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Ovarian cyst

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Ovarian cyst

Classification and external resources

Ovarian cyst










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An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within an ovary.[1] Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. Such cysts range in size from as small as a pea to larger than an orange. Most ovarian cysts are functional in nature and harmless (benign).[1][2] Ovarian cysts affect women of all ages. They occur most often, however, during a woman's childbearing years.

Some ovarian cysts cause problems, such as bleeding and pain. Surgery may be required to remove cysts larger than 5 centimeters in diameter.

1 Classification

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1.1 Functional 1.2 Non-functional

2 Signs and symptoms 3 Diagnosis 4 Treatment 5 Ovarian cyst rupture 6 References 7 External links

Ovarian cysts may be classified according to whether they are a variant of the normal menstrual cycle, called a functional cyst, or not.[3]

Functional cysts form as a normal part of the menstrual cycle. Such cysts may include:

Follicular cyst, the most common type of ovarian cyst. In menstruation, a follicle containing the ovum (unfertilized egg) will rupture during ovulation. If this does not occur, a follicular cyst of more than 2.5 cm diameter may result.[3]

Corpus luteum cysts appear after ovulation. The corpus luteum is the remnant of the follicle after the ovum has moved to the fallopian tubes. This normally degrades within 59 days. A corpus lutem that is more than 3 cm is defined as cystic.[3]

Thecal cysts occur within the thecal layer of cells surrounding developing oocytes. Under the influence of excessive hCG, thecal cells may proliferate and become cystic. This is usually on both ovaries. [3]

Non-functional cysts may include:

An ovary with many cysts, which may be found in normal women, or within the setting of polycystic ovary syndrome.

Cysts caused by endometriosis, known as chocolate cysts. Hemorrhagic ovarian cyst Dermoid cyst Ovarian serous cystadenoma Ovarian mucinous cystadenoma Paraovarian cyst Cystic adenofibroma Borderline tumoral cysts

Signs and symptoms[edit]

Some or all of the following symptoms may be present, though it is possible not to experience any symptoms: [3]

Abdominal pain. Dull aching pain within the abdomen or pelvis, especially on intercourse. Uterine bleeding. Pain during or shortly after beginning or end of menstrual period; irregular periods, or abnormal uterine bleeding or spotting.

Fullness, heaviness, pressure, swelling, or bloating in the abdomen. When a cyst ruptures from the ovary, there may be sudden and sharp pain in the lower abdomen on one side.

Change in frequency or ease of urination (such as inability to fully empty the bladder), or difficulty with bowel movements due to pressure on adjacent pelvic anatomy.

Constitutional symptoms such as fatigue, headaches Nausea or vomiting Weight gain

Other symptoms may depend on the cause of the cysts:[3]

Symptoms that may occur if the cause of the cysts is polycystic ovarian syndrome may include increased facial hair or body hair, acne, obesity and infertility.

If the cause is endometriosis, then periods may be heavy, and intercourse painful.


A 2cm left ovarian cyst as seen on ultrasound

An Axial CT demonstrating a large hemorrhagic ovarian cyst. The cyst is delineated by the yellow bars with blood seen anteriorly.

A CT scan showing a 8.5 cm cyst in a 29 year old female.

Ovarian cysts are usually diagnosed by either ultrasound or CT scan. Follow-up imaging for women of reproductive age with small simple or hemorrhagic cyst is generally not required.[4]

About 95% of ovarian cysts are benign, meaning they are not cancerous.[5] Treatment for cysts depends on the size of the cyst and symptoms. Pain caused by ovarian cysts may be treated with:

Pain relievers, including acetaminophen/paracetamol (Tylenol or Panadol), nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin, Advil), ornarcotic pain medicine (by prescription) may help reduce pelvic pain.[6] NSAIDs usually work best when taken at the first signs of the pain.

A warm bath, or heating pad, or hot water bottle applied to the lower abdomen near the ovaries can relax tense muscles and relieve cramping, lessen discomfort, and stimulate circulation and healing in the ovaries.[7]

Combined methods of hormonal contraception such as the combined oral contraceptive pill the hormones in the pills may regulate the menstrual cycle, prevent the formation of follicles that can turn into cysts, and possibly shrink an existing cyst. (American College of Obstetricians and Gynecologists, 1999c; Mayo Clinic, 2002e)[6]

Also, limiting strenuous activity may reduce the risk of cyst rupture or torsion. Cysts that persist beyond two or three menstrual cycles, or occur in post-menopausal women, may indicate more serious disease and should be investigated through ultrasonography and laparoscopy, especially in cases where family members have had ovarian cancer. Such cysts may require surgical biopsy. Additionally, a blood test may be taken before surgery to check for elevated CA-125, a tumor marker, which is often found in increased levels in ovarian cancer, although it can also be elevated by other conditions resulting in a large number of false positives.[8] For more serious cases where cysts are large and persisting, doctors may suggest surgery. This may involve removing the cyst, or one or both ovaries.[9] Features that may indicate the need for surgery include:[10]

Persistent complex ovarian cysts Persistent cysts that are causing symptoms Simple ovarian cysts larger than 5-10 centimeters Women who are menopausal or perimenopausal

What is the ovary and what are ovarian cysts?

The ovary is one of a pair of reproductive glands in women that are located in the pelvis, one on each side of the uterus. Each ovary is about the size and shape of an almond. The ovaries produce eggs (ova) and female hormones. The ovaries are the main source of female hormones, which control the development of female body characteristics such as the breasts, body shape, and body hair. They also regulate the menstrual cycle andpregnancy. Ovarian cysts are closed, sac-like structures within an ovary that contain a liquid, gaseous, or semisolid substance. The ovary is also referred to as the female gonad.

What causes ovarian cysts?

Ovarian cysts form for numerous reasons. The most common type is afollicular cyst, which results from the growth of a follicle. A follicle is the normal fluid-filled sac that contains an egg. Follicular cysts form when the follicle grows larger than normal during the menstrual cycle and does not open to release the egg. Usually, follicular cysts resolve spontaneously over the course of days to months. Cysts can contain blood (hemorrhagic cysts) from injury or leakage of tiny blood vessels into the egg sac. Another type of ovarian cyst that is related to the menstrual cycle is a corpus luteum cyst. The corpus luteum is an area of tissue within the ovary that occurs after an egg has been released from a follicle. If a pregnancy doesn't occur, the corpus luteum usually breaks down and disappears. It may, however, fill with fluid or blood and persist as a cyst on the ovary. Usually, this cyst is found on only one side and produces no symptoms. Occasionally, the tissues of the ovary develop abnormally to form other body tissues such as hair or teeth. Cysts with these abnormal tissues are called benign cystic teratomas or dermoid cysts. Endometriosis is a condition in which cells that normally grow inside the uterus (womb), instead grow outside of the uterus. The ovary is a common site for endometriosis. When endometriosis involves the ovary, the area of endometrial tissue may grow and bleed over time, forming a brown-colored cystic area sometimes referred to as a chocolate cyst or endometrioma. Both benign and malignant tumors of the ovary may also contain cysts. Furthermore, the condition known as polycystic ovarian syndrome (PCOS) is characterized by the presence of multiple cysts within both ovaries. PCOS is associated with a number of hormonal problems and is the most common cause of infertility in women. Infections of the pelvic organs can involve the ovaries and Fallopian tubes. In severe cases, pusfilled cystic spaces may be present on or around the ovary or tubes. These are known as tuboovarian abscesses.

What symptoms are caused by ovarian cysts?

Comment on thisRead 22 CommentsShare Your Story Most ovarian cysts are never noticed and resolve without women ever realizing that they are there. When a cyst causes symptoms, pain in the belly or pelvis is by far the most common one. The pain can be caused from:

rupture of the cyst, rapid growth and stretching, bleeding into the cyst, or twisting of the cyst around its blood supply (known as torsion).

If the cyst has reached a large size, other symptoms may arise as a result of pressure or distortion of adjacent anatomical structures. These symptoms can include abdominal fullness or bloating, indigestion, feeling full after eating only a small amount (early satiety), feeling an urge to defecate or having difficult bowel movements, or pain with sexual intercourse.

How are ovarian cysts diagnosed?

Sometimes ovarian cysts may be noticed by a health care practitioner during a bimanual examination of the pelvis. If a cyst is suspected based upon the symptoms of physical examination, imaging techniques are used. Most cysts are diagnosed by ultrasound, which is the best imaging technique for detecting ovarian cysts. Ultrasound is an imaging method that uses sound waves to produce an image of structures within the body. Ultrasound imaging is painless and causes no harm.

Cysts can also be detected with other imaging methods, such as CT scan or MRI scan (magnetic resonance imaging).

How can the physician decide if an ovarian cyst is dangerous?

If a woman is in her 40's, or younger, and has regular menstrual periods, most ovarian masses are "functioning ovarian cysts," which are not really abnormal. Examples include follicular cysts and corpus luteum cysts. These are related to the process of ovulation that happens with the menstrual cycle. They usually disappear on their own during a future menstrual cycle. Therefore, especially in women in their 20's and 30's, these cysts are watched for a few menstrual cycles to verify that they disappear. Because oral contraceptives work in part by preventing ovulation, physicians will not generally expect women who are taking oral contraceptives to have common "functioning ovarian cysts." Thus, women who develop ovarian cysts while taking oral contraceptives may be advised against simple observation; rather, they may receive closer monitoring with pelvic ultrasound or, less commonly, surgical exploration of the ovary. Likewise, functioning ovarian cysts are rare in women after they have reached menopause. Other factors are helpful in evaluating ovarian cysts (besides the woman's age, or whether she is taking oral contraceptives). A cyst that looks like it is just one simple sac of fluid on the ultrasound is more likely to be benign than a cyst with solid tissue in it. So the ultrasound appearance also plays a role in determining the level of suspicion regarding a serious ovarian growth. Ovarian cancer is rare in women younger than age 40. After age 40, an ovarian cyst has a higher chance of being cancerous than before age 40, although most ovarian cysts are benign even after age 40. CA-125 blood testing can be used as a marker of ovarian cancer, but it does not always represent cancer when it is abnormal. CA-125 is a protein that is elevated in the bloodstream of approximately 80% of women with advanced ovarian cancer.

First, many benign conditions in women of childbearing age can cause the CA-125 level to be elevated, so CA-125 is not a specific test, especially in younger women. Pelvic infections, uterine fibroids,pregnancy, benign (hemorrhagic) ovarian cysts, and liver disease are all conditions that may elevate blood CA-125 levels in the absence of ovarian cancer. Second, even if the woman has an ovarian cancer, not all ovarian cancers will cause the CA125 level to be elevated. Furthermore, CA-125 levels can be abnormally high in women with breast, lung, andpancreatic cancer.

How are ovarian cysts treated?

Comment on thisRead 7 CommentsShare Your Story

Most ovarian cysts in women of childbearing age are follicular cysts (functional cysts) that disappear naturally in one to three months. Although they can rupture (usually without ill effects), they rarely cause symptoms. They are benign and have no real medical consequence. They may be diagnosed coincidentally during a pelvic examination in women who do not have any related symptoms. All women have follicular cysts at some point that generally go unnoticed. A follicular cyst in a woman of childbearing age is usually observed for a few menstrual cycles because these cysts are common, and ovarian cancer is rare in this age group. Sometimes ovarian cysts in menstruating women contain some blood, called hemorrhagic cysts, which frequently resolve quickly. Ultrasound is used to determine the treatment strategy for ovarian cysts because it can help to determine if the cyst is a simple cyst (just fluid with no solid tissue, seen in benign conditions) or a compound cyst (with some solid tissue that requires closer monitoring and possibly surgical resection). In summary, the ideal treatment of ovarian cysts depends on the woman's age, the size (and any change in size) of the cyst, and the cyst's appearance on ultrasound. Treatment can consist of simple observation, or it can involve evaluating blood tests such as a CA125 to help determine the potential for cancer (keeping in mind the many limitations of CA-125 testing described above). The tumor can be surgically removed either with laparoscopy, or if needed, an open laparotomy (using an incision at the bikini line) if it is causing severe pain, not resolving, or if it is suspicious in any way. Once the cyst is removed, the growth is sent to a pathologist who examines the tissue under a microscope to make the final diagnosis as to the type of cyst present.

What are the risks of ovarian cysts during pregnancy?

Comment on thisRead 1 CommentShare Your Story Ovarian cysts are sometimes discovered during pregnancy. In most cases, they are found as an incidental finding at the time of routine prenatal ultrasound screening. The majority of ovarian cysts found during pregnancy are benign tumors that do not require surgical intervention. However, surgery may be indicated if there is a suspicion of malignancy, if an acute complication such as rupture or torsion (twisting of the cyst, disrupting the blood supply) develops, or if the size of the cyst is likely to present problems with the pregnancy.

Ovarian Cysts At A Glance

Ovarian cysts closed, sac-like structures within the ovary that are filled with a liquid, semisolid, or gaseous substance.

Ovarian cysts form for numerous reasons. When a cyst causes symptoms, pain in the belly or pelvis is by far the most common one. Most cysts are diagnosed by ultrasound. The treatment of ovarian cysts depends upon the individual situation and varies from observation and monitoring to surgical procedures.

An ovarian cyst is an accumulation of fluid within an ovary that is surrounded by a very thin wall. Any ovarian follicle that is larger than approximately two centimeters is an ovarian cyst. Ovarian cysts can range widely in size; from being as small as a pea to larger than an orange - in rare cases ovarian cysts can become so large that the woman looks pregnant. The majority of ovarian cysts are benign (harmless). According to the Centers for Disease Control and Prevention (CDC), USA, most premenopausal women and up to 14.8% of postmenopausal women are found to have ovarian cysts. Ovarian cysts typically occur most frequently during a female's reproductive years (childbearing years). However, ovarian cysts may affect a woman of any age. In some cases, ovarian cysts cause pain and bleeding. If the cyst is over 5 centimeters in diameter it may need to be surgically removed. There are two main types of ovarian cysts:

Functional ovarian cysts - the most common type. These harmless cysts form part of the female's normal menstrual cycle and are short-lived.

Pathological cysts - these are cysts than grow in the ovaries; they may be harmless (benign) or cancerous (malignant).

What is a cyst?
A cyst is a closed sac-like structure - an abnormal pocket of fluid, similar to a blister - that contains either liquid, gaseous, or semi-solid material. A cyst is located within a tissue, and can develop anywhere in the body and may vary in size - some are so tiny they can only be observed through a microscope, while others may become so large that they displace normal organs. In anatomy, a cyst can also refer to any normal bag or sac in the body, such as the bladder. In this text, cystrefers to an abnormal sac or pocket in the body that contains either liquid, gaseous or semisolid substances. A cyst is not a normal part of the tissue where it is located. It has a distinct membrane and division on nearby tissue - the outer or capsular portion of a cyst is called the cyst wall. If the sac is filled with pus it is not a cyst, it is an abscess. Some cysts are solid and may be called tumors (pathological cysts). The word tumor does not necessarily mean it is cancerous - a tumor is a medical term for a swelling. According to Medilexicon's medical dictionary:

An ovarian cyst is "a cystic tumor of the ovary, either nonneoplastic (follicle, lutein, germinal inclusion, or endometrial) or neoplastic; usually restricted to benign cysts, mucinous serous cystadenoma, or dermoid cysts."

What are the signs and symptoms of an ovarian cyst?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign. In the vast majority of cases, ovarian cysts are small and benign (harmless); there will be no signs or symptoms. Even if there are symptoms, they alone cannot determine whether a patient has an ovarian cyst. There are several other conditions with similar signs and symptoms, including endometriosis, pelvic inflammatory disease, ectopic pregnancy or ovarian cancer. A ruptured ovarian cyst may present similar signs and symptoms to those of appendicitis or diverticulitis. The signs and symptoms of an ovarian cyst may include:

Irregular menstruation - periods may also become painful, heavier or lighter than normal. A pain in the pelvis. This may be persistent pain or an intermittent dull ache that may spread to the lower back and thighs.

Pelvic pain may appear just before menstruation begins Pelvic pain may occur just before menstruation ends Dyspareunia - pelvic pain during sexual intercourse. Some women may experience pain and discomfort in the abdomen after sex. Pain when passing a stool (doing a poo) Pressure on the bowels Some pregnancy symptoms, including breast tenderness and/or nausea Bloating, swelling, or heaviness in the abdomen Problems fully emptying the bladder Pressure on the rectum or bladder - the patient may have to go to the toilet more often, either to urinate or pass a stool.

Hormonal abnormalities - in some rare cases the body produces abnormal amounts of hormones, resulting in changes in the way the breasts and body hair grow.

Complicated cyst signs and symptoms Torsion - the stem of an ovary can become twisted if the cyst is growing on the stem, blocking the blood supply to the cyst and causing severe pain in the lower abdomen. Bursting - if the ovarian cyst bursts the patient will experience severe pain in the lower abdomen. If

the cyst is infected pain will be worse. There may also be bleeding. Cancer - in rarer cases an ovarian cyst may be an early form of ovarian cancer.

What are the causes of ovarian cysts?

Functional ovarian cysts - there are two types:

Follicular cysts - the most common type of ovarian cyst. A female human has two ovaries, small round organs which release an egg every month. The egg moves into the uterus (womb), where it can be fertilized by a male sperm. The egg is formed in a follicle which contains fluid to protect the growing egg. When the egg is released the follicle bursts. In some cases, the follicle either does not shed its fluid and shrink after releasing the egg, or does not release the egg. The follicle swells with fluid, becoming a follicular ovarian cyst. Typically, one cyst appears at any one time and normally goes away within a few weeks (without treatment).

Luteal ovarian cysts - these are much less common. After an egg has been released it leaves tissue behind (corpus luteum). Luteal cysts can develop when the corpus luteum fills with blood. In most cases, this type of cyst goes away within a few months. However, it may sometimes split (rupture), causing sudden pain and internal bleeding.

Pathological cysts - dermoid cysts are the most common type of pathological cyst for women under 30 years of age. Cystadenomas are more common among women aged over 40 years. Dermoid cysts (cystic teratomas) - this is a bizarre tumor, usually benign. This type of cyst develops from a totipotential germ cell (a primary oocyte) - in other words, the cell can give rise to all orders of cells necessary to form mature tissues. Dermoid cysts contain hair, skin, bone and other tissues (sometimes even teeth). A totipotential germ cell has the ability to develop in any direction. They are formed from cells that make eggs. These type of cysts need to be removed surgically. Cystadenomas - these ovarian cysts develop from cells that cover the outer part of the ovary. Some are filled with a thick, mucous substance, while others contain a watery liquid. Rather than growing inside the ovary itself, cystadenomas are usually attached to an ovary by a stalk. By existing outside the ovary they have the potential to grow considerably. Although they are rarely cancerous, they need to be removed surgically. The following conditions may increase the risk of developing ovarian cysts: Endometriosis - a condition in which cells that are normally found inside the uterus (endometrial cells) are found growing outside of the uterus. That is, the lining of the inside of the uterus is found outside of it. Endometrial cells are the cells that shed every month during menstruation, and so endometriosis is most likely to affect women during their childbearing years. Women with this condition have a higher risk of developing ovarian cysts. Polycystic ovarian syndrome (PCOS) - in this condition many small and harmless cysts develop on the ovaries, caused by a problem with hormone balance produced by the ovaries. People with PCOS have a higher risk of developing ovarian cysts.

Diagnosing ovarian cysts

As most ovarian cysts present no signs or symptoms, they frequently go undiagnosed. This also makes it difficult to accurately estimate incidence and prevalence of the condition. Sometimes, even without symptoms, a cyst may be diagnosed during an unrelated pelvic examination or ultrasound scan. Patients with ovarian cyst symptoms will probably be referred by their GP (general practitioner, primary care physician) to a doctor who specializes in women's reproductive health - a gynecologist. The specialist will carry out a physical examination, focusing on possible signs and symptoms. In determining a diagnosis, doctors need to know:

The shape of the cyst. The size of the cyst. The composition of the cyst - is it filled with solid, fluid or both? In most cases fluid-filled cysts are not cancerous. Some may require further tests to find out.

The following diagnostic tests may also be ordered:

Ultrasound scan - this will be carried out to help the doctor make a diagnosis. A wand-like scanner probe (transducer) is placed on the abdomen, over where the ovaries are. Sometimes the probe may be placed inside the vagina. In both cases, the doctor is observing the ovaries on a video screen. This test can help the doctor determine whether there is a cyst, and whether it is solid, filled with fluid (or both).

Blood test - if there is a tumor present blood levels of CA125 (a protein) will be elevated. High CA125 levels could also mean the patient has ovarian cancer. If a woman develops an ovarian cyst that is partially solid she may have ovarian cancer. High CA125 levels may also be present in other conditions, including endometriosis, uterine fibroids or pelvic inflammatory disease.

Pregnancy test - a positive result may suggest the patient has a corpus luteum cyst. Laparoscopy - a thin, lighted instrument (laparoscope) is inserted into the patient's abdomen through a small incision (skin cut). If the doctor spots an ovarian cyst he/she may also remove it there and then.

What are the treatment options for ovarian cysts?

Several factors are taken into account when deciding on the type of treatment for ovarian cysts; and whether to treat at all. The main factors are:

The patient's age Whether the patient is pre- or postmenopausal The appearance of the cyst The size of the cyst

Whether or not there are any symptoms

Watchful waiting (observation) - sometimes watchful waiting, also known as observation is recommended, especially if the woman is pre-menopausal and she has a small functional cyst (2cm to 5cm). An ultrasound scan will be carried out about a month or so later to check it, and to see whether it has gone. Post-menopausal women are monitored with ultrasound scans, as well as blood tests to check their CA125 levels. The approach depends very much on the size of the cyst and whether it has changed over time. If a woman has small cysts in just one ovary her risk of developing cancer is very small. In most cases such cysts go away within three months. Post-menopausal women should undergo a followup ultrasound scan four months after the cyst has gone away. Birth control pills - to reduce the risk of new cysts developing in future menstrual cycles, the doctor may recommend birth control pills. Oral contraceptives also reduce the risk of developing ovarian cancer. Surgery - if there are symptoms, the cyst is large, does not look like a functional cyst, is growing, or persists through two or three menstrual cycles, the doctor may recommend that the patient have it surgically removed. In some cases if a cyst is found and no symptoms are present, surgical removal is still recommended - this is because it is not possible to know what type of cyst it is without examining it under a microscope. Removing it addresses the risk of the cyst eventually becoming cancerous.

Laparoscopy (key hole surgery) - two small cuts are made in the lower abdomen and one in the belly button. Gas is blown into the pelvis to raise the wall of the abdomen, away from the internal organs. A small tube with a light on the end (a laparoscope) is inserted into the abdomen. The surgeon can see the internal organs. With very small tools the surgeon is able to remove the cyst through the small incisions. In some cases a sample (biopsy) of the cyst is taken to determine what type it is. In most cases the patient can go home the same day. This type of surgery does not usually affect a woman's fertility, and recovery times are much faster.

Laparotomy - this is a more serious operation and may be recommended if the cyst is cancerous. A longer cut is made across the top of the pubic hairline, giving the surgeon better access to the cyst. The cyst is removed and sent to the lab. The patient usually has to remain in hospital for at least a couple of days.

Cancer treatment - if the cyst is cancerous the patient may need to have more organs and tissue removed, including the ovaries, uterus, the omentum and some lymph nodes.

There is no definite way of preventing ovarian cyst growth. However, regular pelvic examinations, which allow for early treatment if needed, usually protect the woman from complications.

By Mayo Clinic staff Ovarian cysts are fluid-filled sacs or pockets within or on the surface of an ovary. Women have two ovaries each about the size and shape of an almond located on each side of the uterus. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during your childbearing years. Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months. However, ovarian cysts especially those that have ruptured sometimes produce serious symptoms. The best ways to protect your health are to know the symptoms that may signal a more significant problem, and to schedule regular pelvic examinations.

By Mayo Clinic staff

Normal ovary
Most cysts don't cause any symptoms and go away on their own. A large ovarian cyst can cause abdominal discomfort. If a large cyst presses on your bladder, you may feel the need to urinate more frequently because bladder capacity is reduced. The symptoms of ovarian cysts, if present, may include: Menstrual irregularities Pelvic pain a constant or intermittent dull ache that may radiate to your lower back and thighs Pelvic pain shortly before your period begins or just before it ends Pelvic pain during intercourse (dyspareunia) Pain during bowel movements or pressure on your bowels Nausea, vomiting or breast tenderness similar to that experienced during pregnancy Fullness or heaviness in your abdomen

Pressure on your rectum or bladder that causes a need to urinate more frequently or difficulty emptying your bladder completely When to see a doctor Seek immediate medical attention if you have:

Sudden, severe abdominal or pelvic pain Pain accompanied by fever or vomiting These signs and symptoms or those of shock, such as cold, clammy skin, rapid breathing, and lightheadedness or weakness indicate an emergency and mean that you need to see a doctor right away.

By Mayo Clinic staff

Follicular ovarian cyst

Corpus luteum cyst

Most ovarian cysts start during the normal function of your menstrual cycle. These are known as functional cysts. Other types of cysts are much less common. Functional cysts Your ovaries normally grow cyst-like structures called follicles each month. Follicles produce the hormones estrogen and progesterone and release an egg when you ovulate. Sometimes a normal monthly follicle just keeps growing. When that happens, it becomes known as a functional cyst. There are two types of functional cysts: Follicular cyst. Around the midpoint of your menstrual cycle, an egg bursts out of its follicle and begins its journey down the fallopian tube in search of sperm and fertilization. A follicular cyst begins when something goes wrong and the follicle doesn't rupture or release its egg. Instead it grows and turns into a cyst. Corpus luteum cyst. When a follicle does release its egg, the ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. This changed follicle is now called

the corpus luteum. Sometimes, however, the escape opening of the egg seals off and fluid accumulates inside the follicle, causing the corpus luteum to expand into a cyst. The fertility drug clomiphene (Clomid, Serophene), which is used to induce ovulation, increases the risk of a corpus luteum cyst developing after ovulation. These cysts don't prevent or threaten a resulting pregnancy. Functional cysts are usually harmless, rarely cause pain, and often disappear on their own within two or three menstrual cycles. Other cysts Some types of cysts are not related to the normal function of your menstrual cycle. These cysts include: Dermoid cysts. These cysts may contain tissue such as hair, skin or teeth because they form from cells that produce human eggs. They are rarely cancerous. Cystadenomas. These cysts develop from ovarian tissue and may be filled with a watery liquid or a mucous material. Endometriomas. These cysts develop as a result of endometriosis, a condition in which uterine endometrial cells grow outside your uterus. Some of that tissue may attach to your ovary and form a growth. Dermoid cysts and cystadenomas can become large, causing the ovary to move out of its usual position in the pelvis. This increases the chance of painful twisting of your ovary, called ovarian torsion.

Treating ovarian cysts

In most cases, ovarian cysts disappear on their own without the need for treatment. If you have an ovarian cyst, whether it needs to be treated will depend on: its size and appearance whether you have any symptoms whether you have had the menopause (post-menopausal women have a slightly higher risk of developing ovarian cancer)

Watchful waiting

In most cases, a policy of "watchful waiting" is recommended, where you receive no immediate treatment. This is because most cysts disappear after a few weeks without the need for treatment. A followup ultrasound scan will help confirm whether this is the case. Because of the slightly increased risk of post-menopausal women developing ovarian cancer, regular ultrasound scans and blood tests are usually recommended until the cyst disappears.

Large ovarian cysts or cysts that are causing symptoms will usually need to be removed. Doctors sometimes recommend removing cysts even when they are not causing symptoms. This is because it is not always possible to tell what type of cyst it is without closely examining it under a microscope. Removing the cyst also significantly reduces the risk of it becoming cancerous later on. There are two types of surgery that can be used to remove ovarian cysts. They are: a laparoscopy a laparotomy

Both procedures are usually carried out under general anaesthetic (medication used to provide pain relief during surgery). Laparoscopy Smaller cysts can sometimes be removed using a procedure known as a laparoscopy. This is a type of keyhole surgery where small cuts are made in your lower abdomen and gas is blown into the pelvis to lift the wall of your abdomen away from the organs inside. A laparoscope, which is a small, tube-shaped microscope with a light on the end, will be passed into your abdomen so the surgeon can see your internal organs. Using tiny surgical tools, the surgeon will remove the cyst through the small cut in your skin. After the cyst has been removed, the cuts will be closed using dissolvable stitches. Depending on the type and size of cyst, the operation usually takes about an hour. Most women are able to go home later on the same day or the following day. A laparoscopy is the preferred surgical method because it causes less pain and allows you to resume normal activity sooner. Laparotomy If there is a chance that your cyst is cancerous, a more invasive procedure called a laparotomy may be recommended. During a laparotomy, a larger cut will be made to give the surgeon better access to the cyst. Depending on the size of the cyst, this may be along your bikini line or in the midline of your tummy. The whole cyst and ovary will be removed so that it can be sent to a laboratory to check whether it is cancerous. Stitches or staples will be used to close the incision. After the procedure, you will have a catheter (a tube in your bladder to drain urine) and a drip. You may need to stay in hospital for a few days after the procedure.

Your fertility
If only one of your ovaries is removed, your remaining ovary will continue to function normally if you are pre-menopausal. It will release hormones and eggs as usual, which means that your health and fertility should be unaffected, although your fertility may be slightly reduced. If both of your ovaries need to be removed, this will trigger an early menopause (if you have not already reached the menopause). However, it may still be possible to have a baby by having a donated egg implanted into your womb. This will need to be discussed with specialists at a centre that specialises in assisted reproduction techniques. Your surgeon will try to preserve as much of your reproductive system as possible. For example, it may be possible to preserve your ovary and fallopian tube (the tube where the egg passes), which will have a minimal effect on your fertility. This procedure is known as an ovarian cystectomy. Following an ovarian cystectomy, you may be able to return to work within two weeks. However, if the cyst is very large and the whole tube covers the ovary or there are concerns about the nature of the cyst, the whole tube and ovary may need to be removed. In this case, your recovery may still only be two weeks if the procedure is carried out laparoscopically. If an "open" approach is used, such as a laparotomy, your recovery may take six to eight weeks. The results may take three to four weeks to come back. A plan for further management will either be sent to you by your consultant through the post or a follow-up hospital appointment may be arranged.

Cancer treatment
If laboratory results show that the cyst is cancerous, both of your ovaries, your womb (uterus) and some of the surrounding tissue may need to be removed. Again, this would trigger an early menopause and mean that you would be infertile.

Ovarian Cyst RemovalLaparoscopic Surgery

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

This is surgery to remove a cyst on an ovary.

Ovarian Cyst

Copyright Nucleus Medical Media, Inc.

Reasons for Procedure

An ovarian cyst may need to be removed if it is:

Suspected of being cancerous (the chances are lower if you are young) Large (more than 2.5 inches in diameter) Solid (rather than containing just fluid) Causing pain

Possible Complications
Complications are rare, but no procedure is completely free of risk. If you are planning to have an ovarian cyst removed, your doctor will review a list of possible complications, which may include:

Infection Bleeding Cyst returns after it is removed Need for removal of one or both ovaries Infertility Blood clots Damage to other organs

Factors that may increase the risk of complications include:

Obesity Chronic or recent illness Heavy use of alcohol, smoking, or use of narcotics (may make delivering anesthesia more difficult or impair wound healing) Use of certain prescription medicines Pregnancy Previous abdominal surgery

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure
Your doctor may do the following:

Physical exam Review of medicines Blood tests Urine test CT scan a type of x-ray that uses a computer to make pictures of organs Ultrasound a test that uses sound waves to examine the abdomen Electrocardiogram (ECG, EKG)a test that records the heart's activity by measuring electrical currents through the heart muscle

Talk to your doctor about what action should be taken if cancer is found during surgery. One option is to remove the ovary. Leading up to the surgery:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like: o Aspirin or other anti-inflammatory drugs o Blood thinners, such as warfarin (Coumadin) o Clopidogrel (Plavix) Arrange for a ride to and from the hospital. Also, arrange for someone to help you at home. Do not eat or drink for at least eight hours before the surgery.


General anesthesia blocks pain and keeps you asleep through the surgery; given through an IV in your hand or arm Local anesthesiajust the area that is being operated on is numbed; given as an injection and may also be given with a sedative

Description of the Procedure

The doctor will make a small incision just below the navel. Next, the doctor will insert a laparoscope. This is a thin tube with a camera on the end. To allow the doctor to better view the organs, carbon dioxide gas will be pumped into the abdomen. The laparoscope will be used to locate the cyst. Once found, the doctor will make one or two more incisions. Surgical tools will be inserted to remove the cyst. The doctor may remove tissue for testing. If cancer is found, both ovaries may need to be removed. Once the cyst is removed, the doctor will remove the tools. The incision area will be closed with stitches or staples. In some cases, the doctor may switch to an open surgery. He will make a large incision in the abdomen to do the surgery.

Laparoscopic Ovary Removal

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Immediately After Procedure

After the procedure, you will be given IV fluids and medicines while recovering.

How Long Will It Take?

1-2 hours

Will It Hurt?
There will be pain after the surgery. Your doctor will give you pain medicine.

Average Hospital Stay

You may stay overnight, or you may be able to leave the hospital the same day as your surgery.

Post-procedure Care
Recovery may take 1-2 weeks. When you return home, do the following to help ensure a smooth recovery:

Be sure to follow your doctor's instructions . Ask your doctor about when it is safe to shower, bathe, or soak in water. Gently wash the incision area with mild soap and water. Move and elevate your legs while in bed. This will lessen the chance ofblood clots. Take prescription pain medicine only for as long as needed. Take over-the-counter pain relievers (eg, ibuprofen , naproxen ) if the pain is mild. Avoid strenuous exercise for 2-6 weeks. Do not drive until your doctor says it is safe. Do not resume sexual activity until your doctor says it is okay. You may need to wait two weeks. Follow your doctor's guidelines for ultrasound tests. These may need to be done if it is likely that the cysts will return.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

Signs of infection, including fever and chills Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site Pain that you cannot control with the medicines you have been given Increased vaginal bleeding or discharge Cough, shortness of breath, chest pain Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital Headaches, muscle aches, dizziness, or general ill feeling Constipation or abdominal swelling Vomiting Urinary difficulties Onset of pain or swelling in one or both legs New, unexplained symptoms

In case of an emergency, call for medical help right away. RESOURCES: The American Congress of Obstetricians and Gynecologists National Uterine Fibroids Foundation Women's

Ovarian cyst removal

Information FAQs Resources

Ovarian cysts are fluid-filled sacs (pockets) that can occur inside or on the surface of your ovaries. Ovarian cysts are removed using laparoscopy (keyhole surgery). You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About ovarian cyst removal What are the alternatives to ovarian cyst removal? Preparing for ovarian cyst removal What happens during ovarian cyst removal?

What to expect afterwards Recovering from ovarian cyst removal What are the risks?

About ovarian cyst removal

Ovarian cysts are common in women of childbearing age. Most ovarian cysts are harmless and go away on their own. You may need surgery to remove ovarian cysts if they cause pain or discomfort.

What are the alternatives to ovarian cyst removal?

If the cysts aren't causing any symptoms, your doctor may suggest watchful waiting. You will be asked to attend regular ultrasound appointments to check whether the cyst changes size. Most ovarian cysts are likely to go away on their own within a couple of months.

Preparing for ovarian cyst removal

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest or wound infection, which can slow your recovery. Ovarian cysts are usually removed as a day-case procedure. This means you have the procedure and go home the same day. The operation is done under general anaesthesia. This means you will be asleep during the procedure. You will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your anaesthetist or surgeon's advice. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during ovarian cyst removal?

Your surgeon will make three small cuts (about 1cm long) near your belly button. He or she will pass special instruments and a tube-like telescopic camera (called a laparoscope) through the cuts. Your surgeon will then examine your ovaries and remove the cysts. The cuts on your skin are closed with dissolvable stitches. There is a chance your surgeon may need to convert your keyhole procedure to open surgery (a single, large cut is made in your lower abdomen to reach your ovary). This will only happen if he or she is unable to complete the operation safely using keyhole surgery.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off. You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your operation. General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeons advice. Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment. The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should usually disappear in about two to three weeks.

Recovering from ovarian cyst removal

It usually takes about two weeks to make a full recovery from ovarian cyst removal, but this varies between individuals, so it's important to follow your surgeon's advice. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

What are the risks?

As with every procedure, there are some risks associated with ovarian cyst removal. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. After keyhole surgery, you will have some bruising and pain in your abdomen. You may also have some pain in the tips of your shoulders. The pain in your shoulders is known as referred pain and usually improves within 48 hours.

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis). Specific complications of ovarian cyst removal are uncommon but can include damage to other organs in your abdomen (such as your bowel, bladder, major blood vessels, womb, one or both of your ovaries or fallopian tubes). You should contact your doctor if you develop symptoms such as:

severe lower abdominal pain or swelling a high temperature dark or unpleasant smelling vaginal discharge unpleasant smelling discharge, pain or swelling around your belly button If you have these symptoms, its possible you may have developed an infection and will need treatmen t.

Surgery for Ovarian Cysts

When an ovarian growth or cyst needs to be closely looked at, a surgeon can do so through a small incision using laparoscopy or through a larger abdominal incision (laparotomy). Either type of surgery can be used to diagnose problems such asovarian cysts, adhesions, fibroids, and pelvic infection. But if there is any concern about cancer, you may have a laparotomy. It gives the best view of the abdominal organs and the female pelvic organs . Then, if the doctor finds ovarian cancer, he or she can safely remove it. During surgery, a noncancerous cyst that is causing symptoms can be removed (cystectomy), leaving the ovary intact. In some cases, the entire ovary or both ovaries are removed, particularly when cancer is found.
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What To Expect After Surgery General anesthesia usually is used during surgery. After a laparoscopy, you can resume normal activities within a day. But you should avoid strenuous activity or exercise for about a week. After a laparotomy, you may stay in the hospital from 2 to 4 days and return to your usual activities in 4 to 6 weeks. Why It Is Done Surgery is used to confirm the diagnosis of an ovarian cyst, remove a cyst that is causing symptoms, and rule out ovarian cancer. Surgery for an ovarian cyst or growth may be advised in the following situations: o o o Ovarian growths (masses) are present in both ovaries. An ovarian cyst is larger than 3 in. (7.6 cm). An ovarian cyst that is being watched does not get smaller or go away in 2 to 3 months. An ultrasound exam suggests that a cyst is not a simple functional cyst. You have an ovarian growth and you: Have never had a menstrual period (for example, a young girl). Have been through menopause (postmenopausal woman). Use birth control pills (unless you are using low-dose progestin-only pills or have missed a pill, which would make an ovulation-related functional cyst more likely). Your doctor is concerned that ovarian cancer may be present. In this case, it is also advised that you see a gynecologic oncologist. How Well It Works An ovarian cyst can be removed from an ovary (cystectomy), preserving the ovary and your fertility. But it is possible for a new cyst to form on the same or opposite ovary after a cystectomy. New cysts can only be completely prevented by removing the ovaries (oophorectomy). Risks Risks of ovarian surgery include the following: Ovarian cysts may come back after a cystectomy. Pain may not be controlled. Scar tissue (adhesions) may form at the surgical site, on the ovaries or fallopian tubes, or in the pelvis. Infection may develop. The bowel or bladder may be damaged during surgery.