An ovary can frequently become enlarged by a cyst – a fluid-filled compartment or sac formed by an envelope of ovarian tissue. These enlargements distinguish cysts from solid tumors that may also cause an increase in ovarian size. A cyst in an ovary may be part of the ovary’s normal function, or it may be part of a tumor. These cysts may cause pain and pressure symptoms, or may be completely ‘silent’. Those cysts that have not caused pain are usually found during gynecologic exam or ultrasound.
Ovarian cysts are common and will resolve over time, thus confirming that they were functional cysts instead of something more serious. Ovarian cysts may result from corpus luteum cysts, malignancy or dermoid cysts. They are most common between the ages of 20 and 35 and in women who have endometriosis, pelvic inflammatory disease (PID) or the eating disorder bulimia. Those who take a drug for epilepsy called Valporate are also at increased risk.A follicular cyst is one in which the egg-making follicle of the ovary enlarges and fills with fluid. A corpus luteum cyst is a yellow mass of tissue that forms from the follicle after ovulation. These types of cysts come and go each month and are associated with normal ovarian function.
Types of Cyst
- Functional cysts – are the most common type. These cysts are related to variations in the normal function of the ovaries. For example, they form when an egg fails to release as it should during normal ovulation. They can last 4-6 weeks. Rarely do they secrete hormones.
- Abnormal or neoplastic cysts – result from cell growth and are mostly benign. In rare cases, they can be cancerous. Abnormal cysts require medical treatment by your doctor. Examples include:
- Dermoid cyst – which consists of a growth filled with various types of tissue such as fatty material, hair, teeth, bits of bone and cartilage.
- Polycystic ovaries – caused by a buildup of multiple small cysts which cause hormonal imbalances that can result in irregular periods, body hair growth and infertility. Polycystic Ovary Syndrome, a separate condition, causes follicular cysts to develop as a result of pituitary overproduction of luteinizing hormone in an attempt to initiate ovulation.
When an ovarian cyst is found, the first important decision to be made is whether this cyst will go away without treatment. Spontaneous resolution is expected and normal for the functional cysts related to ovulation. Women with healthy ovaries normally release an egg from a small ovarian cyst each month. The small cyst becomes a corpus luteum cyst and then lasts for two to three weeks waiting to support a new pregnancy. If pregnancy does not occur, the woman will experience a menstrual period as part of the process of the disappearing corpus luteum cyst. These normal cysts, also called functional cysts, are usually only 2-3cm in size but may reach 6-8cm if filled with blood or lots of fluid. Functional cysts resolve within one to two menstrual cycles and so can be identified by their disappearing behavior. Their presence explains why women of reproductive age have small cysts in the ovary all the time. What is not as common are functional cysts that grow so fast as to cause pain, or so large as to be easily felt on exam.
Your doctor may order a pelvic ultrasound if a mass is found during the pelvic exam. The ultrasound will evaluate the ovaries and any suspected cysts. Functional cysts are characterized by being fluid-filled and composed of one single sac or chamber. The ultrasound can identify the cyst as being single-chambered. Confirming a functional cyst means it will not likely need treatment and should simply be observed. If that cyst does persist over two to three months, then it should be re-evaluated and treated.
Any ovarian growth with multiple cystic areas or mixed solid and cystic features should be considered a tumor and possibly a malignancy. These should be surgically removed to determine the exact diagnosis. When a functional cyst or simple benign tumor is identified, the ovary can be preserved for younger women because only the cyst is removed in those cases.
Signs, symptoms & indicators of Ovarian Cysts
(Left/right) lower abdominal ache
Severe/severe left/severe right lower abdominal pain
Slight/intermittant/constant abdominal fullness
Unexplained vomiting
Having a moderate/having a slight/having a high fever
Frequent/occasional unexplained fevers
Irregular menstrual cycles
Painful menstrual cramps
Conditions that suggest Ovarian Cysts
Bulimic Tendency
Polycystic or multifollicular ovarian cysts are common in bulimics.
Risk factors for Ovarian Cysts
History of painful menstrual cramps
Recommendations for Ovarian Cysts
Castor Oil
Castor oil packs can help reduce inflammation.
Progesterone
Intravaginal application of progesterone cream provides higher doses where needed in cases of endometriosis, fibroids and ovarian cysts.
The signaling mechanism that shuts off ovulation in one ovary each cycle is the production of progesterone in the other. If sufficient natural progesterone is supplemented prior to ovulation, LH levels are inhibited and both ovaries think the other one has ovulated, so regular ovulation does not occur. This is the same effect as contraceptive pills. Similarly, the high estriol and progesterone throughout pregnancy successfully inhibit ovarian activity for nine months. Therefore, adding natural progesterone from day 10 through 26 of the cycle suppresses LH and its luteinizing effect. Thus, the ovarian cyst will not be stimulated and, in the passage of one or two such monthly cycles, will very likely shrink and disappear without further treatment.
Hydrotherapy
Contrast sitz baths, using separate basins of hot and cold water, can improve circulation in the pelvic area, speeding healing and reducing pelvic pain and treating ovarian cysts. Submerge the hips in the bath at least up to the level of the belly button. Begin with a three to four minute soak in hot water, followed by a 30 to 60 second cold soak. Repeat three to five times, ending with cold.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| May do some good |
| Likely to help |
Glossary
Cysts
A closed pocket or pouch of tissue; a cyst may form within any tissue in the body and can be filled with air, fluid, pus, or other material. Cysts within the lung generally are air filled, while cysts involving the lymph system or kidneys are fluid filled. Cysts under the skin are benign, extremely common, movable lumps. These may develop as a result of infection, clogging of sebaceous glands, developmental abnormalities or around foreign bodies.
Ovarian Cysts
These occur in two forms, namely "functional" and "organic". may not be present but can include pressure or pain in the abdomen, problems with urine flow or pain during sexual intercourse. Rarely, a very large cyst can become twisted and stop its own blood supply, possibly causing nausea, fever or severe abdominal pain. Functional ovarian cysts form part of the normal functioning of the ovary and are always benign. They may be either "follicular cysts", produced by all menstruating women every month and reaching up to 2-3cm in diameter before they rupture at ovulation, or "corpus luteum cysts", which appear after ovulation and may grow to produce "hemorrhagic cysts" if ovulation does not occur or is delayed. Rupture of such a cyst can sometimes cause painful ovulation or bleeding, which is often moderate and resolves by itself. Organic ovarian cysts may be benign or malignant and are not linked to the functioning of the ovary. They occur as either "dermoid cysts", which are benign tumors that may nevertheless recur on either ovary and contain elements derived from the skin (hairs, sebum, teeth), or other organic cysts.
Corpus Luteum
Yellow endocrine body formed in the ovary that secretes estrogen.
Endometriosis
A condition whereby endometrial tissue builds up in parts of the uterus where it does not belong or areas outside of the uterus, forming 'ectopic implants'. Unlike the normal tissue lining the uterus, ectopic tissue has no place to shed in response to a decline in estrogen and progesterone. This results in debris and blood accumulating at the site of the implant leading to inflammation, scarring and adhesions that ultimately cause symptoms and complications. Symptoms typically occur in a cyclic fashion with menstrual periods, the most common being pelvic pain and cramping before and during periods; pain during intercourse; inability to conceive; fatigue; painful urination during periods; gastrointestinal symptoms such as diarrhea, constipation, and nausea.
Pelvic Inflammatory Disease
(PID) A Purulent (pus-like) vaginal discharge with fever and lower abdominal pain.
Bulimia Nervosa
An eating disorder characterized by lack of control - abnormal eating behavior including dieting, vomiting, purging and particularly bingeing that is usually associated with normal weight or obesity (unlike anorexics, who tend to be considerably underweight). The syndrome is associated with guilt, depressed mood, low self-esteem and sometimes with childhood sexual abuse, alcoholism or promiscuity.
Epilepsy
Chronic brain disorder associated with some seizures and, typically, alteration of consciousness.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Benign
Literally: innocent; not malignant. Often used to refer to cells that are not cancerous.
Cartilage
Specialized fibrous connective tissue that forms the skeleton of an embryo and much of the skeleton in an infant. As the child grows, the cartilage becomes bone. In adults, cartilage is present in and around joints and makes up the primary skeletal structure in some parts of the body, such as the ears and the tip of the nose.
Pituitary
The pituitary gland is small and bean-shaped, located below the brain in the skull base very near the hypothalamus. Weighing less than one gram, the pituitary gland is often called the "master gland" since it controls the secretion of hormones by other endocrine glands.
Luteinizing Hormone
Anterior pituitary hormone stimulating estrogen production by the ovary; promoting formation of progesterone by the corpus luteum in women and stimulating testosterone release in men.