Most of the time, ovarian cysts are totally normal and nothing to worry about.
By Abi Millar
An ovarian cyst is a fluid-filled sac that develops on an ovary. It might sound like cause for concern, but they’re actually very common and most ovarian cysts are nothing to worry about. Cysts are a normal part of the workings of the ovaries and generally disappear without treatment. In fact, for women of childbearing age cysts are nearly always benign.
To put your mind at rest, we speak to Dr Karen Morton, a consultant gynaecologist and founder of Dr Morton’s medical helpline about ovarian cysts, symptoms, causes and treatments:
What is an ovarian cyst?
It’s a common misconception that ovarian cysts are always a cause concern. In menstruating women, the ovaries are full of immature eggs, one of which comes to maturity every month. This happens over the space of about 14 days in a structure called a follicle, before being released for possible fertilisation. Because the follicle is filled with fluid, it technically counts as a cyst. It will measure around 3cm across by the time it ruptures. Most of the time, the structure disappears without causing any symptoms.
Ovaries are cystic structures – that’s how they work. The word cyst is just a description for something containing fluid.
‘Ovaries are cystic structures – that’s how they work,’ says Dr Morton. ‘The word “cyst” is just a description for something containing fluid, so depending on what point in the menstrual cycle you’re at, you’d find a cyst on the ovary of varying sizes.’
‘I am referred so many patients who went to the GP with stomach pain – they’ve been for a scan, and something measuring 3cm was seen on one of the ovaries. 99 times out of 100 it’ll be a normal follicle,’ she adds.
When do cysts become a problem?
Every now and again, the follicle fails to burst. While these cases normally resolve within a few weeks, once the cyst grows past a certain size it may place pressure on surrounding organs. This can cause discomfort or pain during sex.
‘Often a lady will go to the doctor and have a scan that shows something like a follicle full of watery fluid, around 5cm diameter,’ says Dr Morton. ‘It’s just an egg that forgot to pop, so we call that a “simple cyst”. They’ll often go away on their own, and the lady will need a scan to check it’s gone.’
In other cases, the cyst arises not from the follicle itself, but from other types of cell. Of these, the two most common types are dermoid cysts and endometrial cysts. ‘The one that lots of people have heard of is a dermoid cyst, which is a bit revolting and contains hair and teeth and greasy stuff,’ says Dr Morton.
‘Endometrial cysts, properly called “endometriomas”, often get called chocolate cysts. They occur in sufferers of endometriosis when they have womb lining on their ovary, so every time they have a period they’re also bleeding into this cyst. This can be very painful.’
Ovarian cyst symptoms
While many cysts are asymptomatic, others can lead to dull aches in your lower back, difficulty urinating, menstrual irregularities or gastrointestinal symptoms like nausea and vomiting. Most of the time, these symptoms will go away on their own, once the cyst resolves.
In the case of dermoid cysts, these are slow-growing structures that may not come to light until spotted on a routine scan. Occasionally, there may be complications such as torsion.
While many cysts are asymptomatic, others can lead to dull aches in your lower back and difficulty urinating.
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‘You can have them for years with no problems, so it can come out of the blue in an emergency,’ explains Dr Morton. ‘Because they’re very heavy, they can twist, blocking the blood supply and causing gut-wrenching pain. It’s an emergency surgical procedure to get it untwisted.’
Endometrial cysts are more likely to be spotted early, as they are related to endometriosis and cause painful periods. Untreated, this kind of cyst can lead to infertility, alongside chronic pelvic pain. A doctor may recommend medication or surgery.
While cysts in younger women are nearly always benign, after the menopause there is a higher chance of malignancy.
‘Finding an ovarian cyst in an older woman requires very careful investigation as it is more likely to be an unpleasant malignant cyst,’ says Dr Morton. ‘Women may go to the doctor with vague tummy symptoms – it can feel almost like indigestion – and this is why detection of ovarian cancer tends to be rather late. Because ladies aren’t looking at their fertility, they don’t think about gynaecological things so much.’
If you are past the menopause, and are experiencing symptoms such as constant bloating or pelvic discomfort, it is important to see the doctor as soon as possible to rule out the possibility of ovarian cancer.
The difference between cysts and PCOS
As the name implies, Polycystic Ovary Syndrome (PCOS) does generally include lots of small cysts on the ovaries. However, it should be considered separately from ovarian cysts, as the cysts are not the only factor required for diagnosis.
In this case, the cysts are due to so-called “follicular arrest”, where the maturing egg fails to develop in full, and the woman doesn’t ovulate.
‘Sometimes the ovaries are a bit lazy and they don’t bring the egg to maturity, so the follicle gets to the size of a pea and it just stops growing,’ explains Dr Morton. ‘So a polycystic ovary is a tiny bit bigger than a normal ovary, and around its edge there are small pea-sized beads of fluid. However, PCOS is a very specific condition including all sorts of other chemistry problems. Small cysts don’t mean very much unless they’re part of a bigger picture.’
Signs of PCOS may include irregular periods, high levels of male hormones, or difficulty getting pregnant.
Other signs of PCOS may include irregular periods, high levels of male hormones, or difficulty getting pregnant. However, because its symptoms and severity vary so much from person to person, it is difficult to pin it down to a single definition. It is not to be confused simply with cysts on the ovaries.
The important thing to remember is that not all ovarian cysts are made alike. And while they’re generally nothing to be concerned about, your GP or gynaecologist should be able to put your mind at rest if you’re worried.