Ovarian cysts

What they are, how they appear and when you should worry

Ovarian cysts are fluid-filled (or sometimes semi-solid) formations that develop within or on the surface of one or both ovaries. They are very common, especially in women of reproductive age, and in most cases are benign and transient.

Formation mechanism

During the menstrual cycle, a follicle develops in the ovary that prepares for ovulation. When ovulation does not occur properly, or when the corpus luteum does not degenerate properly after ovulation, functional cysts can form. Other cysts form for reasons other than the menstrual cycle.

Classification of cysts

Functional cysts (most common)

They develop during the menstrual cycle and usually disappear within a few weeks or cycles:

• Follicular cyst – When the ovary does not release the egg and the follicle continues to grow.

• Corpus luteum cyst – When after ovulation, the remaining part of the follicle does not break down properly and fills with fluid.

Benign pathological cysts

• They form without any connection to the menstrual cycle and have a higher risk of growth, complications, or the need for treatment.

• Dermoid cyst (mature teratoma) – Contains various tissues (hair, fat, teeth). Benign, but can become large or cause torsion.

• Cystadenoma – Cyst originating from epithelial cells of the ovary. May be serous or mucous. Rarely becomes malignant.

• Endometrioid cyst (chocolate cyst) – Filled with old blood, associated with endometriosis. May affect fertility.

Symptoms

Most cysts do not cause symptoms and are discovered incidentally on ultrasound. However, if they grow or cause complications, they may present with:

• Pain on one side of the lower abdomen

• Abdominal bloating or feeling of heaviness

• Pain during sexual intercourse

• Irregular menstrual bleeding

• Frequent urination or difficulty completely emptying the bladder

• Nausea, fatigue, or a general feeling of discomfort

  
  

In case of complications:

• Cyst rupture – causes severe, immediate pain and may require immediate care

• Ovarian torsion – when the cyst causes the ovary to twist and cut off its blood supply; it is a gynecological emergency

Troubleshooting

The diagnosis is usually made by:

• Transvaginal ultrasound – the most commonly used method for assessing the structure, size, and contents of the cyst

• Blood tests – to assess tumor risk (CA-125, HE4), hormonal levels, etc.

• MRI – in cases where a more detailed assessment is required

• Laparoscopy – diagnostic and therapeutic in some cases

treatment

It depends on:

• Patient's age

• Size and characteristics of the cyst

• Type (benign or suspicious)

• Symptoms

• The desire to preserve fertility

Therapeutic options:

• Active surveillance – for small functional cysts without symptoms

• Use of oral contraceptives – to regulate the menstrual cycle and prevent new cysts

• Surgery – if the cyst is large, persistent, symptomatic, or has suspicious features

• Cystectomy (cyst removal, ovary preservation)

• Ovariectomy (removal of the ovary – rarely, in more serious cases)

Cysts and fertility

Most cysts do not negatively affect fertility, except for those associated with:

• Endometriosis

• Polycystic ovary syndrome

• Surgical interventions that can damage ovarian tissue

  
  

cONcluSiON

Ovarian cysts are common and often temporary. However, if you have unusual symptoms or a mass in your abdominal area, it is important to have a gynecological checkup. Early diagnosis and treatment avoids complications and helps maintain reproductive health.