Ovarian cyst is the fluid filled sac in ovary. This is one among the most common abnormal condition found in ovary. There are many types of ovarian cysts.
It can be functional that produce normal female hormones. Basically two types of functional cysts are produced during the process of egg maturation and rupture.
Follicular cyst when the egg that was supposed to be ruptured doesn’t rupture and continues to grow. It usually produces one of the female hormones (oestrogen), and can grow up to size of 5 cm in diameter.
Second type of functional cyst are corpus luteal cyst, which are produced after rupture of ovarian follicle in natural manner but instead of degeneration it continues to produce hormone (progesterone) and accumulation of fluid / blood inside ovary forms the cyst.
This type of cyst develops when the cells present in the inner lining of uterus grow outside of uterus (endometriosis). Some of the tissue can get attached to/ implanted into the ovarian tissue and start growing. The endometrial lining cell has the property to shed and bleed periodically and same happens with these cells also leading to periodical accumulation of blood inside the cyst. These accumulated blood and debris causes intense inflammation and produce a lot of toxic product that causes severe pain during periods, hampers the egg quality, and decreases the probability of becoming pregnant naturally as well in IVF cycles.
Also called teratomas, these can contain tissue, such as hair, skin or teeth, because they form from embryonic cells. They’re rarely cancerous.
These develop on the surface of an ovary and might be filled with a watery or a mucous material.
Most cysts remain asymptomatic and dissolve on their own. However, a large ovarian cyst can cause:
• Pelvic pain — a dull or sharp ache in the lower abdomen on the side of the cyst
• Fullness or heaviness in lower abdomen
• Incidental finding during ultrasonography.
• Hormonal imbalance: The imbalance in cyclical variation of female hormones in the body may lead to formation of cyst.
• Drug induced: Some medicines that are used for ovulation induction may lead to cyst formation.
• Endometriosis: This condition causes uterine endometrial cells to grow outside uterus. Some of the tissue can attach to surface of ovary and form a growth.
• Cystic ovarian masses that develop after menopause might be cancerous (malignant).
• Ovarian torsion: Medium size cyst having both solid areas and cystic areas are more likely to undergo twisting (ovarian torsion). Symptoms may include a sudden onset of severe pelvic pain in lower abdomen, nausea and vomiting. Ovarian torsion can decrease or stop blood flow to the ovaries, thus leading to total loss of viability of that ovary.
• Rupture: A cyst may sometimes rupture. The larger the cyst, the greater the risk of rupture.
• Haemorhage: Sometimes bleeding occurs inside cyst.
• Malignant transformation, very rarely ovarian cyst can change to cancer. Cysts in post-menopausal lady are more likely to undergo cancerous transformation.
Endometriomas: Endometriomas are cysts caused by endometriosis, may be associated with fertility problems.
Ovarian cysts resulting from polycystic ovary syndrome. Polycystic ovary syndrome (PCOS) is marked by many small cysts in ovaries, irregular periods and high levels of certain male hormones (androgen), increased insulin resistance, & obesity. PCOS is associated with irregular ovulation, which may contribute to problems with fertility.
Ultrasound is the best way to diagnose ovarian cysts. But at times to figure out the nature of cyst hormonal tests and /or tumour markers are advised. In very rare cases if there is confusion, CT scan or MRI can be helpful.
Functional cysts usually resolve spontaneously within 3 months. Some hormonal medications may be prescribed to treat these type of cysts. Cysts of size more than 4 cm may need surgery (laparoscopy).
At times endometriotic cysts need long term oral / injectable medications and/or surgery.
Dermoid cysts can be treated by surgery only.
Malignant ovarian cysts need extensive surgery and oncology consultation.
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