Ovarian Cyst

Ovarian cysts are fluid-filled sacs in the ovary. Each woman has two ovaries; one on the right and the other on the left.

Ovarian cysts can cause pain or feeling of pressure around and below the belly button. Most of the time it is asymptomatic. The patients may worry about a cyst assuming that it might be associated with cancer. But in reality, most often ovarian cysts are not cancerous or even pre-cancerous.

Symptoms

Many women have no complaints. If the patient is symptomatic, there may be pain or pressure in the lower abdomen, usually on only one side.

In some cases, an ovarian cyst may rupture or cause the ovary to turn over on itself. These may result in serious problems. If you feel severe pain that persists in the lower abdomen (there may be pain that makes it difficult for you to walk; or you may experience nausea and vomiting), contact your doctor immediately.

Causes

There are many possible causes of ovarian cysts. Some common causes are:

Ovulation or Pregnancy: Ovulation is oocyte (egg) release from an ovary every month in women who have regular periods. For this to happen, a sac filled with a fluid called a follicle grows in that ovary. In some cases, although the follicle grows, the egg is not released and a cyst forms instead. Otherwise, after the egg is released and if the woman becomes pregnant, the follicle cyst does not disappear thanks to some hormones of pregnancy and may stay for several weeks. Both two types of cysts we have mentioned here are harmless and disappear by themselves over time.

Polycystic Ovary Syndrome (PCOS): While the ovary is expected to develop one large follicle every month, numerous small follicles develop in PCOS. These usually do not regress spontaneously, but they do not require treatment or surgical removal either. Women with polycystic ovarian syndrome are followed up with recommendations and treatments regardless of their cyst.

Dermoid Cysts: These are common cysts in women, especially in their 20s. These are cysts that can contain teeth, hair, adipose (fatty) tissue and can reach sizes from 2-3 cm to 15-20 cm. There is no harm to the general health of the patient. The likelihood of malignant tumors is very low (<1%). The probability of spontaneous regression is very low. Therefore, we sometimes recommend surgery depending on the characteristics of the patient. When surgery is indicated, we normally perform laparoscopic cystectomy (removal of the cyst only).

Endometrioma (Chocolate Cysts): You can get detailed information about endometriosis and endometrioma (Chocolate Cysts) from the relevant section on our site.

Cancer: Generally speaking, the probability of malignancy (cancer) occurring in all ovarian cysts is below 1 in 100 cases. This risk is slightly higher, especially for women who are in menopause or for those who have a family history of ovarian cancer. With examination and ultrasonography, we can distinguish cancerous conditions or cysts that suggest borderline tumor from other benign cysts that do not even require treatment.

Tests

As we have already noted, ovarian cysts most often do not cause any symptoms. It can be revealed by ultrasound during your routine gynecological examination. In select cases, we may request MRI (Magnetic Resonance Imaging) or CT (Computerized Tomography) in addition to ultrasound.

In some of our patients with cysts, we may also request blood tests to better assess cancer suspicion (such as CA-125, CA 15-3, CEA, CA 19-9, ß-hcg).

Treatment Methods

Depending on the characteristics and symptoms of the patient, along with the characteristics of the cyst (size, appearance, Doppler flow etc.), the following methods can be proposed:

Follow up: Many cysts do not require treatment. Your doctor may call you for follow-up at regular intervals. The size of your cyst can remain the same, shrink or disappear completely.

Birth control pills: This is a rather outdated treatment modality therefore we do not recommend it very often to our patients for cysts. The aim here is to suppress the development of new follicles and ovulation. Thus, the newly developing cyst will not cause confusion in the follow-up of the existing cyst. We do not recommend birth control pills only for simple cyst follow-up.

Surgery: We may recommend surgery for large cysts that are unlikely to regress, for those that do not regress for a long time, or in cysts that cause suspicion of borderline tumors/cancer, or in cases where we think it may affect chances of conceiving. Our gold standard for surgical treatment is laparoscopy (keyhole surgery). You can get detailed information about laparoscopy from the relevant section on our website.


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