Ovarian cysts

Most women who have ovarian cysts don’t know that they have them. But some cysts cause dull pain in the lower belly area.

Ovarian cysts can also lead to problems with the monthly menstrual cycle, such as heavy or irregular periods, or spotting (abnormal vaginal bleeding between periods). Menstrual cycle problems occur if a cyst produces sex hormones that cause the lining of the womb to grow more.

Very large cysts may push against the bowel or bladder. This can lead to a swollen belly, a feeling of pressure, pain when urinating, or constipation.

If a cyst ruptures (bursts), it can be felt as a sudden pain – but usually doesn’t cause any other problems. The weight of the cyst can sometimes pull on the ovary and cause it to become twisted. This leads to sudden, severe, cramping pain on the affected side of the lower belly, as well as nausea, vomiting and a high pulse rate.

Most ovarian cysts develop during one part of the menstrual cycle (the growth and release of egg cells). Known as “functional cysts,” these mainly occur in puberty or during menopause. They may develop in one ovary or in both ovaries at the same time.

These are the most common types of functional ovarian cysts:

• Follicular cysts: Each egg cell is surrounded by a capsule known as a follicle. If the follicle doesn’t open and release the egg cell (if ovulation doesn’t occur), the follicle might gradually become filled with a fluid and turn into a cyst.
• Corpus luteum cysts: These occur when a corpus luteum fills with blood. The corpus luteum develops from the follicle that released the egg cell during ovulation. It secretes the sex hormones known as progesterone and estrogen.
• Theca lutein cysts: These mainly occur after infertility treatment with hormones. The hormones stimulate the growth of egg cells in the ovaries. Cysts may develop as a side effect.

There is also a special type of cyst known as chocolate cysts (endometriomas). These are filled with dark, thick blood. They can develop as a result of endometriosis, for example.

Dermoid cysts (which are not functional cysts) are less common. They may develop if a non-cancerous tumor grows and it contains things like skin cells and sebaceous glands. Sebaceous glands produce an oily substance (sebum) that usually keeps skin moisturized. Because the sebum in this kind of tumor can’t “escape,” it builds up inside the cyst. Dermoid cysts are sometimes there at birth. They only rarely become malignant (turn into cancer).

In another illness known as polycystic ovary syndrome (PCOS), there are a lot of small cysts in the ovaries. Women who have PCOS make too many male sex hormones (androgens), which prevent the egg cells from maturing properly.

Most ovarian cysts are 1 to 3 centimeters in diameter and go away on their own within a few months. They only rarely grow large enough to cause severe symptoms. In very rare cases they can grow as big as 30 centimeters in size.

Complications are rare. They may occur if the wall of the cyst ruptures (bursts) and the fluid leaks out into the space around it. Although ruptures can be painful, they are usually harmless. Only rarely do they lead to bleeding that needs to be stopped through surgery.

A more serious complication may occur if the ovary becomes twisted around the tissue that supports it. Known as ovarian torsion, this mainly happens in women who have larger cysts – often after jerky movements, for instance when playing tennis. Ovarian torsion is very painful. It may also cut off the blood supply to the ovary. If that happens, surgery is needed as soon as possible to prevent the ovary from dying.

Ovarian cysts can be seen in an ultrasound. They are often discovered by chance, for instance when doing an ultrasound scan of the ovaries. Some cysts can be felt too.

If it is thought that you might have an ovarian cyst, the doctor will ask you about symptoms such as menstrual (period) problems and pain, and you may have a blood test.

Other examinations, such as a CT scan or laparoscopy (keyhole procedure to look inside your belly), are only rarely needed. Diagnostic examinations are usually done to find out whether the changes in ovary tissue could be cancer. Although cysts are usually benign (not cancer), it’s not always easy to tell whether it’s a cyst or a tumor.

If a cyst causes no symptoms, or only mild symptoms, it’s usually okay to wait and see what happens. Most cysts go away on their own. Depending on the results of diagnostic examinations, it’s sometimes a good idea to go for regular check-ups (every few months) so the doctor can keep an eye on the cyst. If the cyst is painful, painkillers such as ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) can help.

If a cyst changes over time or doesn’t get smaller and if the symptoms don’t go away, laparoscopy is an option. This procedure involves inserting small instruments into the abdomen (belly) through small cuts in the belly wall. Doctors can then take a closer look at the cysts and remove them if necessary. But new cysts may develop after others have been removed.

In rare cases doctors suggest removing an ovary, or even both ovaries – for instance, if they think it could be cancer or that it won't be possible to cut the cysts out of the ovary tissue. At least one of the two ovaries is kept, if possible – especially in women who wish to have (more) children. Removing both ovaries can be particularly distressing for younger women because that immediately leads to menopause. The sudden drop in hormones can cause symptoms such as hot flashes, dizziness, headaches and nausea.

Some doctors recommend treating ovarian cysts with the birth control pill. But the pill doesn’t help in the treatment of functional cysts. Although it reduces the amount of hormones produced in the ovaries and prevents ovulation, research has shown that this doesn’t make the cysts go away any faster.

When people are ill or need medical advice, they usually go to see their family doctor first. For problems related to women's health, you can also make an appointment with a gynecologist. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.