Their size varies considerably, but cysts less than five centimetres in diameter often do not need treatment. Most of the time, ovarian cysts are small, do not produce any symptoms, and are therefore considered harmless, with these types ultimately resolving on their own. At other times, they can rupture or twist, thereby causing significant pain and bleeding through the vagina or both.
When it twists in a situation known as torsion, it constitutes a medical emergency often requiring emergency surgery. While cysts occur most frequently during the reproductive years, they can be seen at any age, including among newborn female babies. In rare scenarios, ovarian cancer can present as a cyst. On the other hand, some cysts can become cancerous over time.
While most cysts have no symptoms and are usually found when undergoing investigations for other reasons, such an incidental finding nevertheless requires them to be monitored at intervals so that the pattern of growth or resolution can be noted. When a cyst presents with symptoms, they can resemble other conditions like a urinary tract infection, kidney stones, acute appendicitis or ectopic pregnancy.
Some of the symptoms of ovarian cysts include changes in menstruation, such as the duration of bleeding, quantity and pain, which may be confined to the lower abdomen or extend to the thigh, lower part of the back, or across the lower abdomen. There may be associated vomiting and a feeling of fullness with resultant bloating. There could also be pain when passing stool, during sex and just before the beginning of menstruation or the end of it.
There could also be pressure on the bowels resulting in frequent visits to the toilet even when the stools have a normal consistency. The frequency of urination may also increase, and there could be some unexpected weight gain or pain within the breasts. Typically, the pain is dull in nature except when torsion has occurred.
There are two main categories of ovarian cysts. Functional ovarian cysts are the most common type, and they occur around the menstrual cycle. They are not usually cancerous. The other group is categorised as pathological cysts, which are not related to the menstrual cycle.
These may be harmless or cancerous in nature. The different types of ovarian cysts will be briefly discussed here; these include a corpus luteum cyst, which forms after an ovary has released an egg but fails to shrink in the usual way and instead fills up with blood.
Usually, cysts like this will disappear within a few weeks but can cause much pain if they grow into a large size and may cause vaginal bleeding as well. Follicular cysts, on the other hand, develop when a follicle fails to open and release an egg during the ovulatory period. These are the most common types of cysts, but they produce no symptoms and often disappear within one to three months.
Another common type of ovarian cyst is the dermoid cyst, which develops from certain cells that are present in the body right from birth. Because of this origin, they are usually made up of things like hair, nails, mucus, a solitary tongue or a solitary eyeball. They can grow to immense dimensions, cause severe pain and twist suddenly.
Then there are those ones called cystadenomas, which are essentially large cysts filled with fluid, and contrast sharply with dermoid cysts. These can also become large, twist, and cause pain or vaginal bleeding. When a diagnosis of cystadenoma is made, treatment can be offered without an operation, as the fluid can be drained using a special kind of needle under ultrasound guidance.
Another category is called endometrioma, which is basically endometrial tissue developing over the ovary. Being outside the womb, abnormal menstrual patterns, vaginal bleeding, painful intercourse, and painful menstruation can all result. Another increasingly and commonly diagnosed entity today is polycystic ovary syndrome, in which many small cysts develop over the ovary.
This often causes pain and is related to fertility problems. Usually, it also has links to other health problems such as metabolic syndrome and obesity. Most of these are diagnosed during investigations conducted in relation to infertility. Lastly, there is ovarian cancer, which is not very common, occurs typically outside the reproductive period, and must be treated like any other cancer once the diagnosis is made.
Ovarian cysts have different causes depending on the type. Hormonal factors and the use of medications aimed at helping women to ovulate can cause either follicle or corpus luteum cysts. During pregnancy, corpus luteum cysts help to maintain the pregnancy by producing and releasing progesterone during the first trimester. This function is gradually taken over by the placenta after the first three months.
If the corpus luteum cyst persists after the placenta has taken over its function and is large in size, surgical removal will be required. A patient who has endometriosis is also likely to develop endometriomas. Lastly, any infection affecting the ovary and fallopian tubes makes the development of ovarian cysts much more likely.
The diagnosis of this condition is based on taking a good history of the symptoms, certain blood tests, including a pregnancy test, and an ultrasound scan.
In some cases, an abdominal CT scan or MRI may be required if a need exists to more properly define the nature of the cyst. The treatment depends on the size of the cyst, whether it involves a woman in her reproductive age or she has undergone menopause. A cyst of five centimetres or less requires periodic monitoring only using ultrasound evaluation.
However, if results demonstrate that there is a noteworthy source of concern, the treatment offered will depend on what has been found. For example, evidence of cancer demands the institution of treatment without delay. So, it is vital to confirm the diagnosis by performing a biopsy, the required operation, followed by chemotherapy and radiotherapy if needed. If a torsion has occurred, an emergency operation is required because when a cyst twists, it cuts off the blood supply to the ovary, resulting in terrible abdominal pain.
– Dr. Sylvester Ikhisemojie
@ Punch Newspaper
