Ovarian Cysts

There are many types of ovarian cysts, ranging from clinically insignificant to very serious in nature. At The Woman’s Health Pavilion in Queens and Long Island, NY, our physicians are well-versed in the diagnosis and management of ovarian cysts. They offer the most up-to-date treatments available. If you think you might have an ovarian cyst, we encourage you to call us as soon as possible.

What Is an Ovarian Cyst?

By definition, a “cyst” is a collection of fluid. Ovarian cysts are sacs of fluid that can develop inside or on the surface of one or both ovaries. They can be very small or grow to huge proportions. Ovarian cysts can sometimes contain solid components or they may be completely fluid filled. While most ovarian cysts are benign, some cysts that form in the ovary can be malignant (cancerous).

How Are Ovarian Cysts Diagnosed?

Ultrasound uses sound waves to “see” structures inside your body. It provides excellent images of fluid-filled structures like cysts. Ultrasound can be performed in the following ways:

• Pelvic ultrasound is performed over the lower abdomen.
• Transvaginal ultrasound is performed using a wand inserted into the vagina.

Transvaginal ultrasound is the preferred option because it allows us to get close to the cyst while viewing it and see details of its structure. This is not painful.

Our Offices Are Fully Equipped

At The Woman’s Health Pavilion, each of our offices is equipped with modern, high-definition, 3-D ultrasound and staffed by experienced and certified sonography technicians. This advanced equipment allows us to see the fine detail in ovarian cysts. The details of cyst structure are important because they help us to determine whether a cyst is benign or malignant. Cysts are often found using other types of imaging like CT scanning or MRI, but transvaginal ultrasound is the gold standard for evaluating most ovarian cysts.

Types of Ovarian Cysts

There are dozens of types of ovarian cysts. Common types of cysts include:

• Functional cysts (commonly referred to as “ovulation cysts”)
• Dermoid cysts (benign cystic teratomas)
• Endometriomas
• Cysts associated with Polycystic Ovary Syndrome (PCOS)
• Cysts associated with ovarian cancer

Functional Cysts of the Ovary

The most common type of ovarian cyst is the “functional” cyst. Commonly referred to as “ovulation cysts,” functional cysts arise from the natural ovulatory function of the ovaries. Prior to ovulation, the cell destined to be released as the “egg” is recruited from among millions of other similar cells in the ovary. As the egg develops in the ovary, it grows within in a tiny collection of fluid called the follicle. Generally, when this collection grows to be about 1.5 centimeters (about the size of a grape), the microscopic egg is released from the follicle. The remaining collection of fluid resolves over the next several weeks, producing hormones that would serve to support a pregnancy if the egg were fertilized.

In some cycles, the collection of fluid around the egg continues to grow for reasons that are not well understood. These “functional” cysts can grow to be quite large—closer to the size of a grapefruit than a grape—and can become quite painful. If they rupture, the pain is acute and severe, and often results in trip to the emergency room.

What are the symptoms of functional ovarian cyst?

Because functional cysts produce hormones, women with a growing functional cyst will often notice changes in their menstrual cycle, such as:

• Menstrual bleeding may occur early or late.
• Menstrual bleeding may be unusually heavy or disorganized.

How do you diagnose a functional ovarian cyst?

Functional cysts are usually diagnosed by transvaginal ultrasound performed in the office. During this test, a slender wand is gently inserted into the vagina, allowing us to closely examine the pelvic organs with sound waves (ultrasound). Transvaginal sonography is not painful and takes just a few minutes to perform. Functional cysts typically are seen as round, thin-walled structures in the ovaries filled with fluid or blood.

How do you get rid of functional ovarian cysts?

Functional cysts typically resolve without treatment. For women who are not experiencing discomfort, it is perfectly appropriate to wait a cycle or two for the cyst to resolve. Of course, the ultimate proof that a cyst is simply “functional” is the fact that it does disappear. As such, follow-up is essential.

Can birth control pills treat ovarian cysts?

Traditionally, gynecologists have prescribed birth control pills to treat functional cysts. Recent evidence suggests that birth control pills do not make functional cysts disappear; being on birth control pills, however, does tend to prevent functional cysts from forming in the first place. Women who are prone to recurrent, symptomatic functional cysts will often benefit from staying on birth control pills or similar hormonal contraception that suppresses ovulation.

Dermoid Cysts of the Ovary

The dermoid cyst (technically called benign cystic teratoma) is unique because it grows tissues that belong in other organs. Dermoid cysts frequently will contain:

• Hair
• Teeth
• Fragments of bone
• Glandular tissue (e.g., thyroid tissue) that produces hormones

Usually, these solid components are encased in a thick capsule filled with an oily or cheesy liquid.

Dermoid cysts can be tiny or grow to be huge. They are most often discovered in women age 15 to 40. In about 15% of cases, dermoid cysts are found in both ovaries.

Can dermoid cysts cause problems?

Because dermoids are dense and heavy, they tend to make the ovaries “dangle” in the pelvis making them particularly prone to torsion. An enlarged ovary containing a cyst will sometimes twist around its blood supply (think of a disco ball or an apple hanging on its stem), interrupting the blood flow to the ovary. When blood flow to the ovary is interrupted, ovarian tissue rapidly begins to die. Torsion is extremely painful and usually will result in an emergency room visit. Suspected torsion is a true surgical emergency.

Endometriomas

Another common type of cyst in the ovary is an endometrioma or chocolate cyst. An endometrioma is a type of endometriosis, a condition in which the lining of the uterus (womb) flows backwards through the fallopian tubes and deposits in the pelvis. When this tissue deposits on the ovary, an endometrioma can form. Endometriomas are characteristically stubbornly attached to the ovarian tissue and filled with old thick blood, similar in consistency to chocolate syrup—hence the name “chocolate cyst”.

Endometriomas occur in women during their reproductive years and are frequently seen in conjunction with endometriosis implants elsewhere in the pelvis.

What are symptoms of an endometrioma?

An endometrioma may cause a variety of symptoms, including:

• Chronic pain
• Severe menstrual cramps
• Painful intercourse
• Problems with fertility

Because endometriosis is a chronic condition, women may require ongoing treatment to prevent recurrence.

Polycystic Ovary Syndrome (PCOS)

What happens during normal ovulation?

Each month, the ovaries begin to develop several small follicles, tiny collections of fluid that each contain an egg. Early in the menstrual cycle, one follicle is “recruited.” This “dominant follicle” grows larger than the rest, and ultimately releases an egg at the time of ovulation. After ovulation, the follicle is termed a corpus luteum. If fertilization occurs, the corpus luteum will continue to produce hormones to support early pregnancy. If fertilization does not occur, the corpus luteum resolves and ovulation is followed by a menstrual period two weeks later.

How does PCOS affect ovulation?

In women with PCOS, many follicles develop inside the ovaries, but an egg is not released regularly. Women with PCOS are usually either:

• Anovulatory: they do not ovulate at all
• Oligo-ovulatory: they do not ovulate on schedule

What are symptoms of PCOS?

Since ovulation is a prerequisite for pregnancy, women with PCOS frequently have difficulty conceiving. Also, since ovulation triggers the chain of events that lead to menstrual flow, women with PCOS often do not get regular periods.

Do the ovaries look different with PCOS?

The ovaries in women with PCOS have a characteristic appearance on sonography. The many developing follicles typically look like a “chain of pearls” clustered around the surface of the ovary. Usually, the ovaries are enlarged as a result of all the developing follicles.

What happens when the hormones are out of balance?

Fundamentally, PCOS represents a hormonal imbalance that can cause the ovaries to produce:

• More androgens (male hormones) than normal. As a result, women may notice increased hair growth on the chin or chest, acne, or thinning hair in a male baldness pattern.
• Too much estrogen and not enough progesterone. An imbalance in these “yin and yang” female hormones contributes to menstrual irregularity and fertility issues.

What are the risks of having PCOS?

Women with PCOS have an increased risk of endometrial cancer. A woman’s body is designed to build up the inner lining of the uterus (the endometrium) and then clean it out each month with a period. Over a lifetime, constant buildup without a regular monthly clean out increases the risk of endometrial cancer, a cancer in the lining of the uterus.

What causes PCOS?

Ultimately, the precise cause of PCOS is not known, but the following contributing factors have been identified:

• PCOS does seem to run in families. We often encounter sisters who each report having irregular periods and/or fertility problems.
• For many women, PCOS is caused by being overweight. Because fat cells are hormonally active, excess body fat disrupts a woman’s hormonal balance.

Is PCOS a lifelong disease?

While there is no known cure for PCOS, there are many ways to decrease or eliminate PCOS symptoms, including:

• Weight loss. It is well-known that overweight women who do not get their periods regularly will often resume regular monthly periods if they lose just 10% of their body weight.
• Birth control pills. Combined birth control pills, which contain both estrogen and progestin, are often used to “cycle” women with PCOS.
• Other medications. Women who want to conceive may be offered medications that stimulate ovulation. Also, because PCOS is linked to diabetes, certain medications that are commonly used to treat diabetes (e.g., metformin) may be used to treat PCOS.

Symptoms of Ovarian Cysts

Many ovarian cysts—even large ones—are completely asymptomatic. Common symptoms of ovarian cysts include:

• Mild or moderate pain, pressure, or heaviness over weeks to months (usually from a slowly growing cyst).
• Pain that is acute and severe enough to call for a trip to the emergency room (usually from a ruptured cyst).
• Constant or intermittent pain or pain only with activity or intercourse.
• Bleeding abnormalities (since certain ovarian cysts produce hormones that can alter the menstrual cycle.
• Chronic complaints of bloating and vague urinary symptoms.

What about ovulation?

Technically, ovulation is a type of cyst rupture. In the ovary, eggs develop within a sac of fluid called a “follicle.” At the time of ovulation, which is typically midway through the menstrual cycle, the follicle ruptures, releasing the egg together with a small amount of fluid into the pelvis. While this process is completely normal, ovulation can be very painful for some women. Painful ovulation is known as mittleshmerz (German for “middle pain”) and is one of the more common reasons we see women in the emergency room. If you suffer from recurrent mittleshmerz, effective treatments are readily available.

Can ovarian cysts cause torsion?

Torsion occurs when the ovary containing a cyst twists around the “stalk” that contains its blood supply, like an apple twisting on a tree. When the blood supply of the ovary is interrupted, oxygen does not reach the ovarian tissue, and it begins to die. Like rupture of a cyst, torsion is severely painful, and may be associated with nausea, vomiting, and a low-grade fever. Torsion can often be diagnosed by a special Doppler ultrasound, which can demonstrate the lack of blood flow to the ovary. Torsion is a true surgical emergency.

Is It Ovarian Cancer?

When women are diagnosed with an ovarian cyst, many are concerned about the possibility of ovarian cancer. Ovarian cancer is indeed a frightening disease and affects 1 in 70 women in this country. Most women with ovarian cancer are first diagnosed when they already have advanced-stage disease. Unfortunately, this means that the prognosis of ovarian cancer is often not as favorable as many other types of cancer.

Who is at high risk for ovarian cancer?

Certain women are particularly at risk for ovarian cancer. Risk factors include:

• Age. Nearly half of ovarian cancers occur in women over age 63; ovarian cancer is rare before age 40.
• Obesity. Women with a body mass index (BMI) of at least 30 have up to 50% higher risk of ovarian cancer.
• Having babies. Women who have not delivered a baby have a higher risk of ovarian cancer.

Interestingly, women who spend a few years on birth control pills have a significantly lower risk of ovarian cancer.

Can you catch ovarian cancer early?

Traditionally, ovarian cancer has been regarded as a “silent killer.” It has been widely taught that the disease has few early symptoms and thus is nearly impossible to catch in its early stages. While only about 20% of ovarian cancers are discovered in their early stages, recent studies suggest that most women with ovarian cancer do indeed have symptoms, even with early stage disease.

In recent studies, almost all women diagnosed with ovarian cancer reported symptoms—although sometimes vague and non-specific—when carefully questioned. These recent findings underscore the importance of a careful medical evaluation for even vague pelvic and abdominal symptoms.

How is ovarian cancer diagnosed?

The diagnosis of ovarian cancer may be suspected based on findings of imaging studies like sonography, CT scan, or MRI. While none of these tests can tell the difference between benign cysts of the ovary and cancerous growths with 100% accuracy, ovarian cancers do tend to have a different appearance than benign cysts, especially on sonogram. Tumor markers in the blood (for example, CA-125) can be used in some women to gain additional information.

How is ovarian cancer treated?

If a cancerous growth of the ovary is suspected, surgery is usually indicated. Ideally, surgery is performed in consultation with a gynecologic oncologist—a gynecologist with special training in the treatment of gynecologic cancers. Most women with ovarian cancer will require removal of:

• Both ovaries and the uterus
• Fallopian tubes
• Omentum (fatty tissue around the intestine, liver, and stomach)
• Lymph nodes in the abdomen and pelvis

Usually, chemotherapy is required after surgical staging.

How Are Ovarian Cysts Treated?

Typically, we make the diagnosis of an ovarian cyst using the high-resolution sonogram equipment located in each of our offices. Our equipment is modern, 3-D and Doppler capable, so we are able to collect as much information as possible about ovarian cysts and other types of pathology before you leave.

Once diagnosed, a treatment plan can be developed. For small cysts that are thought to be functional, based on how they look on ultrasound, patients may be asked to follow up after a few weeks. For larger cysts or cysts with suspicious characteristics, further testing may be warranted. Testing may include additional imaging (for example, CT scan or MRI) or blood work that measures levels of tumor markers like CA-125.

Occasionally, it may be prudent to simply monitor a small cyst, but in most cases, persistent ovarian cysts will need to be removed. In most cases, ovarian cysts are removed laparoscopically, using a telescope inserted through your navel. This procedure, called laparoscopic ovarian cystectomy, is performed in the hospital, but patients are generally discharged the same day. Typically, women can return to their normal activities about one week after laparoscopic ovarian cystectomy.

Get Checked Right Away

Because there are so many types of ovarian cysts, any known or suspected ovarian cyst should be evaluated promptly by a gynecologist. If you think you might have an ovarian cyst, we encourage you to call us as soon as possible to see a gynecologist at any of our Queens or Long Island locations. We see patients 7 days a week and offer same-day appointments for urgent conditions.