Ovarian Cysts

Ovarian cysts are sacs containing fluid or semisolid material that develop in or on the surface of an ovary. Ovarian cysts are common, and can develop at any time in a female’s life. The most common types of ovarian cysts are follicular and corpus luteum, which are related to the menstrual cycle. Follicular cysts occur when the cyst-like follicle on the ovary in which the egg develops does not burst and release the egg. They are usually small and harmless, disappearing within two to three menstrual cycles. Corpus luteum cysts occur when the corpus luteum—a small, yellow body that secretes hormones—does not dissolve after the egg is released. They usually disappear in a few weeks but can grow quite large and may twist the ovary. There is also a condition known as polycystic ovary syndrome (PCOS) in which the eggs and follicles are not released from the ovaries and instead form multiple cysts. These small cysts do not require surgical removal. However, a procedure called laparoscopic ovarian drilling may help restore normal ovulation to patients with infrequent menstrual cycles who would otherwise sometimes go many months without menstruating due to failure to ovulate. This is usually reserved for patients who have failed non-surgical therapy with medications for inducing ovulation.

Many ovarian cysts have no symptoms. Non-symptomatic ovarian cysts are often felt by a doctor examining the ovaries during a routine pelvic exam. When the growth is large or there are multiple cysts, the patient may experience fullness or heaviness in the abdomen, pressure on the rectum or bladder, painful intercourse, and pelvic pain that is a constant dull ache or occurs shortly before the beginning or end of menstruation. Because symptomatic ovarian cysts cause symptoms that may be the same as ovarian tumors that may be cancerous, ovarian cysts should always be diagnosed through a pelvic exam and ultrasound.

Medical Treatment Options

In some cases, observation may be all that is necessary, especially for small, functional cysts causing no symptoms. Sometimes, monitoring with ultrasound and further blood testing may be required during the observation period, especially for post-menopausal women. Many follicular and corpus luteum cysts require no treatment and disappear on their own. Often the physician will wait and re-examine the patient in six to eight weeks before taking any action. Although birth control pills are also prescribed to shrink functional cysts, there is limited evidence that they affect the resolution of cysts already formed. They can limit the likelihood of new cysts developing.

Surgical Treatment Options

Surgery is usually indicated for pre-pubertal (rare) or post-menopausal patients who have an ovarian mass. Surgery also is indicated if the growth is larger than 5 centimeters, growing, persistent, solid and irregularly shaped, on both ovaries, or causes pain or other symptoms. The majority of ovarian cysts and masses in women are benign, and can be removed with laparoscopic ovarian surgery, while preserving the ovaries. The Georgia Advanced Surgery Center performs these procedures using minimally invasive techniques that enable same-day outpatient surgery and fast, nearly painless recovery.