When ovarian cysts become a cause for concern

At some point in their lives, most women do develop ovarian cysts — small, fluid-filled sacs that typically form during ovulation, and are located in or on the ovary.

More often than not, these cysts are harmless and painless, and will go away on their own without the need for treatment. However, it becomes a problem when it does not go away or grows bigger.

While most ovarian cysts do not present any symptoms, it might be time to schedule a medical check-up if you experience bloating or swelling of the abdomen, constipation or pain during bowelmovements, irregular menstrual periods, as well as lower abdominal or pelvic pain before or during your menstrual cycle.

Severe cases might be accompanied by nausea and vomiting. In such a scenario, your doctor may order an emergency pelvic ultrasound to rule out ovarian cancer.

TYPES OF OVARIAN CYSTS

Dr Cindy Pang, obstetrician and gynae-oncologist from Mount Elizabeth Novena Hospital, says there are different types of cysts.

Functional cysts occur as part of the menstrual cycle. These can cause problems sometimes in women in the reproductive age group. In the first half of the cycle – the follicle – which contains the developing egg, can grow up to 2cm before ovulation. After ovulation, the corpus luteal cyst or the egg shell will persist till the start of the next menstrual cycle. If all is good, this process goes on monthly. However, some patients may have hormonal problems leading to the follicle increasing in size, or there could be bleeding into the corpus luteal cyst. This can lead to water cysts and blood cysts forming.

Benign pathological cysts due to processes not related to ovulation can also form. For example, dermoid cyst – which contains hair or sebum and other tissue – can develop from the cells on the ovaries. Another example is endometriotic cyst, which are blood filled cysts due to the lining of the uterus growing on the ovary. These can increase in size and grow independent of the menstrual cycle.

And then there are cancerous cysts. The lifetime risk of a woman getting ovarian cancer is one in 74 — or about 1.3 per cent. It can affect women of any age, but those who are older, have had breast cancer previously or have a family history of ovarian cancer, may be at a higher risk of developing the disease. The ultrasound will usually show sinister features like solid areas in the cyst and increase blood supply.

The symptoms of cysts can be vague. A slowly growing cyst can cause symptoms with bloating or swelling of the abdomen, constipation or pain during bowel movements. There could be irregular menstrual periods, as well as lower abdominal or pelvic pain before or during your menstrual cycle.

If the cyst is leaking or twisting at the blood supply, which is medically known as ovarian cyst torsion, the presentation can be sudden with severe lower abdominal pain with nausea and vomiting. This is called an ovarian cyst accident. Surgical intervention is usually needed on an emergency basis as delay can cause the ovary and its surrounding tissue will be damaged, which may affect fertility.