About seven percent of women have one or more cysts in the ovary, usually discovered by chance during an ultrasound. Fortunately, these fluid-filled cavities are rarely a cause for concern; in fact, they often disappear on their own. Ovarian cysts can occur at any age, singly or in larger numbers, on one or both ovaries. They grow not by proliferation of cells, but by accumulation of tissue fluid. They are the most common benign tumors on the ovary.
How do ovarian cysts develop?
The vast majority of cysts develop from the normal hormonal function of the ovary. Therefore, they are called functional cysts. They occur predominantly in women at sexual maturity, and particularly often at puberty and menopause, times when the interplay of hormones is undergoing major change.
- The most common form is the follicular cyst (vesicular cyst). It is more likely to develop in young women during a menstrual cycle when a fertilizable egg is developing in the ovary. The follicle (follicle), matures but does not burst to release the egg. Thus, ovulation does not occur, and the follicle continues to grow due to fluid accumulation. iI over 90 percent, follicular cysts spontaneously regress or burst over the course of one or two menstrual cycles.
- Other functional cysts include corpus luteum cysts, which are formed by hemorrhage (often during pregnancy) and usually regress spontaneously.
- Another form are the – often occurring in both ovaries – lutein cysts, which arise mainly due to increased production of a certain hormone (HCG). They can also be a consequence of hormone treatment for unfulfilled desire for children and usually form back when the hormone treatment is discontinued.
- Polycystic ovaries (PCO) are numerous ovarian cysts that occur as a main feature in PCO syndrome (a disease in its own right).
Cysts that grow independently of ovarian function and are caused by secretion retention are less common. They are called organic cysts or retention cysts. They also form a cavity, but it contains, for example, glandular secretions or chocolate-colored thickened blood waste products (chocolate cyst), but also once hair, teeth or other body tissues (dermoid cyst). Chocolate cysts develop in the setting of endometriosis; dermoid cysts rarely become malignant over time.
What are the manifestations of ovarian cysts?
Most ovarian cysts are inconspicuous and are discovered incidentally during an ultrasound examination. If a cyst becomes noticeable, it is usually already quite large and thus presses on surrounding tissue or organs. The symptoms are often only diffuse, often there is a feeling of pressure or unilateral pulling pain in the abdomen. Irregular or heavy menstrual bleeding also occurs.
Complications
A special case is large pedunculated cysts that can twist around their pedicle and cause sudden severe pain. In addition, cysts can rupture (ovarian cyst rupture) and cause bleeding into the ovary or free abdominal cavity. The acute abdomen that may result in such cases is a life-threatening complication that requires intensive medical care.
During pregnancy, ovarian cysts 6 cm or larger are at increased risk for such complications and miscarriage; therefore, surgery is usually recommended early in the 2nd trimester.
