The ovaries are two small organs about the size of a walnut on each side of the uterus. One of the two ovaries produces an egg every month during the menstrual cycle. It is normal for a small cyst (a fluid filled sac or pouch) to develop on the ovaries. During childbearing years ovarian cysts are quite common. Most cysts result from the changes in hormone levels that occur during the menstrual cycle with the production and release of eggs from the ovaries. A woman can develop one or more cysts that can vary in size from as small as a pea to as large as a grapefruit. Ovarian cysts may cause a variety of symptoms, including abdominal pain and cramping. Cysts are usually harmless and most go away on their own, but there are some that need further work up and all cysts should be evaluated by your provider.
Types of Ovarian Cysts
Functional Cysts (or Ovulatory)
The most common type of ovarian cyst is called a functional or ovulatory cyst. This cyst develops from tissue changes found in the normal process of ovulation. There are two types of functional cysts: the follicle and the corpus luteum. Both of these cysts are usually have asymptomatic and disappear within a few months.
Dermoid cysts are made up of multiple kinds of tissue, such as skin, hair, fat, and teeth. This type of cyst is often small and asymptomatic. They can, however, grow large and produce symptoms such as abdominal pain or cramping.
Cystic adenomas are cysts that develop from cells on the outer surface of the ovary. They are usually benign, but they can grow very large and interfere with other abdominal organs and become painful.
An endometrioma is a cyst that forms when endometrial tissue grows in the ovaries. Endometrial tissue is usually located on the inner lining of the uterus and responds to monthly hormonal changes by creating the lining that is normally shed during menses. On the ovary the tissue also bleeds monthly creating a gradually growing cyst. An endometrioma is also known as a chocolate cyst because it is filled with dark, reddishbrown blood. An endometrioma is often linked to a condition known as endometriosis. Endometriosis can cause pain during the menstrual cycle or during sexual intercourse.
This occurs when the ovaries are enlarged and contain many small cysts. It can be linked to a condition called polycystic ovary syndrome (PCOS). In a PCOS, there are many follicles but they do not mature and an egg is not released. Because the eggs are not released, progesterone levels are low and androgen and estrogen are high.
This condition has many symptoms including:
- Either irregular menstrual periods or lack of periods
- Excess hair on the face and body (hirsutism)
- Darkened color and change in texture of the skin along the neck, armpits, groin and inner thighs
- Vaginal yeast infections
- Hair loss
PCOS and Insulin
Another hormone that plays a role in PCOS is insulin. Insulin is a hormone that controls the body’s use of sugar. Many women with PCOS either produce too much insulin or the insulin they produce doesn’t work as it should. This is one reason why women with PCOS tend to gain weight or have difficulty losing weight. This insulin imbalance also has an increased risk of progressing to diabetes (increased level of blood sugar in the blood). Insulin also interrupts the normal growth of the follicle in the ovaries. The ovaries slowly become enlarged because of the number of the eggs they contain. PCOS is linked to heart disease, diabetes, and high blood pressure. Also, in some women, the presence of estrogen without progesterone increases the risk that the lining of the uterus will over grow (endometrial hyperplasia) which can be linked to uterine cancer.
Your provider will ask you questions about your health, your menstrual cycle, and your family history. Followed by a complete exam that may include blood tests including those that check levels of insulin, hormones, and blood glucose (sugar). If your doctor detects an enlarged ovary, a pelvic ultrasound may be ordered to visualize the ovaries and to check the lining of the uterus to see if it is thickened. A blood test called CA 125 may be used to detect a risk for ovarian cancer. If needed a surgical procedure known as laparoscopy may be used to directly visualize the ovaries and other pelvic organs.
Symptoms of Ovarian Cysts
Most ovarian cysts are small and asymptomatic. At times there may be symptoms due to twisting, bleeding, or rupture of the cyst. This may cause a dull ache in the abdomen and pain during sexual intercourse. If you have any of these symptoms, see your provider and share your concerns.
Treatment of Cysts
The type of treatment depends on several factors:
- Size and type of cyst
- Patient age
- Degree of symptoms
- Patients desire to have children
In the case of PCOS very specific treatments are used including those that affect the way the body uses insulin including:
- Daily exercise for at least 30 minutes a day.
- Weight loss may lower insulin levels enough to allow ovulation to begin. It also may help relieve some of the symptoms of PCOS, such as decrease new hair growth and decrease risk of endometrial hyperplasia.
- Avoid a diet of foods high in carbohydrates such as breads, pasta, potatoes and sweets.
For more information on All Female Health Care, call (954) 742-3536 or visit us at 8890 W Oakland Park Blvd., Sunrise, FL 33351. You can set up an appointment for a pelvic exam, pap smear, birth control or STD testing with one of the representatives of All Female Health Care.