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DESCRIPTION
The ovaries are a pair of organs in the female reproductive system. They are located in the pelvis, one on each side of the uterus, which is the hollow, pear-shaped organ where a baby grows. Each ovary is about the size and shape of an almond. The ovaries produce eggs and female hormones. Hormones are chemicals that control the way certain cells or organs function.
Every month, during the menstrual cycle, an egg is released from one ovary in a process called ovulation. The egg travels from the ovary through the fallopian tube to the uterus. The ovaries are also the main source of the female hormones estrogen and progesterone. These hormones influence the development of a woman's breasts, body shape, and body hair. They also regulate the menstrual cycle and pregnancy.
A cyst is a fluid-filled sac, and can be located anywhere in the body. On the ovary, different types of cysts can form and can contain fluid or semi-solid material. The most common type of ovarian cyst is called a functional cyst, which often forms during the normal menstrual cycle. Each month, a woman's ovaries grow tiny cysts that hold the eggs. When an egg is mature, the sac breaks open to release the egg, so it can travel through the fallopian tube for fertilization. Then the sac dissolves. In one type of functional cyst, called a follicular cyst, the sac doesn't break open to release the egg and may continue to grow. This type of cyst usually disappears within one to three months. A corpus luteum cyst, another type of functional cyst, forms if the sac doesn't dissolve. Instead, the sac seals off after the egg is released. Fluid then builds up inside of it. This type of cyst usually goes away on its own after a few weeks. However, it can grow to almost four inches and may bleed or twist the ovary and cause pain. Clomid or Serophene, which are drugs used to induce ovulation, can raise the risk of getting this type of cyst. These cysts are almost never associated with cancer.
There are also other types of cysts:
- Endometriomas. These cysts develop in women who have endometriosis, when tissue from the lining of the uterus grows outside of the uterus. The tissue may attach to the ovary and form a growth. These cysts can be painful during sexual intercourse and during menstruation.
- Cystadenomas. These cysts develop from cells on the outer surface of the ovary. They are often filled with a watery fluid or thick, sticky gel. They can become large and cause pain.
- Dermoid cysts. The cells in the ovary are able to make hair, teeth, and other growing tissues that become part of a forming ovarian cyst. These cysts can become large and cause pain.
- Polycystic ovaries. The eggs mature within the follicles, or sacs, but the sac doesn't break open to release the egg. The cycle repeats, follicles continue to grow inside the ovary, and cysts form.
Ovarian cysts are usually small, but in some cases, they may grow large enough to make a woman appear pregnant. Often, the largest ovarian tumors turn out to be benign. In some cases, the tumor may have features that suggest it will behave as a cancer, but over a long period of time (10 to 20 years). These are called low malignant potential overian tumors or borderline ovarian tumors.
Polycystic ovary syndrome (PCOS) is a disorder in which the ovaries are enlarged and contain many small cysts (fluid-filled sacs). PCOS occurs as a result of an increase in the production of androgens (male hormones) by the ovaries and the adrenal glands. Women with PCOS may have irregular or no menstrual periods. PCOS is a condition that can last many years and can have a major impact on a woman's health.
MoonDragon's Obgyn Information: Polycystic Ovary Syndrome
In the US: Ovarian cysts occur in 30% of females with regular menses, 50% of females with irregular menses, and 6% of post-menopausal women.
THE MENSTRUAL CYCLE
An average menstrual cycle is about 28 days, including 5-7 days of bleeding - counting the first day of bleeding as day 1. Normal cycles can vary from 23 to 35 days. During the menstrual cycle, the ovaries produce hormones that prepare the lining of the uterus - the endometrium - for a possible pregnancy.
Hormones trigger the menstrual cycle. From about day 5 to day 14, the hormone estrogen signals the endometrium to thicken. Or about day 14, an egg is released from one of the ovaries. This process is called ovulation. After ovulation, the hormone progesterone causes blood vessels in the endometrium to swell and other changes to occur in preparation for a possible pregnancy.
After the egg is released from the ovary, it moves into one of the fallopian tubes connected to the uterus. If an egg joins with a sperm in the fallopian tube, it is fertilized. After the egg is fertilized, it travels through the fallopian tubes to the uterus. It then attaches to the endometrium and begins to grow.
If the egg is not fertilized, the hormone levels decrease, and the endometrium is shed with some bleeding (menstrual period) on about day 28. The first day of the menstrual period marks the start of a new cycle (day 1).
PCOS AND MENSTRUATION
Everyone has both male and female hormones. PCOS occurs as a result of in increase in the production of androgens (male hormones) by the ovaries and the adrenal glands. In PCOS, the ovaries often become enlarged and contain many small cysts. The increase in androgen causes the irregular menstrual periods and may stop ovulation. Because of this, women continue to make estrogen, but they do not produce progesterone.
In some women, the presence of estrogen without progesterone increases the risk that the endometrium will grow too much. This is a condition called endometrial hyperplasia. If untreated over a long time, endometrial hyperplasia may turn into cancer. PCOS is linked to other diseases that occur later in life, such as diabetes, atherosclerosis, and high blood pressure.
FREQUENT SIGNS & SYMPTOMS
Many women have ovarian cysts that may not cause symptoms. If symptoms occur, they may include:
- Mild pelvic pain, pressure, fullness or pain in the abdomen.
- Pain or dull ache in the lower back and thighs.
- Discomfort or pain with/during sexual intercourse.
- Problems with passing urine completely.
- Abnormal bleeding with menstruation, including changes in menstrual flow, length of periods and intervals between periods. PCOS may have irregular or no menstrual periods. Painful menstrual periods.
- Nausea or vomiting.
- Breast tenderness.
- Excessive hair growth, deep voice and weight gain (sometimes). PCOS may produce excess hair on the face and body (Known as hirsutism), acne, obesity and infertility.
- If a large ovarian tumor twists or ruptures, the following will occur in the lower abdomen -- severe pain, rigid muscles, swelling.
If you have any of these symptoms, you should contact your health care provider and get help right away by going to your clinic or the emergency room of your local hospital:
- Pain with fever and vomiting.
- Sudden, severe abdominal pain.
- Faintness, dizziness, or weakness.
- Rapid breathing.
CAUSES
Usually unknown, but it is probably related to abnormalities in female hormone production and secretion.
Endometriosis.
RISK INCREASES WITH
Unknown. However, functional ovarian cysts usually occur during the childbearing years. Most often, cysts in women of this age group are not cancerous. Women who are past menopause (ages 50-70) with ovarian cysts have a higher risk of ovarian cancer. At any age, if you think you have a cyst, it is important you contact your health care provider.
PREVENTIVE MEASURES
No specific preventive measures are available since ovarian cysts cannot be prevented. Fortunately, the vast majority of cysts don't cause any symptoms, are not related to cancer, and usually go away on their own without treatment. Discuss with your health care provider any changes you experience in your period, pain in the pelvic region, or any of the major symptoms given above. An exam, possibly with an ultrasound, can help determine if a cyst is causing a problem.
Women not seeking pregnancy and developing functional cysts may use hormone therapy in the form of oral contraceptives, Depo-Provera, Norplant, or other hormone-contraception. Hormone therapy may prevent cyst formation. Use caution when using oral contraceptives or any hormone-based treatment as they may produce serious side effects in some women.
EXPECTED OUTCOME
Most ovarian tumors require no treatment and disappear spontaneously within 2 months. In other cases, treatment usually provides a complete cure.
POSSIBLE COMPLICATIONS
Emergency abdominal surgery caused by twisting, rupture or bleeding of the ovary.
Death and illness be caused by pain from rupture, hemorrhaging with rupture, peritonitis, adnexal torsion, infertility, irregular vaginal bleeding, dysmenorrhea, dyspareunia, and underlying malignancy.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
Diagnostic tests include laboratory blood studies and pelvic examination. Since ovarian cysts may not cause symptoms, they are usually found during a routine pelvic exam. During this exam, your health care provider is able to feel the swelling of the cyst on your ovary. Once a cyst is found, your health care provider may perform an ultrasound (sonogram), which uses sound waves to create images of the body. With an ultrasound, the cyst can be seen and its shape, size, and location is noted. The ultrasound can tell whether it is fluid filled, solid or mixed. Usually, ultrasound studies with and without blood flow measurements to the involved ovary are useful for diagnosis and to help determine the best therapy. The ultrasound/sonogram can be done either through your abdomen or your vagina.
A pregnancy test may also be done. Hormone levels in your blood, such as LH, FSH, estradiol, and testosterone, may also be checked.
Your health care provider may want to do other tests to help with or confirm diagnosis. Laparoscopy (a telescopic instrument with fiber optic light is used to examine the abdominal cavity) in some cases, and rarely, a CT scan or MRI may be recommended.
To find out if the cyst might be cancerous, your health care provider may do a blood test to measure a substance in the blood called CA-125. The amount of this protein is higher if a woman has ovarian cancer. However, some ovarian cancers do not make enough CA-125 to be detected by the test. There are also non-cancerous diseases that increase the levels of CA-125, like uterine fibroids and endometriosis. These non-cancerous causes of increased CA-125 are more common in women under 35, while ovarian cancer is very uncommon in this age group. For this reason, the CA-125 test is recommended mostly for women over age 35, who are at high risk for the disease and have a cyst that is partially solid.
TREATMENT
Treatment may not be necessary, except to have regular pelvic examinations so the tumor's growth can be monitored. Watchful waiting in which the patient waits and gets re-examined in one to three months to see if the cyst has changed in size. This is a common treatment option for women who are in their childbearing years, have no symptoms, and have a fluid-filled cyst. It also might be an option for post-menopausal women.
Some tumors require surgery to diagnose accurately, ruling out malignancy, or to treat. If the cyst doesn't go away after several menstrual periods, has gotten larger, looks unusual on the ultrasound, causes pain, or you're post-menopausal, your health care provider may want to remove it. There are two main surgical procedures:
- Laparoscopy - If the cyst is small (the size of a plum or smaller) and looks benign on the ultrasound, your health care provider may perform a laparoscopy. This procedure is done under general anesthesia. A very small incision is made above or below the navel, and a small instrument that acts like a telescope is inserted into the abdomen. If the cyst is small and looks benign, it can be removed through a small incision in the pubic hair line.
- Laparotomy - If the cyst is large and looks suspicious, your health care provider may perform a procedure called a laparotomy. This procedure involves making bigger incisions in the stomach to remove the cyst. While you are under general anesthesia, the practitioner is able to have the cyst tested to find out if the tissue is cancerous. If it is cancerous, she/he may need to remove the ovary and other tissues that may be affected, like the uterus or lymph nodes.
If one ovary must be removed, normal conception and childbirth is possible as long as a normal ovary remains on the other side.
OTHER TREATMENT OPTIONS
If you are overweight, losing weight can help relieve the symptoms of PCOS. Weight loss can also help lower the risk of other long-term conditions.
Oral contraceptives (birth control pills) may be prescribed. If you develop cysts, your health care provider may want you to use hormone therapy, as found in birth control pills, to prevent you from ovulating. This will lower the chances of forming new cysts. Before using hormonal treatment, be sure you discuss with your health care provider the risks and benefits as well as side effects associated with oral hormone therapy. Women with a past history of adverse reactions to oral contraceptives, have health issues that are contraindicated or lifestyle concerns, such as smoking, should not take them.
HELPFUL RESOURCES
American Academy of Family Physicians (AAFP)
Internet Address: http://familydoctor.org
Agency for Healthcare Research & Quality (AHRQ) Phone: (800) 358-9295
Internet Address: http://www.ahrq.gov
American Society for Reproductive Medicine (ASRM)
Phone: (205) 978-5000
Internet Address: http://www.asrm.org
National Institute of Child Health and Human Development (NICHD)
Phone: (800) 370-2943
Internet Address: http://www.nichd.nih.gov/womenshealth
InterNational Council on Infertility Information Dissemination, Inc. (INCIID)
Phone: (703) 379-9178
Internet Address: http://www.inciid.org
MEDICATION
Female hormones or clomiphene may be prescribed. These help to shrink or destroy some tumors. Oral contraceptives are often used as the first step in treatment. The hormone progesterone may be used alone or in combination with other hormones. Use oral contraceptive with caution as they may produce some serious side effects.
Women who wish to become pregnant may be given fertility drugs instead of birth control pills.
Birth control pills or other hormones may be used to slow the growth of new excess body hair. It may take several months, however, before you will notice the results. To remove unwanted hair sooner, you may want to try electrolysis or other hair removal methods.
ACTIVITY
No restrictions if surgery is not necessary.
DIET
No special diet. However, you should follow a nutritious diet keep a healthy immune system to prevent infection. If you are overweight, try to lose the extra pounds.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or your family member has symptoms of an ovarian tumor or cysts, especially severe pain, rigidity and abdominal distension.
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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