Ovarian Cysts

Ovarian cysts are fluid-filled sacs usually found of the surface of an ovary. Ovarian cysts occur in 30 percent of females with regular menstrual cycle and in 50 percent of females with irregular menstrual cycles. There are many different types of cysts, each with a different underlying cause. The most common type is a functional cyst which forms during the normal menstrual cycle. Two types of functional ovarian cysts may develop; during the first two weeks of the cycle follicular, cysts occur and corpus luteal cysts occur in the later half of the cycle. The cysts usually disappear within 8–12 weeks and are common in women of childbearing age.

The other types of cysts include endometriomas, cystadenomas, dermoid cysts, and polycystic ovaries. Endometriomas are cysts formed when endometrial tissue grows in the ovaries. Cystadenomas develop from cells on the outer surface of ovary. Cystadenomas of the serous type are filled with watery fluid, while the mucinous is filled with sticky, thick fluid; both types are usually benign. If a neoplasm begins in a germ cell, a dermoid cyst may develop. Dermoid cysts are structures that are filled with pieces of bone, teeth, hair, and skin; they can become malignant. Polycystic ovaries are caused by hormone imbalances which causes multiple functional cysts to develop.

Ovarian cysts can be divided into three main classifications: functional, benign, and malignant. However, most ovarian cysts are benign in nature and are usually asymptomatic. When symptoms do occur, they include pain, particularly if it is associated with rupture (may cause peritonitis and shock), perforation into nearby structures, torsion of nearby structures, for example, to fallopian tube, and hemorrhage. Pain may radiate but is usually located within the pelvis. Strenuous activities, such as exercise or sexual intercourse (dyspareunia), may precede cyst rupture. The pain may become worse during bowel movements and during the course of the menstrual cycle. Other symptoms of ovarian cysts include abnormal uterine bleeding and abdominal enlargement, breast tenderness, change in frequency of urination due to pressure on bladder, nausea, vomiting, fatigue, increased levels of testosterone, hirsutism, and infertility. Risk factors for developing cysts include obesity, early menarche, hypothyroidism, and also the use of tamoxifen therapy.

Treatments for cysts depend on the size of cyst and symptoms experienced. Treatment for pain includes pain relievers such as nonsteroidal inflammatory drugs. Obesity is a significant risk factor for development of cysts particularly in women suffering from polycystic ovarian syndrome. These women have a slower metabolic rate than their normal counterparts and, hence, face difficulty in losing weight. Upper abdominal obesity in these patients can lead to insulin resistance and hence the resulting hyperinsulinemia leads to altered hormone metabolism and the eventual development of the disease.

In patients with polycystic ovaries who are obese, dietary restriction generally improves endocrine-metabolic parameters such as a decrease in free testosterone, hence decreasing the risk of hirsutism. Weight loss in patients with the disease who are obese is associated with a return of ovulatory cycles in 30 percent of women. A daily decrease in 500–1,000 calories deficit and 2.5 hours of exercise per week can cause ovulation in women.

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