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[ Types of Ovarian Cysts ] [ Symptoms, Diagnosis & Treatment of Ovarian Cysts ]

What are Ovarian Cysts?

Ovarian cysts are fluid-filled, sac-like structures within an ovary. The term cyst refers to a fluid-filled structure. Therefore, all ovarian cysts contain at least some fluid. The ovaries are two organs — each about the size and shape of an almond — located on each side of a woman's uterus. Eggs (ova) develop and mature in the ovaries and are released in monthly cycles during a woman's childbearing years.

Many women have ovarian cysts at some time during their lives. Most ovarian cysts present little or no discomfort and are harmless. The majority of ovarian cysts disappear without treatment within a few months.

However, ovarian cysts — especially those that have ruptured — sometimes produce serious symptoms that can be life-threatening. The best way to protect your health is to know the symptoms and types of ovarian cysts that may signal a more significant problem, and to schedule regular pelvic examinations.

Types of Cysts

Ovarian cysts may be of 2 types - Functional, or simple cysts, are part of the normal process of menstruation. They have nothing to do with disease, and usually disappear after your next menses or after simple treatment with oral contraceptive pills. The second type is known as Pathological types which are tumours, endometriosis etc.

Functional Cysts:

Follicular cyst

One type of simple cyst, which is the most common type of ovarian cyst, is the graafian follicle cyst, or follicular cyst. This type can form when ovulation doesn't occur, and a follicle doesn't rupture or release its egg but instead grows until it becomes a cyst, or when a mature follicle involutes (collapses on itself). It usually forms during ovulation, and can grow to about 2.3 inches in diameter. Its rupture can create sharp, severe pain on the side of the ovary on which the cyst appears. This sharp pain (sometimes called mittelschmerz) occurs in the middle of the menstrual cycle, during ovulation. About a fourth of women with this type of cyst experience pain. Usually, these cysts produce no symptoms and disappear by themselves within a few months. Ultrasound is the primary tool used to document the follicular cyst. A pelvic exam will also aid in the diagnosis if the cyst is large enough to be seen. A doctor monitors these to make sure they disappear, and looks at treatment options if they do not.

Corpus luteum cyst

Another is a corpus luteum cyst (which may rupture about the time of menstruation, and take up to three months to disappear entirely). This type of functional cyst occurs after an egg has been released from a follicle. The follicle then becomes a new, temporarily little secretory gland that is known as a corpus luteum. The ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. If a pregnancy doesn't occur, the corpus luteum usually breaks down and disappears. It may, however, fill with fluid or blood, causing the corpus luteum to expand into a cyst, and stay on the ovary. Usually, this cyst is on only one side, and does not produce any symptoms. It can however grow to almost 4 cm in diameter and has the potential to bleed into itself or twist the ovary, causing pelvic or abdominal pain. If it fills with blood, the cyst may rupture, causing internal bleeding and sudden, sharp pain.

Hemorrhagic cyst

A third type of functional cyst, which is common, is a Hemorrhagic cyst, which is also called a blood cyst. It occurs when a very small blood vessel in the wall of the cyst breaks, and the blood enters the cyst. Abdominal pain on one side of the body, often the right side, may be present. The bleeding may occur quickly, and rapidly stretch the covering of the ovary, causing pain. As the blood collects within the ovary, clots form which can be seen on a sonogram. Occasionally hemorrhagic cysts can rupture, with blood entering the abdominal cavity. No blood is seen out of the vagina. If a cyst ruptures, it is usually very painful. Hemorrhagic cysts that rupture are less common. Most hemorrhagic cysts are self-limiting; some need surgical intervention. Even if a hemorrhagic cyst ruptures, in many cases it resolves without surgery. Sometimes surgery is necessary, such as a laparoscopy.

Pathological Cysts:

These are of various types and a few common ones are described below. Pathological means ones that are of some disease type and need active and sometimes urgent treatment.

Dermoid cyst

A dermoid cyst, also called a dermoid or mature cystic teratoma, is an abnormal relatively rare cyst that usually affects women during their childbearing years (15-40; the average age is 30), is usually benign, and can range in size from half an inch to 15-20 inches in diameter. It is similar to those present on skin tissue, and can contain fat and occasionally hair, bone, nails, teeth, eyes, cartilage, and thyroid tissue. Up to 10-15% of women with them have them in both ovaries. A CT scan and MRI can show the presence of fat and dense calcifications. Though it often does not cause any symptoms, it can on the other hand become inflamed, and can also twist around (a condition known as ovarian torsion), causing severe abdominal pain and imperiling its blood supply, which is an emergency and calls for urgent surgery. These cysts can generally be removed easily, which is usually the treatment of choice, with either conventional surgery (laparotomy; open surgery) or laparoscopy. Removal does not generally affect fertility. The larger it is, the greater the risk of rupture with spillage of the contents, which can create problems with adhesions and pain and usually is a medical emergency. Although the large majority (about 98%) are benign, the remaining fraction (about 2%) becomes cancerous (malignant) -- those are usually in women over 40.

Endometrioid cyst

An endometrioma, endometrioid cyst, endometrial cyst, or chocolate cyst is caused by endometriosis, and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries. As the blood builds up over months and years, it turns brown. When it ruptures, the material spills over into the pelvis and onto the surface of the uterus, bladder, bowel, and the corresponding spaces between. Adhesions can develop because of the rupture, and may lead to pelvic pain. It affects women during their reproductive years, and may cause chronic pelvic pain associated with menstruation. Overall prevalence in women has been estimated to be 1-10%.

Endometriosis is the presence of endometrial glands and tissue outside the uterus. It occurs primarily in women during their reproductive years, usually in women aged 25-29. Women with endometriosis may have problems with fertility, because 80% of all pelvic endometriosis is found in the ovary (1 or both). These cysts, often filled with dark, reddish-brown blood, may range in size from 0.75-8 inches. Treatment for symptomatic endometriosis can be medical or surgical. Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used first in patients with pelvic pain, particularly if the diagnosis of endometriosis has not been definitively established. The goal of directed medical treatment is to achieve an anovulatory [where eggs are not released] state. Typically, this is achieved initially using oral contraceptives. This can also be accomplished with progestational agents (i.e., medroxyprogesterone), danazol, or gonadotropin-releasing hormone analogues (Leupride etc), as well as other less well-known agents. These agents are generally used if oral contraceptives and NSAIDs are ineffective. Laparoscopic surgical approaches include ablation of implants, lysis of adhesions, removal of endometriomas, uterosacral nerve ablation, and presacral neurectomy. They frequently require surgical removal. Conservative surgery can be performed to preserve fertility in young patients. Laparoscopic surgery provides pain relief and improved fertility over diagnostic laparoscopy without surgery. Definitive surgery is a hysterectomy and bilateral oophorectomy [of course this is done only if pain is severe and the patient has finished her family].

Ovarian tumours

These are also types of pathological cysts and can be benign [non cancerous] as well as malignant [cancerous]. These need to be evaluated carefully and treated urgently. Tumours are usually:

• persistent

• larger than 6cm

• thicker walled

A tumour may be possibly malignant [cancerous] if it shows any one or more of the following:

• multiple loculations

• septums within the cyst

• solid areas within the cyst

• bilaterality - cysts on both ovaries

• free fluid in the abdominal cavity

Ultrasound image of an ovarian tumour	Laparoscopic view of an ovarian tumour

Poly Cystic Ovaries

These are a different entity all together and are often a cause of infertility. More information can be found here.

[ Types of Ovarian Cysts ] [ Symptoms, Diagnosis & Treatment of Ovarian Cysts ]