Ovarian cysts are most often fluid filled growths that arise from the ovaries. Their size can vary from a few centimeters to over 1 foot in size. They are a very common reason for gynecologic consultation.
Functional Cysts: The most common type in reproductive aged women. Examples include follicular, corpus luteum, and theca-lutein cysts. In general these cysts are caused by changes in hormone levels, and can themselves cause further hormonal imbalances. On average these cysts are about 4-5 cm in diameter and usually regress spontaneously within 4-8 weeks. They can cause abdominal pain, especially if they rupture and release either blood or fluid into the abdomen.
Benign Neoplastic (meaning growth of abnormal tissue) Cysts: less common than functional cysts. The most common type is the benign cystic teratoma or dermoid cyst. These cysts can be asymptomatic or cause pelvic pain, and usually do not resolve spontaneously.
Endometriotic Cysts: can occur when endometriosis develops in the ovaries. These cysts which are also known as “chocolate cysts” due to their characteristic appearance when they rupture can cause pelvic pain, adhesions, and infertility. These cysts usually do not resolve spontaneously.
Malignant Cysts: occur more frequently after menopause but can occur in any age group. Suspicion for malignancy is increased when certain characteristics are seen on physical exam, ultrasound, and patient history. There is currently no good screening test for ovarian cancer, although certain new blood markers are being studied.
Cyst Rupture and Torsion
A rupture of an ovarian cyst is a common occurrence for women of reproductive age. The ovarian rupture of a cyst can be asymptomatic or associated with sudden onset of unilateral lower abdominal pain. Pain usually begins during physical activity such as exercise or intercourse. Differential diagnosis is of the ovarian cysts are mittelschmerz, ectopic pregnancy, ovarian torsion, degenerating myoma, pelvic inflamatory disease, acute endometritis, and non-gynecologic causes.
Management is based on severity of symptoms, whether there is hemo-dynamic instability. The major goal in the evaluation of a female patient with suspect rupture of an ovarian cyst are to exclude rupture, ectopic pregnancy, and ovarian torsion. Clinicians should identify if it is safe to manage patients expectantly or should be managed with surgical intervention.
Ovarian Torsion is referred to the twisting of the ovary on its ligamentus support and often resulting in impedance of its blood supply. It is the fifth most common gynecological emergency and happens in women of all age groups. Most commons etiologies of torsion in women are ovarian Cyst, pre and post menopausal patients. Neoplastic processes are always a possibility in pre and post menopausal patients.
Most common symptoms are sudden onset of sharp lower abdominal pain, nausea/vomiting. Pain can radiate from back flack to groin area of the body. Approximately 2-3% of patients develop fever and peritoneal signs.
Cyst and Cyst Rupture:
Management is based on severity of symptoms, whether there is hemo-dynamic instability. Treatment is individualized based on severity of symptoms, whether there is hemodynamic instability, and also findings on ultrasound and physical exam.
Clinicians should identify if it is safe to manage patients expectantly or should be managed with surgical intervention.
The treatment of ovarian torsion is surgical intervention.
To find out more information on Ovarian Cysts, Rupture and Torsion or to find out if you may be a candidate for this condition, contact a representative at Nezhat Medical Center to request an in-office consultation with Dr. Ceana Nezhat.