Ovarian cysts

An ovarian cyst is a collection of fluid in the ovary. It can be formed during ovulation and disappear after ovulation. This is normal in a menstrual cycle.

At the start of a menstrual cycle new follicles develop in the ovary. Each follicle contains fluid and a developing egg. If the egg is not released from the follicle the follicle becomes a follicular cyst.

After a follicle releases its egg, it becomes a corpus luteum. If pregnancy does not happen, the corpus luteum disappears. However, sometimes it doesn’t disappear and fluid collects inside it, resulting in a corpus luteum cyst.

Follicular cysts and corpus luteum cysts are functional cysts. Functional cysts are benign and often resolve after a few menstrual cycles.

Most ovarian cysts are benign.

Some ovarian cysts contain sebum, hair and even teeth. These are called dermoid cysts and are often benign.

Some ovarian cysts contain thick, old menstrual blood and appear as ‘chocolate cysts’. These are also known as endometriotic cysts or endometriomas and are benign.

Ovarian cysts can be unilateral meaning they occur in one ovary, or they can be bilateral, meaning they are present in both ovaries.

Women with ovarian cysts often have no symptoms. If they do, they can experience pain in the lower abdomen, painful periods, bloatedness, distension in the abdomen, difficulty with passing of urine or motion. Sometimes they can experience weight loss, which is worrying.

An ultrasound scan will tell you whether you have an ovarian cyst. The features of the cyst on ultrasound will give us an idea of what type of cyst it is. Simple, fluid-filled cysts are generally benign. It is the complex cyst that is a cause for concern as it increases the possibility of a malignancy. Complex cysts tend to have a mixture of fluid and solid areas in the cyst. Complex cysts tend to be septated, with several internal compartments in the cyst. Sometimes a complex cyst can also show irregular margins on ultrasound.

Not all ovarian cysts require treatment though. Your age, symptoms, characteristics of the cyst and whether you plan to have a baby will determine which treatment is best for you.

Some cysts just need follow-up ultrasound scans. Some cysts need removal. We call this a ‘cystectomy’. Ovarian cysts which need surgical removal are often carried out via laparoscopic cystectomy (keyhole approach) rather than the conventional laparotomy (open approach).

Laparoscopy is a procedure where a small incision (cut) is first made at the belly button. A camera is then inserted through the incision to see the uterus, fallopian tubes and ovaries. 2 further small incisions are made in the abdomen and surgical instruments inserted through them to do the surgery.

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