause that? Since she start having her periode is been a problem and anybody cannot give us a straight answer she's been a hospitolize and had to have blood transfussion she's always anemic and sh'es been putting on pills but her body did not react good to it we had to stop.Sometimes she fells so weak that she pass out.The doctor say she may need to hospitolized again she doenst want to and we dont know how to help her she just wants a normal teenager and get ready to go away to collegebut we are scare that may not happens,she loves school so much and she feltthat she will never be a normal woman like everybody and scare that she may never have children one day i tell her to not be worry about it but i feel helpless.Please tell me what's wrong with her since nobody seems to give us a straight answers.Is follicular cyst of ovaries can put her in so much pain.

A. The menstrual cycle is not the same for every woman. On average, menstrual flow occurs every 28 days (with most women having cycles between 24 and 34 days), and lasts about 4 days. However, there is wide variation in timing and duration that is still considered normal, especially if your periods began within the last few years. Causes:
Anovulation (failure of ovaries to produce, mature, or release eggs)
Endometrial polyps (the endometrium is the inner lining of the uterus)
Endometrial hyperplasia (thickening/build up of the uterine wall)
Endometrial cancer
Uterine fibroids
For the full article: http://health.nytimes.com/health/guides/symptoms/menstrual-periods-heavy-prolonged-or-irregular/overview.html Hope this helps.

More discussions about ovarian cysts
References in periodicals archive ?
But just as some young women with a lot of ovarian cysts do not have PCOS, some women with metabolic syndrome and insulin resistance are thin.
Ovarian cysts are nothing but small fluid-filled sacks that develop in a woman's ovaries.
Regarding the tubular appearance of cyst the first possible diagnosis was hydrosalpinx and then ovarian cyst.
A 1994 clinical study tested the effect of Myomin on 255 women with ovarian cysts and endometriosis (Figure 4).
The most common adverse events were uterine bleeding/spotting, headache, ovarian cysts, vaginitis, dysmenorrhea, pelvic pain, and breast tenderness.
In this edition, the flowchart style is new and there are added clinical topics, such as COX-2 inhibitors, sleep disorders, post-traumatic stress disorder, ovarian cysts, and others; new critical thinking questions; revised charts and a revised chapter on muscles; reorganization of the endocrine system coverage; and answers to end-of-chapter questions.
A total or partial hysterectomy can be performed, but after women have experienced menopause the surgeon may suggest removing the ovaries and fallopian tubes as well, to prevent ovarian cysts developing.
While at the Network, I helped write a fact sheet on ovarian cysts and have responded to health queries on cysts.
He or she can do blood tests to rule out any problems and may even recommend an ultrasound scan to check for ovarian cysts.
Sharon Fontana was told as a teenager that she could not get pregnant because of ovarian cysts.
Although surgery is almost always performed, some patients with complex ovarian cysts and those with coexisting diseases which make surgery unsafe may be offered chemotherapy without surgery.