Who is most at risk for getting ovarian cysts?
In general, ovarian cysts mostly affect women of reproductive age, which means after menstruation begins and before menopause; dermoid cysts tend to be diagnosed between ages 10 to 30. Also, people with endometriosis are at higher risk of forming ovarian cysts.
What about PCOS?
Polycystic ovarian syndrome (PCOS) is a bit of a misnomer because those with this condition do not necessarily have ovarian cysts. PCOS is a syndrome associated with excess androgen, or male sex hormone, and irregular menstruation due to ovulatory dysfunction. Some patients which PCOS have enlarged ovaries with multiple follicles, but others have normal appearing ovaries.
How are ovarian cysts treated?
Usually, ovarian cysts are asymptomatic. With small cysts, especially simple cysts, patients may have some discomfort, but it’s usually mild. It’s rare for patients to need any kind of intervention for small functional cysts because they tend to go away on their own over the course of weeks or months.
Taking hormonal birth control pills may help some patients who experience discomfort from recurrent functional cysts; since birth control prevents ovulation, it should theoretically be a perfect way to prevent the formation of functional cysts, but it hasn’t shown perfect success. The pill isn’t right for everyone, and it won’t prevent all types of cysts. For example, it can’t prevent dermoid cysts.
Treatment for dermoid cysts is a bit different. If you’re in a reproductive age and have a dermoid cyst, we usually conduct annual ultrasounds to make sure they’re not getting larger. If you have a stable dermoid cyst that doesn’t get much bigger and doesn’t cause discomfort, you may never need surgery. But if you have a dermoid cyst that grows to six centimeters or more, you become at risk for torsion. This is when you should see a doctor about next steps, which may include surgical removal.
Sometimes ovarian cysts can become emergencies. The two emergencies we worry about the most are ovarian torsion and ovarian cyst rupture. Both present with sudden onset pelvic pain, which we take very seriously. If a torsion occurs, it can cut off the blood supply to the ovary, and over a longer period of time, could actually cause the ovary to die completely. It can cause extreme pain, and usually nausea and vomiting. With torsion, we need to surgically untwist the ovary and remove the ovarian cyst.
When an ovarian cyst ruptures, it can present similarly to torsion, but the treatment is different. And as long as their blood count is stable, most patients are able to be managed with close medical supervision. Their pain gets better quite quickly in a matter of hours, and we are able to treat with pain medication and observe to make sure that they’re not experiencing internal bleeding (which is luckily rare).
Can an ovarian cyst be a sign of cancer?
Although the vast majority of ovarian cystic masses in women before menopause are benign, we are always looking for signs that could point to cancer. For women over 45, the risk of an ovarian mass being cancerous is about 33%, so we treat these patients a bit differently than younger patients, sometimes with closer follow up or special blood work.
Can ovarian cysts affect fertility?
Most cysts don’t affect fertility, although certain cysts such as endometriomas may. Functional cysts, and for the most part, dermoid cysts have very limited effect, if any, on fertility. The exception would be if a dermoid cyst causes torsion, for example.
If someone suspects they might have an ovarian cyst, when should they seek help?
If you’re having symptoms, such as discomfort in the pelvis or pain with sex, you should go and see a gynecologist. If you’re having such severe pain that over-the-counter pain medication like ibuprofen isn’t helping at all, or if you’re having associated nausea, vomiting, or fevers, it’s advisable to go to the emergency room. Most patients will describe the feeling of torsion, for example, as worst pain of their life. Any sudden onset sharp, severe pain in the pelvis should be treated as an emergency, and you should seek help.