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    Ovarian Cysts: Causes, Symptoms, Diagnosis & Treatment

    An ovary is a female reproductive organ. Producing ova or eggs, the ovary also releases the female hormones oestrogen and progesterone.

    Ovarian cysts are fluid-filled sacs in the ovary of a woman. Causing no symptoms, a majority of women do not even realize that they have ovarian cysts. Ovarian cysts are usually found in women at the time of ovulation when a follicle ruptures to release an egg.

    Ovarian Cysts

    It is when the follicle fails to rupture that an ovarian cyst is formed. Harmless and painless, an ovarian cyst usually goes undetected. Studies in children and adolescents have revealed that while they might also be at risk for developing ovarian cysts, the cysts are quite simple and small in size (1 to 3 cm) [1] .

    Don't Miss: Facts You Should Know About Ovarian Cysts

    Causes Of Ovarian Cysts

    A commonly occurring gynaecological problem, an ovarian cyst can be of two types, pathological cysts and physiological cysts [2] .

    [I] Physiological cysts

    These include the following.

    1. Follicular cysts: Such cysts are formed as a result of the failure of a mature follicle to ovulate at the time of ovulation [3] . Follicular cysts spontaneously resolve on their own in 6 weeks and do not go beyond 8-10 cm in diameter [4] .

    2. Corpus luteum cysts: Typically, every woman has two ovaries, one on each side of the uterus. These ovaries contain eggs or oocytes [5] . At the time of birth, every female already has her entire supply of oocytes. These immature oocytes mature into Graafian follicles prior to ovulation [6] . A corpus luteum cyst is formed when a mature Graafian follicle ruptures [7] . Such cysts typically have the appearance of a spider's web which is caused by internal haemorrhage. In a majority of such cases, corpus luteum cysts resolve on their own within 6-12 weeks [8] .

    [II] Pathological cysts

    The pathological cyst is a term used to define ovarian tumours in general. Tumours in the ovary can either be malignant, benign or borderline [9] .

    While benign tumours are commonly found in younger women, malignant cysts can be seen more frequently in elderly women.

    The majority of ovarian cysts do not cause any symptoms and usually disappear on their own.

    Ovarian Cysts

    Pathological ovarian cysts include the following:

    1. Cystadenomas: Ovarian mucinous cystadenoma is the term used to refer to a benign tumour that arises from the ovarian surface epithelium. With a tendency to grow to large sizes, cystadenomas account for about 15% of all the types of ovarian tumours [10] . Out of this, while 80% are benign, 10% are malignant and 10% are borderline.

    2. Dermoid cysts: These arise from the ovarian germinal cells [11] . Ovarian dermoid cysts are also referred to as mature cystic teratomas [12] . A benign kind of tumour of the germ cell, dermoid cysts are the most common neoplasms of the ovary in women belonging to the fertile age bracket [13] .

    3. Endometriomas: [14] Also called ovarian endometriotic cysts, these are a commonly diagnosed type of endometriosis. The term 'endometriosis' is used to refer to the condition where endometrium or the tissue lining the insides of a uterus, somehow grows outside the uterus. While the endometrial tissue rarely spreads beyond the pelvic region, endometriosis can affect the fallopian tubes, the tissue lining the pelvis and the ovaries.

    Also read: Women! If You See These Symptoms, Get Tested For Ovarian Cysts Immediately

    Ovarian Cysts

    Symptoms Of Ovarian Cysts

    Most of the ovarian cysts are asymptomatic and usually go undiagnosed as no medical supervision is sought in the lack of any discomfort.

    However, large ovarian cysts may lead to the following symptoms [15] :

    Abdominal discomfort

    Frequent urination, especially when pressure is put on the bladder

    • Pelvic pain
    • Nausea
    • Vomiting
    • Breast tenderness
    • Heaviness and fullness in abdomen
    • Difficulty in emptying the bladder
    • Dysmenorrhoea or menstrual cramps and painful period
    • Dyspareunia or painful sexual intercourse

    While mostly resolving on their own with the passage of time, some ovarian cysts might be suspected of malignancy [16] . With the occurrence of ovarian cysts, there is always the risk of ovarian cancer involved. While simple ovarian cysts pose minimal risk for ovarian cancer, complex ovarian cysts are at a significantly higher risk for malignancy [17] .

    Must read: Can Ovarian Cysts Turn Cancerous?

    Diagnosis Of Ovarian Cysts

    Usually, ovarian cysts do not cause any symptoms and are resolved on their own. Nevertheless, there might be occasions where the ovarian cyst ruptures, causing acute pelvic pain [18] .

    Conclusive investigation into an ovarian cyst involves the following. [19]

    A transvaginal ultrasound. Especially in premenopausal women, transvaginal ultrasound [20] is a cost-effective way of identifying ovarian cysts [21] .

    Ovarian Cysts

    Clinical parameters

    Measurement of Plasma CA125 in the ovarian cyst liquid helps in differentiating between an ovarian endometriotic cyst [22] and a cystic corpus luteum [23] . CA125, or cancer antigen 125, is a tumour marker in cases of ovarian cancer [24]
    A Colour Doppler test is quite accurate in demarcating the benign ovarian tumours from the malignant ones. To establish ovarian malignancy, Colour Doppler or Spectral Doppler ought to be the diagnostic tool of choice owing to "good sensitivity, specificity, and positive predictive value" [25] .

    For an effective diagnosis, results got from the above tests are compared with the assessment done by the doctor.

    Treatment Of Ovarian Cysts

    The course of treatment for an ovarian cyst depends upon its nature. As the nature determines the treatment, correct diagnosis is of crucial importance [26] .

    A majority of ovarian cysts are physiological and are effectively resolved with the help of oral contraceptives alone [27] . Hormonal treatment has been found to have the same effect as expectant management.

    Diagnosis, as well as treatment [28] of ovarian cysts, is done in relation to the following factors.

    • Age
    • Menopausal status
    • Pregnancy
    • Benign or malignant cyst.

    Generally speaking, expectant management is advisable in premenopausal and pregnant women that have normal levels of CA125 and non-suspicious cysts. In post-menopausal women, unilocular or simple cysts that are lesser than 5 cm in diameter as well as with a normal CA125 may require following-up [29] .

    Operation is recommended in those women that have cysts larger than 5 cm and/or an elevated level of CA125 [30] . Women who have elevated CA125 and/or a cyst bigger than 5 cm in diameter should be operated upon, irrespective of their ultrasound findings, age or menopausal status.

    Ovarian cysts are quite common. It is estimated that worldwide, around 7% of the women [31] have an ovarian cyst at some or the other point in their entire lives. While most ovarian cysts are benign and usually resolve on their own, some might require medical intervention and even surgery. Proper diagnosis is essential in cases of ovarian cysts, as the nature of the cyst will determine the future course of action, in terms of diagnosis as well as treatment.

    Also read: Natural Remedies For Ovarian Cysts That Work!

    View Article References
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