Ovarian cysts

Ovarian cysts are fluid-filled sacs that develop in the ovaries that may hinder a normal ovulatory process

Ovarian cysts can be benign or malignant depending on their characteristics and can be easily diagnosed by ultrasound

Most ovarian cysts go away by themselves after an 8 to 12 week period. Otherwise ovarian cysts may hinder a normal ovulatory process and treatments to achieve pregnancy (which include ovulation induction and in vitro fertilization) may be necessary.

What are ovarian cysts?

Ovarian cysts are fluid-filled sacs that develop within the ovaries.

These are very common and affect women of all ages, particularly during their fertile lifespan (from puberty to menopause).

A woman can develop one or more ovarian cysts, which can be microscopic or grow to several centimeters in diameter, obstructing a woman’s normal ovulatory process.

Main symptoms of ovarian cysts

Most ovarian cysts are small (less than 3cm/1.2in) and produce no symptoms. However, larger cysts (6cm/2.4in or more) can cause the ovary to twist and cause severe pelvic pain. Similarly, they may burst or bleed and cause serious problems requiring immediate treatment.

Other ovarian cysts symptoms include:

  • Acute or chronic pelvic pain
  • Pelvic heaviness sensation
  • Bloating or abdominal swelling
  • Dyspareunia (or pain during intercourse)
  • Amenorrhea (or menstrual period absence)
  • Menstrual period disorders
  • Uterine bleeding or bleeding not related to a menstrual period
  • Hirsutism or unwanted hair growth
  • Infertility

Although ovarian cysts are usually benign, it is necessary that you schedule a doctor’s appointment at the first suspicion of an ovarian cyst. Early treatment may prevent ovarian cancer, particularly among postmenopausal women.

Ovarian cysts causes

Each month during a woman’s menstrual cycle, a follicle (a small sac that contains the upcoming ovulated egg) develops in one of her ovaries. Most months, this follicle releases the egg during ovulation. However, sometimes this follicle fails to break open and a “functional” cyst is formed.

Ovarian cysts are very common and tend to take place during a woman’s fertile lifespan.

Other factors that may be involved in ovarian cysts formation are:

  • Polycystic Ovarian syndrome
  • Endometriosis
  • Pelvic infections
  • Hormonal changes

How are ovarian cysts diagnosed?

In addition to a patient’s medical record analysis, procedures to diagnose ovarian cysts include:

A pelvic examination may reveal an enlarged ovary or a cyst.

A transvaginal ultrasound (or pelvic vaginal ultrasound), during which the doctor carefully inserts an ultrasound probe into the patient’s vagina to examine her ovaries. Transvaginal ultrasound is simple, painless and can determine the size, shape and location of a cyst in all cases.

If the ultrasound results indicate that the patient could be at risk of developing ovarian cancer, the doctor may order additional tests.

Treatments to achieve pregnancy in patients with ovarian cysts

Most ovarian cysts go away by themselves after an 8 to 12 week period. Otherwise, treatments to achieve pregnancy include:

  1. Before starting any treatment, use of oral contraceptives is recommended to decrease the size of the cyst. If this cyst persists, it is possible to perform a quick and simple procedure for which a transvaginal ultrasound probe is used to guide a thin needle to puncture the cyst and aspirate its content
  2. Ovulation induction, which usually uses specialized medicaments whose administration must be carefully monitored by a specialist. This treatment is particularly useful in women under 35 with no other infertility causing factors.
  3. If medication is not enough, the best option is In-Vitro Fertilization (IVF ), which permits to join the patient’s eggs with an improved quality sperm sample in a special culture dish under controlled laboratory conditions. This increases the likelihood of a successful fertilization to generate embryos that are later transferred back into the patient’s uterus.
  4. Women with cysts that cause ovarian twisting, rupture or bleeding may require laparoscopic surgery to remove them. Although most ovarian cysts are not malignant (cancer associated), it is recommended that once removed, they are sent to a specialized laboratory to confirm that they are benign.

Each patient is different; it is thus essential to schedule an appointment with a reproductive specialist to help you decide the appropriate treatment for you.