Gynaecology · Pain

Ovarian Cysts 101

My experience with ovarian cysts has been traumatic, to say the least.

My first ovarian cyst was picked up back in February prior to my surgery.  Although it was a classed as a “simple” one, it was pretty damn big and I was forced to see if it shrunk before anything was done about it.

The sad part is, I knew I had a cyst before it was confirmed, but it took a long time for my GP practice to believe me.  Because of this, I’ve learnt I am very in-tune with my body and should really trust it, rather than listen to those who tell me otherwise.

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Ovarian cysts come in all sorts of types, the majority being harmless and undetectable with regards signs and symptoms.  As the name suggests, they occur on the ovaries, but you can get cysts pretty much anywhere in the body.  As already mentioned, they are normally undetectable to us ladies, unless they become too big or rupture, which is rather unpleasant.

 

Types of Cysts

Functional 

These are cysts that form as part of the menstrual cycle, and often are very small, cause no symptoms and disappear of their own accord.

Functional cysts can be broken down into three subtypes;

  1. Follicular cysts – they occur when a ovulation doesn’t happen.  Normally, a follicle containing the egg will rupture/release it during ovulation, but if this doesn’t happen and ovulation does not happen, a follicular cyst will form.  Normally, these are small and simple and disappear within a few months
  2. Corpus luteum cysts – these cysts occur after an egg has been released from a follicle.  When conception doesn’t happen, the corpus luteum (the gland where the follicle sits) should break down, but can form into a cyst.  These can rupture at the time of menstruation.
  3. Theca lutein cysts – often occurring bilaterally, these result from exaggerated physiological stimulation and are often associated with certain health conditions or medications

 

Non-Functional 

These cysts are not linked to the menstrual cycle and can be filled with tissue rather the fluid.  There are many types of non-functional cysts;

  1. Ovaries with many cysts – these are found in women with Polycystic Ovary Syndrome (PCOS)
  2. Endometriomas, also known as chocolate cysts – these are cysts that occur when the Endometriosis growths have infiltrated the ovaries, and are filled with old blood, hence the name “chocolate”.  Because they are not related to the menstrual cycle, they only shrink with hormonal treatment or with surgical removal
  3. Haemorrhagic cysts – these may be linked to the development of functional cysts, such as follicular or corpus luteum cysts.  For example, when they form something may cause them to bleed, filling them with blood and turning them into haemorrhagic cysts.  They are very symptomatic and their rupture can be serious and cause a lot of pain and irritation in the peritoneum
  4. Dermoid cysts – a cyst that contains an array of mature tissues, such as hair and skin.  They can be quite large and often need surgical removal.

 

Signs and Symptoms

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Whilst most cysts will produce no symptoms and often they are incidental findings during an ultrasound scan, if they grow large enough or cause complications, they may produce the following signs and symptoms;

  • abdominal pain, which may be one-sided
  • abdominal pain during sex
  • uterine bleeding, such as spotting before or after a period
  • swelling and bloating, which may be more one-sided
  • a feeling of fullness or pressure within the abdomen
  • increased frequency of urination
  • struggle to empty the bladder or bowel, possibly due to pain
  • fatigue and headaches
  • nausea and vomitting
  • weight gain

If the cyst is a result of an underlying condition, such as Endometriosis or PCOS, there may be other signs and symptoms too.

And as you can see, the signs and symptoms of ovarian cysts do overlap with other conditions, which may explain why they are not too easy to diagnose  For example, I was constantly told it was simply me Endometriosis playing up.

Cyst Ruptures

Whilst smaller cysts may rupture without you knowing, larger ones almost certainly produce symptoms.  These are often;

  • sudden, sharp and severe pain
  • possible bleeding

When my first cyst ruptured, I was woken my such severe pain on my left side and a sudden increase in menstrual bleeding.  I couldn’t stand up straight, let alone walk.  The symptoms settled after taking pain relief, but over a period of roughly 4 weeks, I had 3-4 cysts rupture.  I went to my GP practice a few times and quite regularly, but I was told that a cyst was unlikely and that it was just the fact my Endometriosis was playing up – oh and it was simply my sensitive chronic pain.  It wasn’t until my regular GP returned from holiday and saw me that they believed me and were clearly worried.  Thankfully, they were picked up by my gynaecologist at my urgent appointment.

However, I am still getting all sorts of symptoms from them – so much so that my GP practice has been in touch with the emergency gynaecology consultants at my local hospital to have them monitor me.  The largest cysts is expected to take several weeks to resolve (what?!), but if I am still symptomatic they may want to do something about it.

Interestingly, only 3 days ago did I have those sudden, severe and sharp pains again and we suspect yet another cyst went pop.

 

Complications

Ovarian Torsion

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If the cyst is big enough and a specific type, a complication is ovarian torsion.  This is when the cyst starts to twist and distort the ovary, causing a disrupted blood supply.  It is deemed a medical emergency if suspected or picked up on ultrasound.

The signs and symptoms of ovarian torsion are similar to a cyst rupture – sudden onset of severe, sharp and one-sided pain – but it will often be accompanied with nausea and vomiting

 

Diagnosing Cysts

Cysts are most likely to be picked up on ultrasound, which may just be incidental or because a patient is having symptoms.

 

Treatment

No Underlying Conditions

If there is no underlying condition that has caused or is causing recurring cysts, then it is often a “wait and see” approach, as most will disappear on their own.

If they are causing pain, then treatment focuses on managing this with pain medication.

Sometimes, hormonal medication may be used to either shrink cysts (Endometriomas only) or prevent new ones from developing.

If a cyst is particular large and symptomatic, then surgery may be a suitable treatment option to remove them.  Most NHS trusts will have set size requirements before surgery is considered, which is why the “wait and see” approach is used – if a cyst is growing in size it is more likely to be surgically removed than on that isn’t or is shrinking.

Surgery is typically laproscopic, and sometimes the cyst is simply drained rather than removed.  The affected ovary may be removed also (but this will be discussed with you beforehand, and does depend on the location, size and type of cyst).

Underlying Conditions

If there is an underlying cause to the cysts, then this is treated.  For example, if it is Endometriosis, the treatment approaches for this disease are put into place to help manage cysts and prevent new ones from developing.

Other underlying conditions include Polycystic Ovary Syndrome (PCOS), thyroid disorders and hormonal imbalances.  Treatment and management strategies for theses conditions can be used to help with cysts.

 

The Bottom Line…

Ovarian cysts can limit a persons life, particularly if they are large and certain types.  If you suspect you have a cyst, or there is something not quite right with the menstrual pain or abdominal pain you are experiencing, it is always worth getting it checked out, even if it is just reassurance.  You can always seek second opinions too, particularly as the phase of your menstrual cycle can change what a sonographer can see on an ultrasound.  And if you’ve got a confirmed cyst and the symptoms change or change suddenly, you should always seek medical attention.

With my cysts, I’ve learnt to trust my body even more and not be afraid of pushing for an answer, and you shouldn’t be either.

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