What Is an Ovarian Cyst? What Are the Symptoms?

What Is an Ovarian Cyst? What Are the Symptoms?

The ovaries are organs that, during a woman's reproductive years, mature egg cells to prepare them for fertilization and also produce various hormones. Every woman has two ovaries, one on the right and one on the left. Cystic structures that can form inside the ovaries are called ovarian cysts. Ovarian cysts, which are common especially among women of reproductive age, are usually benign and tend to shrink and disappear after a few months of follow-up. However, cysts that are found to be malignant, that cause bleeding or similar problems, or that show no improvement despite being monitored for a certain period may require surgical treatment.

What Is an Ovarian Cyst?

A cyst is a sac, usually filled with fluid, that develops within ovarian tissue. It is normal for the ovary to develop some small cysts, such as follicular cysts, during its normal functions within the menstrual (menstrual cycle). These may be part of the preparation process for reproduction. Such cysts are usually small and disappear on their own over time. However, in some cases, cysts do not resolve on their own and may even show a tendency to keep growing. Because these cysts may be either malignant or benign, they must always be investigated further. Even benign cysts may lead to complications as they grow, such as rupture or torsion (twisting of the ovary around itself). Therefore, cysts that do not shrink with monitoring must be accurately classified, evaluated for the possibility of cancer, and cysts that pose a risk must be removed through surgery.

What Are the Types of Ovarian Cysts?

Most ovarian cysts are formed regularly as part of the normal menstrual cycle in the female reproductive system and disappear once they have completed their role. Known as functional cysts, these cysts, which are necessary for the continuity of natural processes, are seen only during the reproductive years and are not seen after menopause or in childhood. Cysts other than functional cysts are called pathological cysts, and malignant cysts usually belong to this group.

Functional Cysts

Every month, small cysts called follicles form during the process of egg maturation in the ovaries. Any disruption in this process may cause a cyst to form in the ovary. Functional cysts, which are generally painless and harmless, are expected to disappear on their own within two or three menstrual cycles. Functional cysts have two subtypes: follicular cysts and corpus luteum cysts.

Follicular Cysts

On days falling around the middle of the menstrual cycle, an egg cell is expected to be released from the follicle and begin moving toward the fallopian tube. However, if the follicle does not rupture due to some problem, it cannot release the egg cell inside it and continues to grow as a follicular cyst. Simple cysts seen in the ovaries, most of which are benign, usually form in this way.

Corpus Luteum Cysts

Following the rupture of the follicle and the release of the egg cell, the remaining follicle shrinks and begins to synthesize the hormones estrogen and progesterone; after this, the follicle is called the corpus luteum. From the corpus luteum, the hormone secretions needed for pregnancy to begin are maintained if the egg is fertilized. When the space from which the egg was released becomes blocked in some cases, fluid or blood accumulates inside it, and corpus luteum cysts are formed.

Pathological Cysts

Cysts that form in the ovaries and are not related to menstrual (related to the menstrual cycle) processes are pathological cysts. Pathological cysts are more likely than functional cysts to cause complications such as pain, bleeding, and reproductive problems. Dermoid cysts, chocolate cysts (endometrial cysts), and cystadenomas belong to this group. Dermoid cysts and cystadenomas in particular can grow to very large sizes, cause torsion (twisting) of the ovaries, block blood flow, and lead to serious complications.

Dermoid Cysts

Dermoid cysts, which originate from germ cells responsible for egg production in the ovaries, are also known in medicine as teratomas. These sac-like structures are rarely found to be malignant, and their contents may include different tissues such as fat, skin, hair, and teeth.

Endometrial (Chocolate) Cysts

When cells belonging to the endometrium, the tissue lining the inner surface of the uterus, settle in an area outside the uterus and develop tissue, the disease called endometriosis occurs. When this tissue forms on the surface of the ovary, endometrial cysts, commonly known as chocolate cysts, develop.

Cystadenomas

Cystadenomas, which are made up of cells on the surface of the ovary, are cysts that may contain fluid or mucus-like content. These types of cysts can grow to very large sizes.

What Are the Symptoms of Ovarian Cysts?

The vast majority of ovarian cysts, although varying by type, usually do not cause any symptoms in the early stages and are detected incidentally during ultrasound imaging. However, some cyst types, such as chocolate cysts, or cysts that grow to large sizes may present with various symptoms. Common ovarian cyst symptoms in such cases may include:

Pain in the pelvic area (lower abdomen and groin)

Swelling in the abdomen or a palpable mass

A feeling of fullness or pressure in the abdomen

Pain that intensifies during movements such as bending over or moving into the fetal position

Menstrual periods that are very painful or involve heavy bleeding

Intermenstrual bleeding and spotting occurring outside of menstrual bleeding

Pain during sexual intercourse

Patients experiencing symptoms such as those listed above should consult an obstetrician-gynecologist for an examination. If rupture or torsion of an ovarian cyst occurs, sudden, stabbing pain may develop on the side where the cyst is located. Therefore, in such a case, it is essential to go to the emergency department without delay.

How Are Ovarian Cysts Diagnosed?

An ovarian cyst can easily be diagnosed through a simple ultrasound examination in women who experience ovarian cyst symptoms or who undergo a routine gynecological check-up. By examining the ovaries in detail through abdominal ultrasound or transvaginal ultrasound, it can be determined whether a cyst is present and, if so, the size and type of the cyst. For cysts thought to be possibly malignant, a group of blood parameters called tumor markers can be checked through blood tests. Your physician may also order certain tests to determine the levels of reproductive hormones. Ovarian cysts can be diagnosed by evaluating ultrasound findings and supporting blood test results, and the type of existing cysts can be determined. Then, a follow-up and treatment plan is made by your physician, taking into account the type and size of the cyst.

How Are Ovarian Cysts Treated?

Treatment of ovarian cysts is determined specifically for each person and each disease, taking into account factors such as the type and size of the cyst, the patient's general health status, and pregnancy status. Other factors, such as the patient's age, whether she has previously given birth, and any accompanying diseases, may also be effective in the treatment process. Therefore, a personalized treatment plan should be determined according to the type and size of the cyst after the patient's history has been taken in detail. For small functional-type cysts in women of reproductive age, a follow-up appointment may be scheduled for the next menstrual periods. For cysts that are large or do not resolve on their own, treatment options should be evaluated. In cysts before and after menopause, the likelihood of malignancy is much higher than in the reproductive years. Therefore, advanced investigative methods should be applied during these periods, even for small cysts.

Another common question about ovarian cysts is whether they prevent pregnancy. Most ovarian cysts, especially simple and functional cysts, do not prevent pregnancy. However, large cysts that damage ovarian reserve or completely cover the ovary may pose an obstacle to pregnancy. In addition, some cyst types, such as chocolate cysts, may disrupt the hormonal balance and adversely affect the ovulation cycle, or may hinder the continuation of a pregnancy if one occurs. In such cases, it is beneficial for patients planning a pregnancy to consult a gynecologist.

Medication Treatment

For cysts that occur during the reproductive years, do not resolve on their own, or show a tendency to grow, medication treatment usually constitutes the first of the treatment options. In such cases, it may be recommended to support the spontaneous dissolution of the cyst by using oral contraceptive pills for several months. For cysts that do not have the appearance of functional cysts, such as endometrioma cysts and dermoid cysts, it is advisable to plan treatment according to the findings obtained from supportive diagnostic tests, such as blood tests.

Surgical Treatment

Surgical removal is necessary if the cyst poses a health risk, does not disappear within a certain period, does not respond to medication treatment, or grows in size. Before a surgical decision is made, detailed planning should be carried out taking into account the location and size of the cyst and the patient-specific characteristics. In most cases, the goal is to preserve the ovary as much as possible through ovary-sparing surgical measures and to remove only the cyst. However, in some cases, although rare, the capsule of the cyst may be so intertwined with the ovary that it cannot be removed on its own. In such cases, one ovary or both ovaries may need to be removed. Given these possibilities, whether the patient has previously had children should also be evaluated before surgery, and the decision for surgery should be made after weighing the benefits and risks.

Ovarian cyst surgery is usually performed using a minimally invasive method (laparoscopy). However, if the cyst is very large or a wider field of view and intervention is needed, open surgery may also be used. In minimally invasive surgery, a camera and laparoscopic instruments are inserted into the abdomen through several small incisions of about 0.5–1 cm on the abdomen, and the operation is carried out inside the body while being monitored by the camera. The patient can return to daily activities within approximately five days and to work within approximately three weeks. In cyst surgeries performed with the open surgical method (laparotomy), the recovery process may take up to 6 weeks.

If you are experiencing symptoms of an ovarian cyst or would like to undergo a general gynecological examination, you may consult an obstetrician-gynecologist and have your examinations and tests performed.