ovarian cyst?ovarian cysts are found in nearly all premenopausal women
By Live Dr - Mon Mar 30, 3:22 pm
An ovarian cyst is any collection of fluid, surrounded by a very thin wall, within 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.
Most ovarian cysts are functional in nature, and harmless (benign). In the US, ovarian cysts are found in nearly all premenopausal women, and in up to 14.8% of postmenopausal women.
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. Surgery may be required to remove cysts larger than 5 centimeters in diameter.Chances are it’s benign and proper medical care will safely resolve the condition, says ‘Today’ health contributor Dr. Judith Reichman
Classification and external resources
Ovarian cysts are found in nearly all pre-menopausal women, and up to 15 percent of those who are postmenopausal. What makes them occur, what is the chance that a cyst is or will become cancerous and how aggressively should it be treated? “Today” health contributor and gynecologist Dr. Judith Reichman was invited to appear on “Today” to share some insight on understanding the cystic nature of a woman’s pelvic area. She shares more on the subject here.
First, what is the difference between a cyst and a fibroid?
A cyst is a fluid-filled sac. Cysts found in the pelvis usually originate in the ovary, but may also develop within the fallopian tube. A fibroid is a solid smooth muscle growth that develops in the walls of the uterus.
Fibroids tend to grow in the later reproductive years and indeed are found in at least one-third of women over the age of 35. They are more common in women whose mothers or sisters have a history of fibroids, and in African American women. They can either grow into the wall of the uterus (intramural), project from the outer surface of the uterus (subserosal), or grow into the endometrial cavity (submusosal). Most women with fibroids have no symptoms. These benign tumors are often found during routine pelvic exam or ultrasound. They constitute a problem only if they become large (causing pressure on the bladder and rectum, and-or protruding abdominally) or cause excessive bleeding or pelvic pain. It may be difficult to differentiate a fibroid from an ovarian cyst or mass by pelvic exam alone, but pelvic ultrasound will definitively differentiate between the two.
Although we are dealing chiefly with ovarian cysts, I want to address a common misconception. Non-symptom causing fibroids do not become cancerous and do not have to be removed “just in case.” Procedures for treatment of fibroids should only be contemplated if these benign uterine tumors cause significant problems.
Now, let’s consider ovarian cysts.
Most cysts that develop in women in the reproductive age are a function of their “working” ovaries. We start puberty with about 400,000 egg-producing follicles in our ovaries. Each month hundreds of these follicles attempt to develop, fail to do so and (sadly) die. Only one (rarely several) succeeds in it’s
developmental effort and continues the process that allows it to produce a mature egg. It enlarges, produces estrogen and secretes fluid that surrounds the egg, then breaks open and releases the egg into the fallopian tube during ovulation. Once its egg is extruded, the follicle continues to function for the next two weeks as a corpus luteum secreting both estrogen and progesterone; hormones that prepare the uterine lining to receive and nourish a possible pregnancy. In the absence of a pregnancy, the corpus luteum collapses and disappears. Hence, each month that a woman ovulates, a small ovarian cyst is formed; this usually measures 1.5 to 2 centimeters. Subsequent to the release of the egg, this cyst or corpus luteum may collect a small amount of blood prior to its degeneration.
Now on to larger functional cysts… Prior to ovulation, the follicle may accumulate too much fluid and form a cyst that is greater than three centimeters. This can cause mid-cycle pain. After ovulation, a corpus luteum can bleed into itself and also enlarge, forming a hemorrhagic cyst. A woman may present to her physician with pain, or she may go in for a routine exam at which time an enlarged ovary or mass in the pelvis is detected. At this point, an ultrasound is usually done. Then comes the announcement: “you have an ovarian cyst.” And that’s where the concern (and unfortunately for many women, the panic) begins. (By the way, women who smoke have a two-fold increased risk of developing functional ovarian cysts compared to non-smoking women.)
So here is my reassuring gynecologic statement: Functional cysts rarely become larger than six centimeters and should resolve and dissolve after two to three cycles.
Aren’t some ovarian cysts tumors?
Yes. But not all ovarian tumors are cancer. A tumor means a growth. There are several types of benign growths that can develop on the ovaries. Once more, the age at which the tumor occurs usually impacts the type of tumor or cyst that is most commonly found. Dermoid cysts (also called benign cystic teratoma) are the most common form of benign ovarian tumors in young women. These develop from germ cells which are primitive cells that are capable of producing eggs and all human tissues. A dermoid cyst is formed if the germ cells multiply bizarrely without fertilization, forming an encapsulated tumor that contains hair, sebaceous or oil materials, cartilage, bone, neural tissue and teeth. Dermoid cysts are most commonly diagnosed in women between the ages of 20 and 40. They range in size from one to 45 centimeters. Up to 15 percent of dermoid cysts occur on both ovaries. The good news is that 98 percent of these tumors are benign. Only on rare occasions do the overactive germ cells form malignant tumors (malignant teratomas).
There are other types of cysts that arise from benign tumors and are more likely to occur in older women. They’re called cystadenomas. These arise from cells on the outer surface of the ovary that secrete a watery or jelly-like fluid. Cystadenomas can become quite large and cause pain. The most worrisome (and largest) are mucinous cystadenomas. They are filled with a sticky, thick, gelatinous material which can seed onto other pelvic and abdominal surfaces causing multiple growths and collections of mucinous fluid. These tend to recur and may ultimately be fatal.
What about the condition called polycystic ovarian syndrome (PCOS)? Doesn’t this cause the formation of many cysts?
PCOS is a complicated endocrine condition in which the follicles develop, but don’t normally erupt and extrude an egg. As a result, multiple small cysts remain under the ovary’s surface causing the ovary to become mildly enlarged. These polycystic ovaries appear “hole-ridden” on ultrasound. But contrary to the name, multiple large cysts, measuring more than two and a half centimeters rarely occur. The small cysts of PCOS do not cause pain.
Can other pelvic organs form cysts?
Fluid can accumulate in the fallopian tubes if they become blocked by infection. This condition is termed hyrdosalpinx. Blood collections and swelling of the tube can occur as a result of an ectopic pregnancy. Occasionally growths from the surface of the tube can fill with fluid and cause small cysts (paratubal cysts). All of these diagnoses have to be considered when pain occurs and a cyst is found.
Some or all of the following symptoms may be present, though it is possible not to experience any symptoms:
- Dull aching, or severe, sudden, and sharp pain or discomfort in the lower abdomen (one or both sides), pelvis, vagina, lower back, or thighs; pain may be constant or intermittent — this is the most common symptom
- Fullness, heaviness, pressure, swelling, or bloating in the abdomen
- Breast tenderness
- Pain during or shortly after beginning or end of menstrual period.
- Irregular periods, or abnormal uterine bleeding or spotting
- Change in frequency or ease of urination (such as inability to fully empty the bladder), or difficulty with bowel movements due to pressure on adjacent pelvic anatomy
- Weight gain
- Nausea or vomiting
- Increased level of hair growth
- Increased facial hair or body hair
- Headaches in some cases
- Strange ribs pains, which feel muscular
- Occasionally, strange nodules that feel like bruises under the layer of skin
- Feeling of lumps on the lower abdomen