Ovarian Cysts (Part One)

Cysts are fluid-filled sacs inside or on the surface of the ovaries. A woman has 2 ovaries, each of them the size and shape of an almond, located on either side of the uterus. The egg cell develops and matures in the ovaries and is released cyclically every month during the reproductive life. Most women will have cysts at least once during their lifetime. Most ovarian cysts cause little or no discomfort and are not dangerous. Most of them disappear without treatment in a few months.

Symptoms

Most cysts do not produce symptoms, but if they do, they include:

• Menstrual irregularities
• Pelvic pain - a constant or intermittent annoying pain that spreads to the lumbar region or thigh.
• The pain starts before the cycle and ends with it.
• Lower abdominal pain during sexual intercourse
• Pain during bowel movements or pressure on the intestines
• Nausea, vomiting, breast pain, similar to those of pregnancy.
• A feeling of heaviness or fullness in the abdomen
• Pressure on the colon or bladder leading to more frequent urination or difficulty in complete emptying.

When should medical help be sought?

• In case of immediate and severe lower abdominal pain
• Pain accompanied by fever and vomiting
• When there are signs of shock such as: body chills, rapid breathing, weakness, cold and clammy skin.

Causes

Most cysts start with the normal function of the menstrual cycle and are called functional cysts.

Functional cysts

Normally, the ovary grows a cyst-like structure each month called a follicle.

The follicle produces estrogen and progesterone and during ovulation releases an oocyte (egg cell). Sometimes this follicle continues to grow and forms a follicular cyst that can be of two types:

• Follicular cyst occurs when the follicle does not rupture to release the egg but continues to grow and turns into a cyst.
• Corpus luteum cyst. When the follicle releases the egg and the ruptured follicle begins to produce large amounts of estrogen and progesterone in preparation for conception, turning into the corpus luteum. But sometimes the egg's release site closes and fluid accumulates inside the follicle turning it into a cyst.

Functional cysts are not harmful, rarely cause pain, and may disappear without treatment within 2 or 3 menstrual cycles.

Other cysts not related to normal menstrual function

• Dermoid Cysts: These cysts may contain hair, skin, or rarely teeth and are not cancerous.
• Cystadenomas. These cysts originate from ovarian tissue and can be filled with watery or mucinous fluid.
• Endometriomas. They develop as a result of endometriosis, during which endometrial cells are located outside the uterus. These can attach to the ovary and cause growth (torsion).

Complications

• Ovarian torsion: Dermoid cysts and cystadenomas can grow and change their usual location which can lead to pain or twisting of the ovary.
• Rupture: A ruptured cyst can cause severe pain and internal bleeding.
• Cysts after menopause may undergo cancerous transformation which requires regular monitoring.