Ovarian cyst: symptoms, cause and treatment

By Cristiano Antonino On Mar 14, 2023

An ovarian cyst is a cavity or sac filled with liquid or solid material, which may affect one or both ovaries

These organs are the ones that contain the female gametes, oocytes, and are located lateral to the uterus and connected to it through the tubes.

It is quite common and in most cases this formation is benign and totally asymptomatic.

Very often ovarian cysts regress spontaneously within a few weeks or months, without the need for intervention.

In some circumstances, however, it may be large and painful.

In the worst case, it may be the manifestation of a malignant ovarian tumour.

Ascertaining the exact nature of an ovarian cyst requires a thorough gynaecological examination and a transvaginal or transabdominal ultrasound.

Less severe ovarian cysts do not require any treatment. It heals spontaneously in a few weeks or months.

Severe ovarian cysts require surgical removal.

Ovarian cyst symptoms

Ovarian cysts of the benign type usually give no symptoms and often, as seen, disappear spontaneously.

Whether ovarian cysts tend to enlarge or whether it is an endometriosis-type cyst is different.

With an ovarian cyst, symptoms may include:

pelvic pain or feeling of weight, especially around the time of menstrual flow
frequent urination, due to the pressure of the cyst on the bladder
dyspareunia, i.e. pain during sexual intercourse
intestinal pain or discomfort
feverish states
increased volume of the abdomen

When ovarian cysts are more serious

In some cases ovarian cysts, most frequently dermoid cysts or cystadenomas, may twist, generating acute pain that may require emergency surgery for removal.

Sometimes, especially in the case of endometriosis cysts, these can interfere with the possibility of achieving pregnancy.

Or they can undermine the good progress of a pregnancy that has already begun.

Finally, ovarian cysts can rupture, causing acute pain and bleeding in the peritoneal cavity.

Or they can become infected, giving rise to fever, abdominal pain and altered bowel movements (diarrhoea).

Most ovarian cysts are benign but, especially after the age of 40 and after menopause, cysts may turn out to be malignant or borderline cancerous in nature.

Causes, functional ovarian cysts and pathological cysts

In most cases ovarian cysts are physiological, i.e. related to the normal menstrual cycle.

Only in some minor circumstances can the cyst be the manifestation of a neoplastic process or other pathological conditions.

For this reason, depending on the case in question, one can speak of

functional ovarian cysts, the most common and considered absolutely harmless as they are closely linked to a normal physiological process
pathological or non-functional ovarian cysts, i.e. those caused by a tumour, benign or malignant, or alternatively produced by specific diseases such as polycystic ovary syndrome or endometriosis.

Functional ovarian cyst

As far as functional ovarian cysts are concerned, they are divided into three main classes:

Follicular cyst case. The egg cell forms inside a protective structure, called the follicle. As soon as the egg cell is mature, i.e. ready for a possible fertilisation process, a hormonal signal is triggered that causes the follicle to rupture. At this point the same egg cell leaks out in the direction of the fallopian tubes and uterus. In some situations, this mechanism does not work perfectly and the egg gets trapped inside the follicle, which fills with fluid and forms a follicular cyst. The follicular cyst is the most common ovarian cyst of all and almost never generates symptoms. It usually resolves on its own, without any treatment, within a few weeks.
Luteal cysts (or lutein cysts). The follicle, after expelling the egg cell, takes on the name of corpus luteum. It may happen that the opening from which the egg cell escaped may close again, retaining fluids of various kinds and blood inside. Under these circumstances, a luteal cyst is formed. Compared to follicular cysts, luteal cysts are less common but more dangerous: they can rupture suddenly and trigger painful internal bleeding. Their spontaneous resolution usually takes a few months. Luteal cysts occur mainly during gestation
Thecal cysts, which are generated from the thecal cells forming the follicle by chorionic gonadotropin, a hormone produced during pregnancy. They are less common than the other two categories mentioned, namely follicular and luteal cysts.

Pathological or non-functional cysts

Pathological or non-functional cysts can be distinguished into:

dermoid cysts, which form from the cells that produce the oocyte during embryonic life. For this reason, they may contain portions of human tissue inside them that resemble hair, bone, adipose, teeth or blood. Dermoid cysts can be very large, reaching up to 15 centimetres in diameter; when the dermoid cyst is very large and causes an alteration in the normal anatomy of the ovaries and uterus, it may need to be removed by surgery. Dermoid cysts are benign tumours that very rarely become malignant. They are the most frequent non-functional cysts among women under 40.
cystadenomas. These are benign tumours that develop on the outer surface of the ovaries and may contain (as cysts) water or mucus. In the former case (water) one has serous cystadenomas, while in the latter (mucus) one speaks of mucinous cystadenomas. Serous cystadenomas generally do not reach a large size and do not cause any particular discomfort; mucinous cystadenomas, on the other hand, can grow considerably and can even reach a diameter of 30 centimetres. A large mucinous cystadenoma may push on the adjacent intestine or bladder, causing episodes of indigestion or frequent urination; it may also rupture or obstruct the blood supply to the ovaries. Again, the transformation of a benign cystadenoma into a malignant tumour is a very rare event. Cystadenomas are the most common non-functional cysts among women over 40 years of age
endometriomas, i.e. cysts due to endometriosis. The latter is a disease characterised by the presence of endometrial tissue outside its natural site (the uterus). In some women, however, it can also be characterised by the appearance of blood-filled ovarian cysts
cysts caused by polycystic ovary syndrome (or ovarian polycystosis) . The latter is a morbid condition characterised by enlarged ovaries covered with many small cysts. The onset of this condition is usually linked to an imbalance in the production of ovarian (i.e. produced by the ovaries) and pituitary (i.e. produced by the pituitary gland) hormones.

Complications are related to the conditions that generate the ovarian cyst

The risk increases if the cyst bleeds, ruptures.
resulting in acute pain and internal bleeding, shows signs suggestive of a neoplasm, or twists.

The twisting of a large cyst may result in dislocation of the ovary from its regular pelvic position.

Such an event increases the likelihood of a painful twisting of the ovary, called ovarian torsion.

Regarding a possible impact on fertility, there are few cases in which ovarian cysts can be associated with a reduction in fertility:

endometriomas (cysts caused by endometriosis)
cysts from polycystic ovary syndrome)

Unless particularly large, however, functional cysts, dermoid cysts and cystadenomas do not cause fertility problems.

Treatment of ovarian cysts

Functional ovarian cysts do not require any treatment but only ultrasound checks, to be repeated cyclically over time, to verify their resolution.

In the past, in the presence of functional ovarian cysts, it was often used to “put the ovaries to rest” through the use of hormone therapy.

Subsequently, it was shown that the same probability of resolution was obtained both by treating and not treating with hormones.

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Today, such an approach is therefore only reserved for young women with functional cysts who apply for a contraceptive.

In these cases, in fact, the contraceptive pill is suggested, in addition to preventing an unwanted pregnancy, to facilitate cyst reabsorption.

The case of torsion of an ovarian cyst is different: in such a circumstance it is essential to seek medical advice and surgery quickly in order to preserve as much ovarian tissue as possible.

Cysts caused by endometriosis require medical evaluation for the correct pathology.

When the cyst does not regress, or when acute pain occurs, or when the doctor suspects the presence of cancer, surgical treatment is the preferred option.

Today, surgical treatment of ovarian cysts is almost always performed through a minimally invasive technique called laparoscopy.

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