Ovarian Cysts

Question 1

What are ovarian cysts?

Answer 1

Ovarian cysts
Many cysts, usually asymptomatic &
undiagnosed, discovered incidentally often via ultrasound
About 20% women will have a cyst at some point, just be aware of the variety
Functional cysts - most common one, follicular or corpus luteul - usually disappear over two or three cycles, though can become haemorragic cysts (burst and pop, can be very painful)
Others include
Endometrioma - aka chocolate cysts
Dermoid cysts - contain other cysts and so on

Question 2

What are the signs and symptoms of ovarian cysts?

Answer 2

• Most cysts no symptoms
• Larger: discomfort unilateral, pressure
  symptoms
• Some are hormonal producing and can affect cycle: Irregular cycle and/or abnormal vaginal bleeding
• Some can be benign or malignant: Ultrasound not able to distinguish between benign or malignant.
• If malignancy: may have fullness, heaviness, bloating or feeling full after eating, weight loss, lymphadenopathy
• Red Flag: Cysts in post-menopausal women have a higher risk of being malignancy

Question 3

What are the risks and compllications of ovarian cysts?

Answer 3

Complications

Large cysts, may cause the ovary to rotate on itself, cutting off blood supply and leading to ovarian torsion, rupture and/or haemorrhage
-> extreme abdominal pain and emergency, can lead to destruction of ovarian tissue, infection and infertility. Emergency

Symptoms: Severe pain, sudden, sharp, unilateral pelvic pain; can lead to peritoneal signs, abdominal distension and bleeding, tachycardia and hypotension. Surgery needed.

Some cysts can become malignant

Question 4

What tests might you run for ovarian cysts?

Answer 4

Diagnostic investigations:
* Abdominal examination (ascites may interfere
with palpation); mass, tender
* Transvaginal ultrasonography, Laparotomy and laparoscopy,
* Definitive DDx ovarian cysts: biopsy
* Tumour markers; Cancer antigen 125 (CA125): false positives and may be elevated in
endometriosis, fibroids, peritonitis, cholecystitis, pancreatitis.

Differential diagnoses - acute pelvic pain

• Gynaecological:
• Ectopic pregnancy
• Nongynecological: appendicitis,
  diverticulitis, nephrolithiasis

Question 5

How do you treat ovarian cysts?

Answer 5

Management and treatment of ovarian cysts
* Functional cysts under 5 cm: ‘wait and see’ as these will usually resolve within two cycles. If the cyst does not resolve after several menstrual cycles it is unlikely to be functional cyst and further investigations needed.
* Herbal treatment is not always appropriate
* Larger persistent ovarian cysts: surgical removal may need to be considered to prevent infertility as a consequence of torsion and rupture, as well as in post-menopausal women with ovarian cysts as there is an increased incidence of malignancy.
* OCP, for recurrent cysts - as OCP prevents ovulation which is the source of these cysts.