Cyst on the ovary: description
An ovarian cyst is a type of blister that may be filled with tissue or fluid. It is usually only a few millimeters to centimeters in size and causes no discomfort. Therefore, physicians often discover them only by chance during a preventive ultrasound examination.
Most often, such cysts develop during puberty or menopause. These phases of life are characterized by strong hormonal fluctuations, which favor the growth of a cyst.
Non-congenital ovarian cysts
Most ovarian cysts develop only at sexually mature age. They are also called “functional” cysts.
Since they form mainly under the influence of hormones, they usually occur as part of the female menstrual cycle. Women are particularly often affected during puberty and menopause, as the hormonal balance undergoes changes during this time.
In some cases, the cysts also form as a side effect of hormone therapy or in the case of hormonal imbalances caused by disease .
Congenital cysts
The gonadal cells of the ovaries produce sex hormones such as estrogens and progesterone. When a glandular duct is obstructed or misplaced and the glandular fluid backs up, a cyst develops. This process occurs during embryonic development. Such a cyst is then considered “congenital.”
Congenital cysts include dermoid cysts and parovarial cysts (accessory ovary cysts). They are much rarer than the functional cysts.
Ovarian cyst: symptoms
After a certain size, as well as in the case of complications, ovarian cysts cause symptoms. These can be, for example, a disturbed menstrual period and pain.
You can read more about the signs of the disease in the article Ovarian cyst – symptoms.
Ovarian cyst: causes and risk factors
While congenital ovarian cysts develop due to blocked gonadal outlets, acquired cysts develop under hormonal influence. Below you can read how the different types of cysts develop.
Corpus luteum cyst
If the egg is fertilized, the corpus luteum initially continues to exist during pregnancy. If fertilization of the egg fails to occur, the corpus luteum is broken down – its hormone production stops, and hormone concentrations in the blood drop. This triggers menstrual bleeding.
Sometimes, however, it happens that the corpus luteum has not been broken down properly or even continues to grow. Then one or more cysts form.
Such corpus luteum cysts can also be caused by bleeding into the corpus luteum.
Corpus luteum cysts can grow up to eight centimeters in size. In most cases, they regress on their own after some time.
Ovarian follicular cyst
During the first half of the menstrual cycle, an egg matures in a follicle of the ovary. The follicle contains fluid to protect the egg. When ovulation occurs, the follicle ruptures and the egg enters the fallopian tube where it can be fertilized.
Especially women of childbearing age develop follicular cysts.
Chocolate cysts
In the disease endometriosis, uterine mucosa (endometrium) settles outside the uterus. The endometriosis tissue reacts to the cyclical hormonal fluctuations just like the normal uterine lining:
It builds up, bleeds down, and builds up again. However, if the blood cannot drain properly at the ovary, blood-filled cysts sometimes form. These cysts are called “chocolate cysts” because their thickened, dark-blooded contents turn them brownish red.
Polycystic ovaries
In polycystic ovaries (PCO, usually asymptomatic) and polycystic ovary syndrome (PCOS, with symptoms), many small cysts are found in the ovaries. However, “cysts” in this case does not mean fluid-filled cavities, but egg follicles. Affected women have an excessive number of them in their ovaries.
The large number of follicles often results from a hormonal imbalance. Among other things, experts discuss an excess of male sex hormones and a so-called insulin resistance as the cause.
Ultimately, in affected women, normal maturation of the follicles is prevented and the formation of numerous cysts in the ovaries is promoted.
In addition to infertility and miscarriages, polycystic ovary syndrome (PCOS) can also result in cardiovascular disease, diabetes mellitus and mental illness. In addition, it is increasingly associated with Hashimoto’s thyroiditis – an autoimmune disease of the thyroid gland.
You can learn more about this disease in our article PCO syndrome.
Dermoid cysts
The so-called dermoid cysts are among the congenital cysts. They form from embryonic gonadal tissue and may contain hair, sebum, teeth, cartilage and/or bone tissue.
Dermoid cysts grow very slowly and can reach a size of up to 25 centimeters. Very rarely – in about one to two percent of cases – they degenerate and develop into a malignant tumor.
Parovarial cysts
The secondary ovary cysts (parovarial cysts) develop next to the actual ovaries. They represent residual tissue from the embryonic development period.
Parovarial cysts are variable in size and may grow on a pedicle.
Ovarian cysts usually develop while the ovaries are still active and the woman has her period. After the last period (called menopause), the risk of such cysts decreases because the body hardly produces the hormones estrogen and progesterone anymore.
However, ovarian cysts are not completely excluded after menopause. In most cases, these are dermoid cysts or so-called cystadenomas. These are benign tumors that grow to form cysts and can fill the entire lower abdomen.
Women after menopause also have a higher risk of cancerous ovarian cysts – although these are rare overall. As a precaution, however, ovarian cysts detected on ultrasound in menopausal or post-menopausal women should always be investigated further.
Ovarian cyst: examination and diagnosis
If you suspect an ovarian cyst, the doctor will first ask you about your symptoms and any previous medical conditions. Possible questions include:
- How old are you? At what age did you have your first menstrual period?
- When was your last menstrual period?
- Do you have a regular cycle?
- Did you take or are you taking hormone supplements?
- How many pregnancies and births have you had?
- Are you known to suffer from endometriosis?
- Do you have a family history of ovarian disease?
- Do you have a desire to have children?
The doctor will then examine you physically. This often allows you to feel any (painful) enlargement of the ovaries.
Ultrasound examination
Ultrasound examination (sonography) allows the ovaries and surrounding structures to be visualized on a monitor. The doctor performs the examination through the abdominal wall and/or the vagina (vaginal sonography).
The ultrasound examination can also be used to determine the type of cyst in many cases.
Abdominal ultrasound
In many forms of cysts, it is sufficient to check the progress by means of ultrasound examination. However, if sonography reveals a suspicion of a dermoid cyst or an endometriosis cyst, this is usually followed by laparoscopy under general anesthesia:
Especially in women over the age of 40, a cyst on the ovary should always be clarified in detail – it may be a malignant tissue change.
Ovarian cyst: treatment
The treatment of an ovarian cyst depends, among other things, on its type and size. Any symptoms also influence the treatment plan.
Provided that an ovarian cyst does not cause any discomfort and is not too large, it is possible to wait and observe its growth for the time being. Regular ultrasound and palpation examinations are useful for this purpose.
In over 90 percent of cases, an ovarian cyst recedes on its own. Sometimes, hormone therapy with medication ensures that the cysts regress. In rare cases, they have to be removed surgically.
Medication against ovarian cysts
Ovarian function can be suppressed by hormone medications such as the birth control pill. In some cases, hormones can also inhibit cyst growth or even cause them to regress.
An agent similar to the male sex hormone is used in the treatment of endometriosis cysts.
Surgical removal of ovarian cysts
Doctors have a choice of different methods for the surgical intervention. Which method is used in a particular case depends on the size and cause of an ovarian cyst.
In most cases, doctors perform a laparoscopy. During this procedure, they can examine the cyst and possibly remove it immediately. Only in the case of large cysts does the abdomen have to be opened through an incision.
Therapy of polycystic ovaries
The therapy of polycystic ovary syndrome depends primarily on whether the affected woman wishes to have a child or not.
The top priorities are generally sufficient physical activity and a balanced diet – especially for overweight women.
If the desire to have children is present, additional medication is needed to promote ovulation. Women who do not wish to have children, on the other hand, are given drugs that inhibit ovulation (ovulation inhibitors).
You can read more about this topic under “PCO syndrome: treatment”.
Cyst on the ovary: course of the disease and prognosis
Very rarely, a cyst ruptures (rupture) or the pedicle of a pedunculated cyst rotates on itself (pedicle rotation). Both can lead to complications. It is also rare for ovarian cysts to develop into malignant diseases such as ovarian cancer.
In summary, this means that in most cases, ovarian cysts do not pose a health risk.
Rupture of an ovarian cyst
An ovarian cyst can rupture, for example, during a palpation examination. Most often, however, a rupture occurs without a particular trigger.
Women often feel a sudden, perhaps stabbing pain when an ovarian cyst ruptures. However, the process is usually harmless.
However, if adjacent vessels also rupture, it can bleed into the abdomen. Such bleeding usually has to be stopped in surgery.
Stem rotation of an ovarian cyst
Large ovarian cysts, such as endometriosis cysts, are sometimes connected to the ovary by a movable vascular pedicle. Sudden body movements can cause the pedicle to rotate, cutting off the blood supply to the cyst or surrounding tissue.
