Ovarian Cysts Explained: Symptoms, Causes, and Treatment

Ovarian cysts are a common occurrence, affecting many women throughout their lives. While the mere mention of the word "cyst" can spark feelings of concern, it's important to understand that not all ovarian cysts are cause for alarm. In fact, most are a normal part of the ovarian cycle and resolve on their own without any intervention.

In this comprehensive guide, we'll dive deep into the world of ovarian cysts, exploring the various types, their symptoms, causes, and treatment options. By the end, you'll have a better understanding of when to worry and the key questions to ask your doctor if you're diagnosed with an ovarian cyst.

Understanding Ovarian Cysts

Ovarian cysts are fluid-filled structures that develop on or within the ovaries. They are a natural part of the ovarian cycle and can occur during the normal menstrual cycle, pregnancy, or even in postmenopausal women. In fact, Dr. Lora Shahine, a double board-certified reproductive endocrinologist and OBGYN, explains that any fluid-filled structure in the body is technically considered a cyst.

The ovaries are dynamic organs, constantly changing and evolving throughout a woman's reproductive years. During a normal menstrual cycle, the ovaries recruit and mature an egg, which is housed in a fluid-filled structure called a follicle. This follicle is a type of cyst, and it's a normal part of the ovulation process.

After the egg is released, the follicle transforms into a corpus luteum, which is another type of cyst that produces progesterone to support the uterine lining and potential pregnancy. These functional cysts are a natural and expected part of the ovarian cycle and do not typically require any intervention.

Types of Ovarian Cysts

While functional cysts are a normal part of the ovarian cycle, there are several other types of ovarian cysts that can develop. According to Dr. Shahine, the five main categories of ovarian cysts are:

• Functional Cysts: These are the follicular and corpus luteum cysts that develop as a normal part of the ovarian cycle.

• Polycystic Ovarian Syndrome (PCOS): PCOS is a hormonal imbalance that can cause the ovaries to develop multiple small follicles, giving them a "polycystic" appearance on ultrasound. These are not true cysts, but rather a collection of immature follicles.

• Endometriomas: Also known as "chocolate cysts," these are cysts that develop when endometriosis tissue becomes trapped within the ovary.

• Dermoid Cysts: These cysts contain a variety of cell types, including hair, teeth, and even bone, and are the result of an overgrowth of cells.

• Cystadenomas: These are cysts that develop from the surface of the ovary and can be either fluid-filled or solid.

It's important to note that while some of these cysts may be benign, others can potentially be more serious and require closer monitoring or treatment. That's why it's crucial to have open and honest conversations with your healthcare provider about any cysts that are discovered.

Symptoms of Ovarian Cysts

Many women with ovarian cysts don't experience any symptoms at all, as the cysts are often discovered incidentally during routine pelvic exams or imaging tests. However, some women may experience the following symptoms:

• Pelvic pain or discomfort, typically on one side of the abdomen

• Feeling of fullness or bloating

• Nausea or vomiting

• Difficulty with bowel movements or urination

• Irregular menstrual cycles

In more severe cases, ovarian cysts can cause significant pain, especially if they rupture or twist the ovary (a condition known as ovarian torsion). This can be a medical emergency and requires immediate medical attention.

It's important to note that the presence of symptoms doesn't necessarily indicate a more serious condition. As Dr. Shahine explains, "Symptoms for ovarian cyst could either be something mild like bloating a little bit of discomfort... or if there is some pathology or something that's really going on in your body, your body's going to tell you."

Causes of Ovarian Cysts

The primary causes of ovarian cysts can be divided into two main categories:

1. Hormonal Changes and Ovulatory Dysfunction: The normal ovarian cycle, which involves the development and release of an egg, can lead to the formation of functional cysts, such as follicular cysts and corpus luteum cysts. Hormonal imbalances or issues with ovulation can also contribute to the development of cysts.

2. Abnormal Cell Growth: Certain types of cysts, like endometriomas, dermoid cysts, and cystadenomas, are the result of an overgrowth or abnormal development of specific cell types within the ovary.

Endometriosis, a condition in which the uterine lining grows outside of the uterus, can also lead to the formation of endometriomas, or "chocolate cysts," within the ovaries.

It's important to note that the exact causes of some types of ovarian cysts, such as dermoid cysts and cystadenomas, are not fully understood. However, researchers continue to investigate the underlying mechanisms that contribute to their development.

Treatment Options for Ovarian Cysts

The treatment approach for ovarian cysts depends on several factors, including the type of cyst, its size, the presence of symptoms, and the overall health of the individual. Dr. Shahine outlines three main treatment options:

1. Monitoring: If the cyst is asymptomatic, small, and appears to be a functional cyst, your healthcare provider may recommend simply monitoring it through regular pelvic exams and follow-up imaging tests to ensure it resolves on its own.

2. Medication: In some cases, particularly for recurrent ruptured cysts or those associated with hormonal imbalances, your doctor may prescribe medications like birth control pills or the NuvaRing to prevent ovulation and reduce the risk of cyst formation.

3. Surgery: If the cyst is large, causing significant symptoms, or there are concerns about its appearance or potential for complications, your healthcare provider may recommend surgical intervention. This could involve a laparoscopic cystectomy to remove the cyst or, in some cases, the entire ovary.

   The decision to pursue a particular treatment approach will depend on your individual circumstances and a careful discussion with your healthcare provider. They will weigh the potential risks and benefits of each option to determine the best course of action for your specific situation.

When to Worry About Ovarian Cysts

While the majority of ovarian cysts are benign and do not require immediate intervention, there are certain situations where more concern may be warranted. Dr. Shahine advises that you should be particularly vigilant if:

• The cyst is causing significant pain or discomfort

• The cyst appears to be changing in size or appearance on follow-up imaging

• There are concerns about the potential for the cyst to be cancerous or precancerous

In these cases, it's important to have an open and honest discussion with your healthcare provider about your concerns and the next steps in your care. Dr. Shahine recommends asking your doctor three key questions:

1. What type of ovarian cyst do I have, and how do we know?

2. How are we going to monitor this cyst, and what is the plan for follow-up?

3. What are the risks to me of having this cyst, and how can we determine the best course of action?

By addressing these questions, you can gain a better understanding of your specific situation and work collaboratively with your healthcare provider to develop a personalized plan for managing your ovarian cyst.

Remember, while the presence of an ovarian cyst can be concerning, it's important to keep in mind that most are benign and do not require immediate intervention. Stay informed, stay proactive, and don't hesitate to advocate for your health by having open and honest conversations with your doctor.

For more insights and resources from Dr. Lora Shahine, be sure to check out her newsletter, listen to her Brave & Curious podcast, and follow her on Instagram, TikTok, Twitter, and Facebook.