Ovarian cysts are fluid-filled sacs that form on the outside or inside of the ovaries. Most premenopausal women with regular periods will get ovarian cysts through a natural ovulation process. These cysts, called functional cysts, are generally small and often resolve on their own as they are related to the menstrual cycle. Large cysts may require treatment, and though they can be cancerous, this is rare. Cysts after menopause are also unusual and generally indicate a higher risk of ovarian cancer.
Follicular cysts happen during the ovulation process. Inside the ovary, an egg forms in a follicle which then breaks and releases the egg. A cyst may occur if the follicle doesn't burst as it normally does and instead continues to grow. Corpus luteum cysts develop when the follicle breaks but doesn't shrink as it should. Instead, the corpus luteum reseals itself and swells with fluid. Polycystic ovarian syndrome (POS) causes some women to produce numerous cysts that can affect the functioning of the ovaries.
Many ovarian cysts are normal or go away on their own. A cyst often develops as a part of the ovulation process or early in pregnancy. However, if they linger too long, they can cause uncomfortable symptoms. In some cases, a doctor must remove the cyst. Hormone imbalances or conditions such as endometriosis and pelvic infections may produce abnormal and painful cysts. Sometimes, a large or persistent cyst can be cancerous -- a doctor must do a biopsy to diagnose a cancerous cyst.
Most of the time, cysts don't cause symptoms. If they do, women may experience localized pain, swelling, and aching near the affected ovary. The pain can be sharp or dull and may come and go in cycles. Some women have bloating, lower back pain, frequent or difficult urination, or pain during sexual intercourse.
Besides local symptoms, general or systemic symptoms may occur. These systemic symptoms are not at the site of the cyst and are usually due to hormones issues associated with the affected ovary. Some women experience breast tenderness that is more painful than usual, bleeding not associated with the menstrual cycle, unexplained weight gain, leg pain, nausea and vomiting, and increased PMS-related symptoms.
Diagnosing an ovarian cyst is usually done through a history of symptoms and medical imaging. The size, type, and location of the cyst will help the doctor determine the next steps. The doctor may request an ultrasound, CT scan, and MRI depending on the severity of the symptoms. Medical imaging and biopsies will also help rule out cancerous tumors.
Potential complications include a ruptured cyst or twisted ovary. The former can cause severe pain, inflammation, and bleeding. A ruptured cyst that causes excessive bleeding may lead to shock and require intervention. A twisted ovary can develop when the cyst is large and causes the ovary to move and twist on itself. The twist can cut off the blood supply to the ovary, which can cause severe pain and shock, so patients need immediate medical attention and usually require surgery. Symptoms such as racing heart, severe pain, vomiting, dizziness, fever, and rapid breathing could indicate a person is in shock.
Most ovarian cysts resolve on their own and don't need treatment. However, for women with severe and repeated cysts, a doctor may recommend hormone treatment through birth control pills to stop or regulate ovulation. Evidence of the efficacy of birth control pills for cysts is not conclusive -- many cysts don't shrink in response to the medication.
In cases where a cyst doesn't go away and causes excessive symptoms, looks suspicious on an ultrasound, or requires a biopsy, a doctor may perform laparoscopic surgery, the least invasive option. The surgeon makes a small incision near the belly button and inserts a tiny instrument to remove the cyst
If a cyst becomes quite large, or doctors suspect a complicated tumor, a surgeon will perform a laparotomy. This surgery is more invasive as it involves making a larger incision in the abdomen to remove the cyst or tumor. The doctor can perform a biopsy immediately, and if cancer is present, the patient may require a full hysterectomy.
Many ovarian cysts do not require treatment. Most symptoms are relatively mild, and people can manage them at home. One helpful remedy is over-the-counter anti-inflammatories, or women may turn to turmeric, ginger, and chamomile tea to reduce inflammation naturally. Other effective home remedies include heating pads, warm baths with Epsom salts, and removing inflammatory foods from the diet. Lastly, supplements such as black cohosh, flax seeds, and maca root help balance hormones, which may help prevent the development of cysts. Women should discuss natural remedies with a doctor before beginning to treat themselves.
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