Q: What are ovarian Cysts?

A: Ovarian cysts are collections of fluid (at times accompanied by solid components) within or on the surface of the ovary. They vary greatly in size, from as small as a pea to larger than a grapefruit. Most cysts are benign (not cancerous), but a few, however, are malignant or cancerous.

Q: What are the symptoms associated with ovarian cysts?

A: While most cysts do not cause symptoms, they may cause pain ranging from a dull ache to more severe pain due to twisting, bleeding or rupture. Sexual intercourse may make the pain worse. Ovarian cancer warning signs include abdominal swelling or enlargement, nausea or heart burn that doesn't go away, loss of appetite and of course, pelvic pain.

Q: What are the types of ovarian cysts?

A: The most common group of ovarian cysts is termed "functional". They develop as a result of the normal ovarian function of ovulation, or egg production, and there are two types. Follicular cysts precede release of the egg and corpus luteum cysts form following egg release. While capable of being sources of pain, and associated with abnormal bleeding patterns, functional cysts are usually self-limited or responsive to conservative treatment.

Dermoid cysts can include several different tissue types and thus often contain hair, teeth and fat, for example. While they may be small, they do often become large enough to be sources of pain and demand surgery.

Cystadenomas are benign cysts developing from cells forming the outer surface of the ovary. Capable of growing large and causing pain, they demand surgery in those instances.

Endometriomas are cysts resulting from ovarian involvement with endometriosis, a process where the tissue that normally lines the uterus, the endometrium, occupies other sites. These are often referred to as "chocolate cysts", given the darkened blood that is the fluid composing them. They are frequently painful, particularly during menstrual periods or during sexual intercourse.

Multiple small cysts present simultaneously are characteristic of polycystic ovarian syndrome (PCOS). This condition is often associated with irregular menstrual periods, infertility and increased body hair.

Q: How are ovarian cysts diagnosed?

A: Ovarian cysts are often learned of through a pelvic exam, either routine or prompted by symptoms. Ultrasound may be the basis for the diagnosis, but may also be employed for its ability to determine more specific cyst characteristics (size, presence or absence of solid elements, etc.)

Blood testing is employed at times, particularly in the form of Ca125, which serves to raise or lower concerns that cysts may be cancerous. The laparoscope (a thin lighted telescope inserted through a small incision into the abdomen) allows for the viewing of the pelvic organs and diagnosis and/or treatment of ovarian cysts.

Q: How are ovarian cysts treated?

A: Cysts that cause only minor symptoms or none at all are most often monitored for 1-2 months, since most functional cysts will resolve in that period of time. When more aggressive management is necessary, the form it takes will be dictated by the size and type of cyst, your symptoms, your age and your desire to have children.

Hormonal therapy, often in the form of birth control pills, may be employed in the treatment of functional cysts. Given the pill's ability to interfere with ovulation, it is thought to likewise interfere with further stimulation of follicular cysts.

Surgery may be demanded in the event of significant symptoms, large cyst size or other unfavorable characteristics, or failed efforts at conservative approaches. Increasingly, surgical approaches to ovarian cysts are laparoscopic and outpatient. Often it is possible to preserve the ovary involved, with removal of only the cyst itself. This is called a cystectomy. Circumstances known of at surgery, may dictate that removal of the entire ovary is the better approach.