Ovarian cyst

What is an ovarian cyst?

The ovaries are part of the female reproductive system. The two main functions of the ovaries are to produce an egg as part of the menstrual cycle (approximately every 28 days) and release the reproductive sex hormones oestrogen and progesterone.

Sometimes fluid-filled sacs called cysts can develop naturally on the ovaries. They can either affect one or both ovaries at the same time, and there are two main types:

• Functional ovarian cysts – these are the most common type and develop as part of the menstrual cycle. They're non-cancerous (benign) and will usually disappear in a few months without the need for treatment

• Pathological ovarian cysts – these are much less common. They develop due to abnormal cell growth inside the ovaries. They can grow to be large and either burst or block the ovaries' blood supply. Although they are usually benign (non-cancerous), a small number can become cancerous (malignant) and need surgery. They can also develop before or after

What are the symptoms of ovarian cysts?

Usually, an ovarian cyst will only cause symptoms if it bursts or blocks the blood supply to the ovaries. Common symptoms of a ruptured ovarian cyst or blockage are:

• Pain in the pelvis, which can vary from being a dull, heavy sensation to pain that is severe, sudden and sharp

• Pain during sex

• Difficulty pooing (constipation)

• Needing to urinate frequently

• Periods that are heavy, lighter than usual or irregular

• A swollen and bloated tummy (abdomen)

• Feeling full after small meals

• Fertility problems

Speak to a GP as soon as possible if you've got any of these ovarian cyst symptoms.

What causes ovarian cysts?

Ovarian cysts often form during the ovulation stage of the menstrual cycle.

Eggs grow inside a protective, fluid-filled structure called a follicle. When it's time for the egg to be released, the follicle bursts open. But if for some reason, the follicle doesn't burst or its fluid doesn't drain properly, the follicle can turn into a cyst.

Ovarian cysts can also be caused by some medical conditions:

• Endometriosis – This is where the tissue that lines the womb (endometrium) also grows outside the womb in organs such as the ovaries, bowel, bladder, rectum, or vagina. This condition can also cause blood-filled cysts to develop in this tissue

• Polycystic ovary syndrome (PCOS) – This is where many small, benign cysts grow on your ovaries. They don't develop to the ovulation stage and are caused by changing hormone levels

How are ovarian cysts treated?

In most cases, ovarian cysts disappear on their own within a few months and treatment isn't needed. The treatment you'll receive for your ovarian cyst depends on its appearance, size, whether you have been through menopause and any other symptoms you may have. Treatment options for ovarian cysts may include:

Watchful waiting

A 'watchful waiting' policy is when the doctor doesn't treat you immediately. Instead, they wait for a few weeks or months. The doctor may then give you an ultrasound scan to check if the cyst has gone.

If you've been through menopause, a GP may advise blood tests and ultrasound scans every four months for a year due to your slightly higher risk of ovarian cancer.

If your cyst disappears, further treatment is not usually needed. But if the cyst is still there, you may need surgery.

Surgery

If your ovarian cysts are causing symptoms, are large or are potentially cancerous, you may require surgery:

• Laparoscopy – this is a type of keyhole surgery under general anaesthetic. Your surgeon will make tiny cuts in your abdomen, and gas will be blown into your pelvis to allow access to your ovaries. A small, tube-shaped microscope with a light on the end (called a laparoscope) will then be passed into your abdomen so that the cysts can be removed and the cuts closed with dissolvable stitches

• Laparotomy – a doctor will recommend this type of surgery if your cyst is large or cancerous. A single cut will be made in your abdomen, and the whole cyst will be removed and sent to a laboratory for testing. The incision (cut) will be closed with staples or stitches

What to expect after ovarian cyst surgery

Following ovarian cyst surgery, you may experience pain in your abdomen if the cyst has been removed. You may be able to go home straight away or have to spend a few days in the hospital, depending on the type of surgery you've had. It may take up to 12 weeks before you can resume your normal activities. The recovery time is different for everyone.

If your cyst has been removed and sent off for testing, a GP will discuss further treatment options with you, depending on the results.

If you notice any of the following symptoms after your surgery, you should contact a GP as soon as possible:

• Heavy bleeding

• Severe abdominal pain or swelling

• Fever (a high temperature)

• Smelly or dark-coloured vaginal discharge

Can I get pregnant with an ovarian cyst?

Sometimes, ovarian cysts can make it harder to get pregnant, although this isn't a common problem. If you're planning a family, it's crucial to speak to the surgeon about the potential effects that it may have on your fertility.

During ovarian cyst surgery, the surgeon will try to preserve your fertility wherever possible. This could be through only removing one ovary or just removing the cyst and leaving the ovaries intact. However, if your cyst is cancerous, it may be necessary for both of your ovaries to be removed, triggering early menopause, which means you will no longer produce any eggs or get pregnant. The doctor may recommend fertility services and counselling if this happens.

When should I speak to a doctor?

If you think you're having ovarian cyst pain or symptoms, you should go and see a GP as soon as possible. Some tests they might recommend include:

• Ultrasound scan – a probe is placed inside your vagina or moved over your abdomen

• A blood test – to find out if you have an infection in your pelvis, and to rule out ovarian cancer

• Physical examination of your abdomen

How can Livi help?

A Livi doctor will ask you questions about your symptoms. They’ll make an individual assessment, recommend a treatment or refer you to a specialist if needed.