Understanding and Treating Ovarian Cysts with Dr. Kevin Koh

What is an ovarian cyst?

Ovarian cysts are fluid-filled sacs that form within the ovary.

Ovarian cysts are extremely common and often will go away by themselves.

They are usually not cancerous, and most will not affect fertility.

Management will depend on the size of the cyst, the kind of cyst, whether it persists and whether it is causing any symptoms such as pain or pressure symptoms.

Types of Ovarian Cysts

Functional Cysts:

These are the most common type of ovarian cysts and are related to the menstrual cycle.

Functional cysts can be either follicular or corpus luteal cysts. They do not behave as they would normally in a menstrual cycle and continue to grow. However, these tend to go away with time and do not require treatment.

Non-functional Cysts

They are non-functional because they do not develop as a result of the menstrual cycle.

These include:

Endometrioma:

Endometriosis is a condition where the cells lining the uterine cavity are also present elsewhere ie in the pelvis and may involve the ovaries. When these cells grow in the ovary and you have a period, these cells bleed and form blood-filled sacs within the ovary, which can get bigger over time. These may cause severe pain and infertility.

Dermoid Cyst:

Dermoid cysts are benign tumours that contain different tissues such as hair, fat, teeth and bone. They are common in young women and grow slowly with time. They however do not disappear by themselves and will need removal by surgery.

Cystadenoma:

They are also benign tumours that are filled with clear fluid or mucus and can become quite big.

Cancerous Cysts

These are cysts that have become cancer. These will need to be dealt with by a cancer surgeon.

Symtoms of Ovarian Cysts

Symptoms will depend on the size and the nature of the cyst.

Cysts may be asymptomatic or may cause abdominal pain, pressure symptoms, or pain with sex

Cysts which are greater than 4cm may cause the ovary to twist on itself (ovarian torsion), compromising its blood supply, leading to severe pain

Cysts may burst, and the fluid that spills into your pelvis can also cause pain
Large cysts may compress surrounding organs like the bowel and bladder, causing changes in bowel and bladder habits
Endometrioma can affect your chances of falling pregnant

Symtoms of Ovarian Cysts

Treatment of Ovarian cyst

Treatment depends on the type of cyst, the size and what kind of symptoms the cyst is causing.

If the cyst is small and is not causing symptoms, monitoring with a repeat ultrasound may be all that is required as it will most likely go away by itself.

If it is big, not going away, is causing pressure symptoms or pain, or there is suspected cancer, the cyst should be removed via surgery. Removing the cyst will prevent complications such as rupture, torsion, and internal bleeding, which may then require emergency surgery. The other benefit of removing the cyst is that it can be sent off for testing to ensure it is not cancerous.

Ovarian cyst removal is usually done with a laparoscope (key hole surgery). This is minimally invasive surgery with only a few small 0.5-1mm skin incisions. This has the advantage of better cosmetic outcomes, less post-operative pain, shorter hospital stay and quicker return to normal activities, compared to an open procedure.

Sydney Obstetrician Clinic's gynaecologist is a specialist and will complete ultrasounds and can help pick up warnings early on if there are any signs that can be associated with the risk of cancer. To help in these rare cases, we will work together with you to develop the best treatment plan.

As every situation is different, we understand your situation may be unique and require an individual plan of management. If these issues may apply to you, please contact us and we will organise a consultation and we will assist with your individual circumstances.