Simplifying the understanding of ovarian cysts
Written in association with:Symptoms of ovarian cysts may encourage a woman to see a gynaecologist for them to be investigated. Often, they will go on to receiving a clinical diagnosis.
From a general perspective, ovarian cysts are very common, especially in women of the reproductive age group. However, misinterpretation of symptoms and mismanagement of this is condition is rife.
We spoke with the expert gynaecologist, Mr Mahantesh Karoshi, to discuss ovarian cysts to clarify once and for all what the different types are, and when they’re a cause for concern.
What are the different types of ovarian cysts? Can they always be removed?
Most ovarian cysts are simple; they usually don’t need any treatment. Patience and reassurance may be all that is needed. The types of cysts that go away on their own are called ‘functional cysts'. The name of these cysts should give you a clue, they are there for a while but will disappear over time.
If someone is troubled with such cysts, we do consider giving birth control pills. This is because, when someone is on birth control pills, the ovarian activity is suppressed as long as the patient is on them. The idea is that, if a woman doesn’t ovulate, she won’t develop the functional cysts.
Functional cysts can include:
- Follicular cysts – these develop when the ovaries release an egg from a tiny sac called a follicle. A cyst may develop if the follicle grows an egg but fails to release it, or if the egg is released but continues to grow.
- Corpus lutem cyst – This occurs when fluid accumulates inside a follicle (due to sex hormone) after a follicle release an egg. This specific follicle is called the corpus lutem, hence the name of this specific type of cyst.
These usually resolve spontaneously without surgical intervention. However, functional cysts (especially corpus lutem cysts) can sometimes be haemorrhagic.
What are haemorrhagic cysts?
Haemorrhagic cysts (or a ruptured ovarian cyst) may cause internal bleeding, cause torsion and may affect the ovarian blood supply. These types of cysts usually resolve on their own within a few months if adequate time is given. However, if they’re larger than 10 centimetres and they’re uncomfortable or painful, surgery may be recommended.
What are non-functional cysts and what are the different types?
These are usually less common; they grow without the influence of hormones. The exact causes of these are unknown.
- Dermoid cysts are one of the more common types of non-functional cysts. They can often surface during pregnancy and may be detected during this time. No one knows why dermoid cysts happen to some women, the content is mixed, i.e. they may feature clear fluid, concentrated sweat, teeth, bone, thyroid tissue and other substances. Dermoid ovarian cysts usually don’t go away on their own, but not all dermoid cysts need intervention. Surgical intervention may be required depending on the size.
- Polycystic ovarian disease is a misnomer [1]. It should be called a poly-follicular condition as the tiny fluid like lesions are in fact arrested during the mid-follicular stage of human egg development.
- Cystadenomas are benign growths that sometimes develop on the outer area of the ovaries. They may be filled either with a transparent watery fluid or are sometimes filled with mucus.
- Endometriomas are tissues that develop outside the uterus and attach to the ovaries. They usually occur due to a condition called endometriosis. Endometriomas mostly occur in women below the age of 50 and they're often associated with painful periods. The surgical intervention of endometriomas may be required depending on the size and severity of pain.
Malignant/borderline cancerous cysts
Then we have borderline and cancerous ovarian cysts. We take many parameters to consider a patient for intervention. Generally, when their size is larger than 5 centimetres or if they are persistent and cause pain, causing pain, then surgery may be considered. Surgery is considered if the cyst has any suspicious features.
In terms of treatment for these types of cysts, we would usually discuss patient’s condition in a multidisciplinary meeting, to take a consensus and then have a chat with the patient about the way forward.
What type of surgery is performed to remove ovarian cysts?
Keyhole surgery is usually the preferred route. However, having said this, size of the cyst matters as well as its content and its adherence to adjacent structures and many more parameters are taken before the invasive intervention.
For more information regarding treatment, we recommend getting in touch with a women’s health expert such as London-based consultant gynaecologist, Mr Mahantesh Karoshi. Click here to learn more about his expertise and his appointment availability.
References
[1] Karoshi, M. and Okolo, S.O., 2004. Commentary: Polycystic ovarian disease (PCOD): a misnomer, looking for a new name. International journal of fertility and women's medicine, 49(4), pp.191-192.
