Ovarian Cysts
Ovarian cysts are a very common problem in women of all ages, especially in those of reproductive age. Most cysts that occur before menopause are non-cancerous. Thorough investigation with transvaginal ultrasound, blood tests including tumour markers, and thorough clinical assessment are necessary to determine the risk profile of an ovarian cyst in a woman and the appropriate management plan.
Ovarian cyst
The most common types of ovarian cysts are:
Follicular cyst
- Large follicle that doesn’t release an egg, instead fills with fluid and forms a cyst.
- Usually resolve on their own after 1-3 menstrual cycles.
Haemorrhagic cyst
- After ovulation the follicular cyst can bleed into itself.
- Sometimes this can cause pain and bleeding, however this is usually self limiting and goes away on its own over time.
Cystadenoma
- Benign thin walled fluid filled cysts.
- Often don’t go away on their own.
Dermoid cyst
- Mature teratomas which contain cells with similar tissue to hair, teeth, skin or bone.
- If >5cm usually require surgical excision as they do not usually resolve on their own.
Endometrioma
- This is often called a “chocolate cyst” and is when endometriosis grows within the ovary and forms a walled off cyst filled with old blood.
- Endometriomas are often stuck to surrounding structures include the side walls of the pelvis, the uterus and other organs, including the bowel.
- They often cause significant pain and don’t resolve on their own and surgical excision via laparoscopic cystectomy has to be done carefully to minimise damage to the surrounding ovarian stromal tissue.
We usually use a cut off of >5cm to determine whether or not we need to perform laparoscopic surgical excision. If they are 5cm or larger they will usually not resolve on their own and the ovary is at risk of twisting, called ovarian torsion, which results in severe pain and can compromise the blood supply of the ovary resulting in loss of that ovary if left untreated.
