A women's reproductive system has two ovaries, one on either side of the uterus. The ovaries, each about the size of an almond, produce eggs (called ova) as well as the female sex hormones estrogen and progesterone. Eggs are fertilized by sperm from the male to produce offspring.
An ovarian cyst is a sac filled with fluid that forms on or inside an ovary. Any ovarian follicle that is larger than about two centimeters is termed an ovarian cyst. An ovarian cyst can be as small as a pea or larger than a cantaloupe.
Ovarian cysts affect women of all ages. They occur most often, however, during a woman's childbearing years. Some ovarian cysts cause problems, such as bleeding and pain. Functional ovarian cysts usually don't need treatment and typically disappear on their own within 8-12 weeks. Surgery may be required to remove cysts larger than five centimeters in diameter.
TYPES OF THE DISEASE
Functional cyst: A functional cyst, or simple cyst, is part of the normal process of menstruation. These cysts are not caused by disease, and they can be treated. The three different types of functional ovarian cysts are
Graafian follicle cysts, corpus luteum cysts, and hemorrhagic cysts.
A Graafian follicle cyst can form when ovulation doesn't occur and a follicle doesn't rupture or release its egg but instead grows until it becomes a cyst, or when a mature follicle involutes (collapses on itself). It usually forms during ovulation and can grow to about six centimeters (2.3 inches) in diameter. It is thin-walled, lined by one or more layers of granulosa cells, and filled with clear fluid. Its rupture can create sharp, severe pain on the side of the ovary on which the cyst appears. This sharp pain (sometimes called mittelschmerz) occurs in the middle of the menstrual cycle, during ovulation. Usually, however, these cysts do not produce noticeable symptoms and disappear by themselves within a few months.
A corpus luteum cyst
occurs after an egg has been released from a follicle. The follicle then becomes a secretory gland that is known as the corpus luteum. The ruptured follicle begins producing large quantities of estrogen and progesterone in preparation for conception. If a pregnancy doesn't occur, the corpus luteum usually breaks down and disappears. It may, however, fill with fluid or blood, causing the corpus luteum to expand into a cyst and stay on the ovary. Usually, this cyst is on only one side and does not produce any symptoms. It can, however, grow to almost 10 centimeters (four inches) in diameter and has the potential to bleed into itself or twist the ovary, causing pelvic or abdominal pain. If it fills with blood, the cyst may rupture, causing internal bleeding and sudden, sharp pain.
A hemorrhagic cyst occurs when a very small blood vessel in the wall of the cyst breaks and blood enters the cyst. Abdominal pain on one side of the body, often the right side, may be present. The bleeding may occur quickly and rapidly stretch the covering of the ovary, causing pain. As the blood collects within the ovary, clots form, which can be seen on a sonogram. Occasionally, hemorrhagic cysts can rupture, with blood entering the abdominal cavity. No blood is seen out of the vagina. If a cyst ruptures, it is usually very painful. Hemorrhagic cysts that rupture are less common. Most hemorrhagic cysts are self-limiting (resolving on their own). However, some need surgical intervention.
Dermoid cyst: A dermoid cyst (also called a cystic teratoma) contains developmentally mature skin complete with hair follicles and sweat glands, sometimes clumps of long hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue.
Endometrioid cyst: An endometrioid cyst is caused by endometriosis and formed when a tiny patch of endometrial tissue (the mucous membrane that makes up the inner layer of the uterine wall) bleeds, sloughs off, becomes transplanted, and grows and enlarges inside the ovaries. As the blood builds up over months and years, it turns brown. When it ruptures, the material spills over into the pelvis and onto the surface of the uterus, bladder, bowel, and the corresponding spaces between them. Treatment for endometriosis can be medical or surgical.
Pathological cysts: Pathological cysts include those found in polycystic ovary syndrome (PCOS) or those associated with tumors. A polycystic-appearing ovary is diagnosed based on its enlarged size (usually twice than normal in size), with small cysts present around the outside of the ovary. It can be found in women with or without endocrine disorders. A polycystic-appearing ovary is different from polycystic ovarian syndrome, which includes other symptoms in addition to the presence of ovarian cysts and involves metabolic and cardiovascular risks linked to insulin resistance.
Ovarian carcinoma: Ovarian cancer can be benign (noncancerous) or malignant (cancerous). There are several types of ovarian cancer. Ovarian cancer that begins on the surface of the ovary (epithelial carcinoma) is the most common type. Ovarian cancer that begins in the egg-producing cells (germ cell tumors) and cancer that begins in the supportive tissue surrounding the ovaries (stromal tumors) are rare.
Ovarian cysts may occur during the process in which an egg is released from the ovary (ovulation). During the days before ovulation, a follicle grows. Usually for most months during ovulation, an egg is released from this follicle. However, if the follicle fails to break open and release an egg, the fluid stays in the follicle and forms a follicular cyst.
An endometrioid cyst is caused by endometriosis. Pathological cysts include those found in polycystic ovary syndrome (PCOS) or those associated with tumors.
Ovarian cysts are somewhat common, and they are more common during a woman's childbearing years (from puberty to menopause). Ovarian cysts are rare after menopause.
SIGNS AND SYMPTOMS
Often there are no symptoms of an ovarian cyst. However, it may cause pain if it bleeds, ruptures (breaks open), is twisted or causes twisting (torsion) of the Fallopian tube, or pushes on nearby structures in the body.
Other symptoms of ovarian cysts may include abnormal uterine bleeding (a change from the normal menstrual pattern), which could occur in an absent menstruation, an irregular menstruation, a longer-than-usual menstrual cycle, or a shorter-than-usual menstrual cycle; bloating or swelling in the abdomen; pain during bowel movements; pain in the pelvis shortly after beginning or ending a menstrual period; pain with intercourse or pelvic pain during movement; or pelvic pain characterized by a constant, dull aching in the pelvic area.
Pelvic examination: Examination of the vagina, uterus, rectum, and pelvis, including the ovaries, for masses or growths is performed during a pelvic examination.
Ultrasound: Pelvic ultrasound provides a safe, noninvasive way to evaluate the size, shape, and configuration of the ovaries. Ultrasound uses high-frequency sound waves to produce images of the inside of the body. However, an ultrasound cannot reliably distinguish between a cancerous growth and one that is not cancerous. Ultrasound can also find ascites (fluid in the abdominal cavity), a possible sign of ovarian cancer.
Blood tests: Blood tests may include those that measure hormone levels (such as LH, FSH, estradiol, and testosterone) or serum HCG (e.g., a pregnancy test).
Other tests: Other diagnostic tests may include computerized tomography (CT), positron emission tomography (PET), or magnetic resonance imaging (MRI).
Possible complication that can occur with ovarian cysts include bleeding, rupture of the cyst, and twisting or torsion of the Fallopian tube.
General: Functional ovarian cysts usually don't need treatment and typically disappear on their own within 8-12 weeks. Birth control pills (oral contraceptives) may help make the menstrual cycle more regular and may decrease the development of functional ovarian cysts.
Analgesics: Pain caused by ovarian cysts may be treated with pain relievers, including acetaminophen (Tylenol©), nonsteroidal anti-Inflammatory drugs (NSAIDs) such as ibuprofen (Motrin©, Advil©), or narcotic pain medicine (by prescription). NSAIDs usually work best when taken at the first signs of the pain.
Birth control pills (oral contraceptives):
Oral contraceptives (OCs) prevent follicles from forming, because they prevent ovulation. Anything that makes ovulation less frequent reduces the chance of developing an ovarian cyst.
OCs do not protect against human immunodeficiency virus (HIV) infection or other sexually transmitted diseases. Conversely, patients with known HIV infection or acquired immunodeficiency syndrome (AIDS) should be aware that the use of this oral hormonal contraceptive will not prevent the transmission of HIV or other sexually transmitted diseases to their partner(s).
Common adverse effects include abdominal pain, breast tenderness, fluid retention, weight gain, and headache. Oral contraceptives are contraindicated during pregnancy and are categorized as FDA pregnancy risk category X. Females receiving combined hormonal contraceptives should be advised not to smoke tobacco. The concurrent use of potassium-containing products (e.g., potassium iodide, potassium salts, dietary salt substitutes) and other potassium-containing medications (e.g., antibiotics) may increase the risk of hyperkalemia, especially in the presence of kidney impairment. Additionally, chronic heparin therapy may predispose a patient to develop hyperkalemia. Other drug-drug interactions include anticonvulsants and antibiotics.
Compresses may be used to stimulate circulation and healing in the ovaries. A hot water bottle covered with a towel soaked in castor and essential oils can be applied to the lower abdomen near the ovaries, which may relax tense muscles and relieve cramping and lessen discomfort. Lavender, rosemary, and chamomile are essential oils that are sometimes used with compresses. A hot compress can also be made by heating a cloth soaked in castor and essential oils in a warm oven, which is then applied to the lower abdomen. Bags of ice covered with towels can be used alternately as cold treatments to increase local circulation. Also, limiting strenuous activity may reduce the risk of cyst rupture or torsion.
Simple ovarian cysts that are larger than 5-10 centimeters and complex ovarian cysts that do not resolve on their own should be removed with surgery (laparoscopy or exploratory laparotomy).
Laparoscopic surgery, also called minimally invasive surgery (MIS), Band-Aid surgery, keyhole surgery, or pinhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5 centimeters), compared to larger incisions needed in traditional surgical procedures.
A laparotomy is a surgical procedure involving an incision through the abdominal wall to gain access into the abdominal cavity. It is also known as a celiotomy. In a diagnostic laparotomy (most often referred to as an exploratory laparotomy and abbreviated ex-lap), the nature of the disease is unknown, and laparotomy is deemed the best way to identify the cause.
Currently, there is a lack of evidence available on the safety or effectiveness of integrative therapies for the prevention or treatment of ovarian cysts.
In patients not trying to get pregnant and who often get functional cysts, hormone medications (such as birth control pills), which prevent follicles from forming, are sometimes recommended by a healthcare provider. Anything that makes ovulation less frequent reduces the chance of developing an ovarian cyst. Birth control pills, pregnancy, and breastfeeding in the first six months following birth prevent ovulation. Ovulation ceases when menopause is complete.
It has been suggested that some foods may contribute to the development of ovarian cysts, such as foods high in estrogen or carbohydrates. Eliminating caffeine and alcohol, reducing sugars, and increasing foods rich in vitamin A and carotenoids (such as carrots and salad greens) and B vitamins (such as from whole grains) may help reduce pain associated with ovarian cysts.
Essential fatty acids found in fatty fish, such as salmon and trout, may help promote hormonal balance. Omega-3 essential fatty acids, such as flaxseed oil or evening primrose oil, may be of benefit. Including a dietary source of iodine, such as seaweed, for thyroid support may be beneficial in some patients. A high-quality multivitamin and mineral supplement is also recommended for overall health.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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