Ovarian cysts: Your questions answered by an expert

Ovarian cysts can, in some cases, cause painful symptoms, a swelling in the abdomen and changes to appetite. In this expert guide to ovarian cysts, renowned consultant obstetrician and gynaecologist Ms Pushpakala Maharajan sheds light on the most common risk factors and explains how they develop. The leading specialist also details when surgical removal of ovarian cysts is necessary and which complications can occur.

What are ovarian cysts?

The menstrual cycle is governed by hormonal changes that allow the ovaries to develop small cyst-like structures called follicles at the time of ovulation. They may keep on growing and become a 'functional cyst', which usually disappear within two to three cycles.

Ovarian cysts are usually solid or fluid-filled pockets in the ovary. Some cysts do not go away or they get bigger and can become painful. There is also the possibility of cancer, but this is very rare.

This happens mostly in women who are post-menopausal and who have risk factors (such as BRCA genes). Other factors that can increase a woman’s risk of developing ovarian cysts include:

• hormone changes
• fertility medication
• pregnancy
• endometriosis
• severe pelvic infection which can spread to your ovaries

What are the signs and symptoms of an ovarian cyst?

Most cysts are diagnosed during routine scanning for other reasons. The most commonly noticed symptoms include:

• lower abdominal pain or pelvic pain which is either constant or intermittent
• painful periods
• pain during sex
• painful bowel movements
• increased urinary frequency
• a change in appetite
• a distended (swollen) abdomen
• fertility issues which may be linked to endometriosis

Are some people more prone than others to developing ovarian cysts?

Ovarian cysts are very common. Most women will be unaware that they have a cyst as they often cause no symptoms and mostly disappear spontaneously over a period of two to three months.

It is recognised that up to one in ten women may need surgery for an ovarian cyst at some point in their lives. There are several causes for the development of ovarian cysts, however identified risk factors include being on hormonal treatment, pelvic infection, endometriosis, pregnancy, genetic predisposition, a previous history of ovarian cysts or cancer.

Are ovarian cysts serious?

Cysts can cause symptoms when they grow to be bigger. Also, some cysts could undergo torsion (twisting) which causes acute pain and requires immediate medical attention.

In addition, some cysts grow silently and can undergo malignant transformation meaning the patient can present very late with advanced cancer. Therefore any acute symptoms of feeling bloated or distended should be reported to your GP or clinician for assessment.

When do ovarian cysts need to be removed?

Cysts that measure less than five centimetres in diameter may not require any treatment and will usually disappear on their own after a few months. Those which measure between five and seven centimetres in diameter will likely require a follow-up, usually an ultrasound scan after around four to six months to assess any changes.

A fluid filled cyst that measures more than seven centimetres in diameter may need further tests, such as magnetic resonance imaging (MRI) and/or surgery. If a required, surgery is usually performed using laparoscopic (keyhole) or laparotomy (open) methods.

Most surgeries are done through the laparoscopic approach as it generally offers better outcomes but open operations may be recommended if the cyst is very large or, rarely, if there is a suspicion of cancer. We discuss the benefits and risks of the approaches to surgery as well as the procedure itself and a decision is taken that is best suited to your situation.

The aim of the procedure is usually to remove the cyst rather than the ovary. There are some exceptional circumstances where the ovary may need to be removed, for example if the cyst is very large or there are suspicions of borderline or cancerous changes. This may also be necessary if the cyst has twisted but we thoroughly discuss the advantages and disadvantages of removing ovaries prior to surgery.

If you are concerned about the symptoms of ovarian cysts or would like to discuss treatment options, visit Ms Maharajan’s Top Doctors profile to schedule a consultation.