| An ovarian cyst is a sac filled with a collection of fluid or semi-solid material that forms on the ovary. These cysts (functional or simple cysts) are relatively common, harmless, and can develop at any time, most often during childbearing years. Most ovarian cysts are benign and go away on their own in a few weeks without treatment.
As part of the normal menstrual cycle, the ovary releases an egg (ovum). This ovum develops within a sac or pouch-like depression (follicle), which then appears as a bulge on the surface of the ovary. When the follicle bursts open, the ovum is released; the ovarian follicle then collapses. Blood within the follicle clots and, under the influence of the luteinizing hormones, the remaining cells of the follicle become the corpus luteum. The corpus luteum secretes estrogen and progesterone for the next 7 to 8 days in preparation for fertilization and pregnancy. If pregnancy occurs, the corpus luteum continues to produce hormones until the placenta develops. If pregnancy does not occur, the corpus luteum deteriorates, becoming the corpus albicans; it eventually disappears. Follicular cysts occur when the ovarian follicle fails to rupture and release the ovum. These cysts continue to secrete estrogen instead of being reabsorbed, and the fluid within the follicle persists, forming a cyst. Follicular cysts usually resolve during the next two menstrual periods without treatment.
A corpus luteum cyst is formed when the ovarian follicle ruptures but fails to deteriorate. These cysts, filled with either serous fluid or blood, continue to produce progesterone. They, also, may disappear during the next two menstrual periods.
Serous cysts, also known as cystomas, usually form from the surface tissue of the ovary. Serous cysts may develop into ovarian cancer. They also have the potential of growing so large that the abdomen may distend.
Another type of ovarian cyst, theca-lutein cysts, may develop as a result of excessive levels of the hormone human chorionic gonadotropin (hCG). When the hormone level drops, the cysts usually shrink. Such cysts may be found in women who take infertility drugs to stimulate the ovaries as part of their infertility treatment. Theca-lutein cysts may also be found in association with tumors that produce excess amounts of chorionic gonadotropin (hydatidiform mole, choriocarcinoma).Risk: No known risk factors. Incidence and Prevalence: Ovarian cysts occur in 30% of females with regular menses, 50% of females with irregular menses, and 6% of postmenopausal females. Approximately 5% of functional cysts may actually be the beginning of a malignant tumor (Kazzi). |
Source: Medical Disability Advisor
| History: Individuals may report symptoms such as abnormal bleeding (shortened or lengthened cycles), absent or irregular menses, constant dull aching pelvic pain, pain when moving, pain shortly after beginning or ending menses (dysmenorrhea), nausea and/or vomiting, or breast tenderness. Pain during sexual intercourse (dyspareunia) may be related to a ruptured cyst. Sudden onset of severe pain or intermittent severe pain, usually associated with nausea and vomiting, is suggestive of the cyst causing twisting of the ovary (ovarian torsion). Physical exam: A complete physical exam should be performed to search for signs of infection or tumor (neoplasm). Ovarian cysts may be discovered by pressing down on the abdomen with hand (palpating the abdomen) or bimanual pelvic exam (during pelvic exam, one hand is on top of the abdomen; the ovary is pressed between the hands to evaluate its size and shape). Tests: Tests should include a blood test (human chorionic gonadotropin or hCG) to rule out pregnancy. CA 125 is usually ordered in postmenopausal patients to evaluate the possibility of ovarian cancer. It should be noted that CA 125 may be moderately elevated in many benign conditions of younger patients so its use in menstruating women is less helpful. An ultrasound, or a thin, lighted fiber optic instrument (laparoscope) inserted into the abdominal cavity for a visual examination (laparoscopy), may be necessary to confirm the diagnosis, and to determine the size and position of the cyst. Doppler ultrasound is often helpful in evaluating the blood flow to the ovary and cyst, and can help the physician decide if the cyst appears benign or malignant, and whether surgery will be needed. MRI and CT may be performed but are less helpful than ultrasound with Doppler. |
Source: Medical Disability Advisor
| Most ovarian (functional) cysts do not require treatment, and usually disappear on their own within 60 days ("Ovarian Cysts"). Oral contraceptives are sometimes prescribed to suppress the hormones that may be causing the cyst to grow, to help re-establish normal cycles, and to reduce cyst size. The individual may be examined after her next menstrual period to see if the cyst has resolved. Discontinuation of gonadotropin therapy, given for infertility, may also cause cysts to spontaneously disappear as the many follicles then begin to mature. It may, however, take several months for them to resolve.
Depending on the size of the cyst and how it appears on the ultrasound, for diagnostic purposes a laparoscope can be inserted into the abdomen through a small surgical opening (exploratory laparoscopy). In many cases the cyst can be removed through the laparoscope. If there appears to be more than one cyst, if the ultrasound indicates the cyst is solid rather than fluid-filled, or if the cyst is larger than 8 centimeters, a larger abdominal cut (laparotomy) may be necessary to remove either the cyst or the entire ovary (oophorectomy).
Any cyst that enlarges or persists longer than 60 days probably is not a functional cyst, and surgery is required to rule out other causes of the symptoms. If a cyst causes the ovary to twist (torsion) and shuts off its blood supply, or ruptures and causes severe bleeding, a laparoscopy or laparotomy is usually necessary. Any postmenopausal ovarian enlargement should be investigated promptly regardless of its size.
Anti-inflammatories are recommended to decrease the amount of pelvic pain. Narcotics may be used if the pain is severe. |
Source: Medical Disability Advisor
| A complete recovery can be expected. Most cysts resolve spontaneously without treatment. Medication or surgery (laparoscopy or laparotomy) effectively treats those cysts that do not resolve spontaneously. |
Source: Medical Disability Advisor
| Complications that generally require emergency surgery include twisting (torsion) of the ovary containing the cyst, or rupture of a cyst that results in severe bleeding (hemorrhage). Enlargement of the cyst, or a cyst that persists throughout several menstrual cycles may also indicate a need for surgery. |
Source: Medical Disability Advisor
| Time off may need to be allotted for follow-up doctor visits. Heavy lifting may be restricted if surgery was necessary. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Is the woman of childbearing age?
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Did the woman experience symptoms consistent with the diagnosis of an ovarian cyst, such as abnormal bleeding, absent or irregular menses, pelvic pain, dysmenorrhea, pain during sexual intercourse or nausea and vomiting?
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Did the woman have symptoms of a ruptured cyst or ovarian torsion?
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Was a mass noted during the pelvic exam?
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Was a complete physical exam done?
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Was a CBC and hCG done?
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Was there evidence of a follicular cyst?
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Was the diagnosis confirmed using laparoscopy?
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Were other conditions considered in the differential diagnosis (acute appendicitis, bowel obstruction, diverticular disease, inflammatory bowel syndrome, ovarian torsion, pelvic inflammatory disease [PID], ectopic pregnancy, renal calculi, ovarian abscess, distention of the fallopian tube by clear fluid [hydrosalpinx], and ovarian cancer)?
Regarding treatment:
- Were follow-up exams performed?
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Did the cyst resolve or shrink in size?
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Were oral contraceptives tried?
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Was surgery indicated? If so, was malignancy or torsion detected?
Regarding prognosis:
- Did the cyst resolve without treatment?
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Was medication or surgical intervention indicated and effective?
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Did the individual have any associated conditions or complications, such as endometriosis, malignancy, torsion associated with bleeding, and infertility that may impact recovery?
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Source: Medical Disability Advisor
| Kazzi, Amin Antoine. "Ovarian Cysts." eMedicine. Eds. Dana A. Stearns, et al. 17 Dec. 2004. Medscape. 2 Nov. 2004 <http://emedicine.com/EMERG/topic352.htm>. "Ovarian cysts." MedlinePlus. National Library of Medicine. 2 Nov. 2004 <http://www.nlm.nih.gov/medlineplus/ency/article/001504.htm>. |
Source: Medical Disability Advisor
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