Ovarian cysts affect the ovaries of a woman. There are two ovaries lying on either side of the uterus. Ovarian cysts may be present in one or both of them in varying numbers. Sometimes, there is only one cyst that is large enough to disrupt the normal functioning of an ovary.

A cyst is a sac-like projection of a membranous tissue of an organ. These are closed capsules, appearing as a blown balloon, often filled with fluid, gas, or semi-solid material depending upon their location.

Varying in size, a cyst is often benign and rarely cancerous. Large cysts may cause symptoms as they are not a normal part of the tissue they arise from.

Ovarian cysts are filled with fluid. They may be present on the surface of the affected ovary or inside it. Cysts in the ovary are a common occurrence in women, and they can be of different types.

Ovarian cyst symptoms are not pronounced in most cases. A majority of symptomless ovarian cysts resolve within a few months and cause no discomfort.

However, some cysts may disrupt the functions of the ovary, especially ruptured cysts. A ruptured ovarian cyst can cause symptoms severe enough to call for an emergency visit.

Regular pelvic exams can rule out any such possibility. Medications and surgery help to prevent and manage any existing ovarian cysts.

Functions of an ovary

To understand the development and types of ovarian cysts, let us have a brief insight into the working of ovaries.

The ovaries carry eggs that mature each month and get ready to fertilize if any chance arises. When a girl is born, she carries the whole number of eggs she will ever have in her ovaries, almost two million on an average.

As a girl hits puberty, that number decreases by 400,000. Out of these, only a few will be released to become mature enough to fertilize. The process of egg maturation happens every month due to a single egg (oocyte) being released.

The ovaries house the eggs in sacs called follicles. Every month, follicles grow and gain size, but only one of them grows through the cycle and releases the egg.

The rest of the follicle remains to become a structure called corpus luteum. The corpus luteum has important functions; it assesses progesterone that prepares the uterus lining to receive fertilized egg in case of conception happens.

If conception does not occur, the corpus luteum gets dissolved, the uterus lining sheds away because the hormonal surge returns to normal. That is when menstruation begins. The process repeats itself till conception begins.

Causes of an ovarian cyst

Any disturbance in the normal physiological function of the ovary is what causes ovarian cysts. The most common causes disrupting the normal function of ovaries include:

• Hormonal

A cyst in the ovaries may develop under the influence of hormones. Your body may be undergoing any hormonal disturbance (stress, anxiety, etc.).

Hormonal drugs are often prescribed to induce ovulation or regulate the menstrual cycle or for contraceptive purposes.

In any case, whenever the hormonal profile of a woman is upset, it may cause the formation of ovarian cysts. These are called functional cysts that are often benign and go away without causing any symptoms.

• Endometriosis

Endometriosis is a condition when tissue resembling the one present in the uterus starts to grow outside it. The uterine tissue may be present almost anywhere in the pelvic cavity; ovaries, fallopian tubes, the lining of the pelvis, etc.

The condition is also associated with the development of an ovarian cyst called an endometrioma.  The ovarian cyst pain in such a condition is severe. The patient suffers from pain during periods and while having intercourse.

• Pregnancy

The corpus luteum formed during the normal egg maturation process supports uterine growth and development in the wake of conception and pregnancy. Sometimes, the luteum stays on in the ovary and develops into an ovarian cyst while pregnancy progresses.

• Pelvic infections

Pelvic infections spreading to fallopian tubes and ovaries may trigger the formation of cysts on ovaries.

• A previous history of ovarian cyst

If a woman has had an ovarian cyst in the past, she will likely develop more of them later in life.

Types of ovarian cysts

Depending upon the cause, an ovarian cyst may be one of the following types:

1. Functional cysts

A cyst in the ovaries may be normally seen during a pelvic ultrasound done for any other reason. If such a cyst is found that causes no symptoms, it most probably is a functional cyst.

These functional cysts develop when a follicle carrying an egg takes on a cyst appearance. Depending on the stage of the menstrual cycle that it occurs, the functional cyst may be of two types:

• Follicular cyst

Normally a mature follicle burst open, often midway through the menstrual cycle, to release the egg. When a follicle fails to release the egg but continues to grow, it forms a follicular cyst.

• Corpus luteum cyst

When the fluid gets collected in the empty corpus luteum left by a ruptured follicle without an egg, it is said to be a corpus luteum cyst. 

• Pathological cysts

Ovarian cysts that develop due to some other cause are called pathological cysts.

• Dermoid cysts

A dermoid ovarian cyst is also called a teratoma. They develop from embryonic tissue (cells that form eggs) and contain hair, teeth or skin. They may cause symptoms but are rarely cancerous.

• Cyst adenomas

Cysts developing on the surface of ovaries from the cells in the outer layer are called cystadenomas. They are filled with watery or mucous material most of the time. A cyst on the ovary is prevalent after the age of forty.

Cyst adenomas do not grow inside the ovary. Rather they hang outside the ovary with a stalk. As they grow in the pelvic cavity, they tend to grow large. Rarely cancerous, but cystadenomas can be troublesome and require surgical removal.

• Endometriomas

When endometria tissue gets attached to ovaries and forms growth, it is called an endometrioma.

Symptoms of ovarian cysts                                                          

The symptoms of an ovarian cyst depend a lot on the type of cyst.

Functional cysts are often symptomless, resolving on their own without any knowledge of the woman affected. However, symptoms of ovarian cysts can become troublesome if they are many in number or large in size.

The same is with a ruptured ovarian cyst, the symptoms of which lead to a hospital visit in an emergency.

The general symptoms of ovarian cysts are the following:

• Pelvic pain that may be dull or sharp usually affecting the side of the cyst location
• The pain may be continuous or intermittent (comes and goes)
• The pain may appear just before menstruation begins or ends
• A feeling of abdomen being full or heavy
• Abdominal bloating, swelling, heaviness and pressure

Other less common signs and symptoms of ovarian cysts include:

• Dull pain in the lower back and thighs
• Problems emptying the bladder or bowel or incomplete emptying
• Pressure on the bowel
• Painful intercourse
• Abdominal discomfort after sex
• Unexplained weight gain
• Painful menstrual cramps not present before
• Unusual vaginal bleeding
• Breast tenderness and pain due to hormonal imbalance
• Frequency and urge to urinate
• Pain on passing a stool
• A frequent need to pass a stool
• Hirsutism (abnormal growth of hair on body; face, chin, upper lips)

An ovarian cyst rupture may present itself as:

• Sudden abdominal or pelvic pain
• Severe pain
• Pain associated with vomiting
• Fever with pelvic pain

Symptoms of shock requiring emergency treatment may also accompany ovarian cyst pain. These include:

• Cold and clammy skin
• Rapid breathing
• Lightheadedness, feeling of faintness or weakness

Ovarian cyst symptoms are accompanied by nausea and vomiting. This happens due to ovarian torsion. That is when an ovary containing a large cyst twists around. This causes severe pelvic pain on the respective ovarian side.

Ovarian pain due to a ruptured cyst causes internal bleeding if the cyst is large. This can trigger the symptoms of shock.

A dermoid cyst ovary does not cause obvious symptoms. If it does, they are usually due to complications when the dermoid cyst is large enough to encroach on surrounding organs. The signs and symptoms of a dermoid cyst include:

• Pain in abdomen, pelvic area or lower back, which may be severe at times
• Abnormal vaginal bleeding
• Difficulty urinating
• Difficulty in passing urine due to pressure on the bladder
• Urinary retention
• Painful intercourse
• Symptoms indicative of ovarian torsion due to a large-sized cyst
• Nausea with or without vomiting

Some form of menstrual irregularities accompanies all types of ovarian cysts. The period bleeding may become heavier or lighter.

Risk factors for ovarian cysts

Some factors predispose a woman to develop ovarian cysts. These include:

• Any previous history of ovarian cyst means that your body profile is at high risk of developing the condition.
• Hormonal imbalances that cause a disturbance at any level of the normal functioning of the ovarian cycle can create an ovarian cyst.
• If you are taking fertility drugs, like clomiphene, conceiving can cause ovarian cysts. Such medications are used to induce ovulation and can cause many follicles to mature without releasing the eggs and so on.
• Pregnancy is a result of ovulation. A corpus luteum from pregnancy can stay and develop into a cyst.
• Endometriosis can cause the uterine tissue to stick to the outside of the ovary, causing a cystadenoma.
• Any pelvic infection increases the chance of developing an ovarian cyst by involving the ovaries.

Complications of an ovarian cyst

• Ovarian torsion

Cysts larger in size may cause ovarian torsion. Cyst on ovaries that grow into the pelvic space and have a stalk are also more likely to result in this complication.

This decreases or completely cuts back the blood supply to the affected ovary.  Ovarian torsion causes sudden pain accompanied by nausea and vomiting. It is a medical emergency.

• Ovarian cyst rupture

An ovarian cyst may rupture, either inside the ovary or outside. The larger cysts have more chances of rupture. Vigorous physical activity or sexual intercourse may trigger such an event. The symptoms, severe pain and internal bleeding, may be severe enough to require urgent treatment.

• Infertility

An ovarian cyst may or may not affect your chances of conception or your fertility profile. It depends on the causative factor of the cyst. Ovarian cysts that develop due to endometriosis or polycystic ovarian syndrome affect the fertility of a woman.

Endometriosis is the growth of uterine tissue outside the uterus, almost anywhere in the pelvic cavity. When the condition involves either of the ovaries, the fertility chances are cut down. 

Polycystic ovary syndrome (PCOS) is when numerous small cysts on the ovary appear, giving the affected ovary a pear-string appearance on its margins.

The condition is accompanied by irregular periods and high levels of certain hormones. This results in irregular ovulation contributing to problems with fertility in some women.

Similarly, the location of the cyst also affects the chances of a woman getting through pregnancy. Most of the time, such cysts do not cause fertility issues.

However, larger cysts with complications that damage the ovary and require surgical removal cut back the chances of conception. Yet, women have been seen to conceive and carry on with successful conception even with one functioning ovary. 

• Ovarian cancer

The risk for ovarian cancer increases with the age of a woman. Postmenopausal women are more at risk of developing cancerous cysts owing to the lack of hormonal support.

• Pregnancy complications

Ovarian cysts during pregnancy are a common occurrence. Usually functional and symptomless, they resolve. A persistent ovarian cyst may cause trouble during childbirth.

Other complications due to a large-sized cyst (rupture, torsion) may also complicate a pregnancy. Regular monitoring by a doctor is necessary in such cases. 

When to see a doctor

 If you have a history of ovarian cyst and suffer from sudden signs and symptoms as:

• Pain with fever and vomiting
• Sudden, severe abdominal pain
• Faintness, dizziness, or weakness
• Rapid breathing

Then that is a sign of a ruptured ovarian cyst. That is a medical emergency that requires urgent treatment.

Normally ovarian cysts require regular pelvic check-ups and follow-ups in case a cyst is discovered. The doctor keeps an eye on the size of the cyst.

In case the doctor feels that the cyst is too large and might cause complications, he/she may resort to surgery. Otherwise, medications do just fine to manage ovarian cysts.

What to expect from your doctor

Your doctor will take a complete history and ask questions to know more about your condition. You should be ready for inquiries like:

• Symptoms
• Their severity
• Their frequency
• Any relation of the symptoms with the menstrual cycle
• What measure improve the symptoms
• What factors make the symptoms worse

During a doctor’s consultation, you can ask about any queries you might have about diagnosis, treatment, recurrence of cysts, etc.

Diagnoses of ovarian cysts

In case of experience the general symptoms of ovarian cysts, consult your doctor. The diagnosis is made on:

• History of the patient
• Presenting signs and symptoms of a patient
• Pelvic examination to physically check for abdominal or pelvic complaints
• Pelvic ultrasound (to identify and check the size, shape, and location of any cyst)
• Ultrasound also shows what the cyst contains (fluid or solid, hair, etc.)
• Hormonal profile to check any underlying hormonal imbalance
• Blood test to rule out pregnancy
• Blood test as screening for ovarian cancer in postmenopausal women (higher levels of cancer antigen, CA-125 for ovarian cancer)
• Sometimes, a doctor may perform diagnostic laparoscopy to observe and make an attempt at removing an ovarian cyst.
• High levels of CA 125 levels can also occur in women of childbearing age. The test in such women often indicates a noncancerous condition, such as endometriosis, uterine fibroids and pelvic inflammatory disease. This can help diagnose and confirm any underlying cause of an ovarian cyst.

Treatment of an ovarian cyst

Not all ovarian cysts require surgery. The treatment usually depends on the:

• Woman’ age
• Type of the cyst
• Size and number of ovarian cyst
• Location of the cyst
• Severity of symptoms

A doctor may go for:

1. Observational approach

The typical approach to treating an ovarian cyst is observation if the cyst is simple, small, and symptomless, regardless of the patient's age. The doctor asks for follow-up visits to check on the cyst progression or regression.

• Medications

Your doctor may also prescribe hormonal birth control pills to prevent any new cysts from developing while observing the existing cyst. The birth control pills do not affect any existing cyst, so a watchful approach is followed.

A vaginal ring, shot, or patch also helps prevent ovulation and the chances of cyst development.

The doctor may prescribe over-the-counter pain killers to manage the pain.

• Surgery

Surgical intervention is often taken up in special circumstances. Your doctor might suggest surgical removal of a cyst that if:

• It is large,
• It does not appear like a functional cyst
• It is growing,
• It does not go away after several menstrual cycles
• It starts to cause symptoms
• It looks unusual on ultrasound
• The woman is postmenopausal

If your consultant thinks that surgery is the better option, there are some approaches to this model. These include:

• Ovarian cystectomy; removing the cyst only.
• Oophorectomy; removing the entire affected ovary and the cyst, leaving the other ovary intact.
• If diagnostic laparoscopy reveals cancerous changes (the removed cyst is always sent for biopsy), the doctor may call for a total hysterectomy; removal of the uterus, ovaries and fallopian tubes.

Laparoscopy is a less invasive procedure than laparotomy. In the former, a very small cut above or below your belly button is made. An ultrasound-guided tube is passed through the small incision into the pelvis.

Removal of the cyst is done via that tube. Smaller and benign-looking cysts are removed this way.

For larger cysts in menopausal women with a high risk of cancer, laparotomy is done. This is a major operation requiring a bigger incision in the abdomen.

The cyst is removed and sent for biopsy. In the case of ovarian cancer, a hysterectomy is undertaken.

Home-based remedies

Though there is no way to prevent the development of ovarian cysts, there are home-based remedies to manage the pain and other symptoms of ovarian cysts.

• Over-the-counter analgesics

Ibuprofen (Advil), acetaminophen (Tylenol), and naproxen (Aleve) effectively relieve the pain and cramps. They are safe to take till the pain lasts.

• Heat therapy

Using hot water bottles or heat pads to relieve the lower abdominal cramps is another effective way. Heat therapy is a good alternative to taking pain medications.

• Epsom salt

Using Epsom salt in your bath is a tried and tested remedy for relieving aching muscles and abdominal cramps.

• Magnesium supplements

Magnesium helps relieve chronic pain, and almonds are high in magnesium. That is why almonds are suggested to alleviate the abdominal cramps associated with ovarian cysts. So munching on almonds is a good idea to manage the pain and cramps if you do not have an allergy to these nuts.

• Dong Quai supplements

An herbal ingredient, supplements containing the root, are said to alleviate the pain and cramps. Nursing mothers and women with blood clotting disorders or taking blood-thinning medications should not take this supplement. Pregnancy is also a contraindication for taking this supplement.

• Chamomile and ginger tea

Chamomile and ginger have anti-inflammatory properties. Drinking their teas can have a soothing and calming effect.

• Healthy diet

Polycystic ovarian syndrome causes multiple cysts on the surface of the ovaries. PCOS is associated with obesity and insulin resistance.

Consuming a healthy diet excluding refined and processed food items is an effective way to manage the condition. When the symptoms are managed, the monthly cycle of periods brings less pain and cramps.

• Flax seeds

Flax seeds are rich in omega-3 fatty acids and are known to bring down the testosterone levels in women, often high in women with ovarian cysts and PCOS.

• Maca root supplements

Another herbal supplement, maca root, is also proposed to balance the hormones. More research is required to see its effectiveness in an ovarian cyst case, but taking maca root tea is seen to relieve the discomfort associated with menstruation.

Always consult your doctor before taking an herbal supplement to avoid dangerous drug interactions. The FDA does not regulate herbal supplements, so there is no guarantee that the supplement or brand you are taking is free from side effects.

Prevention of ovarian cysts

There is no way to prevent the development of ovarian cysts, especially in women of childbearing age. The process of ovulation continues every month, and cysts can develop. However, in recurrent cases, a doctor may prescribe birth control pills to stop the ovulation process.