Ovarian Cysts: Symptoms, Causes, and Treatment Options

Most women get scared by the term "ovarian cyst" on the ultrasound report, even if they don't have any symptoms. In fact, ovarian cysts are one of the most common gynaecological findings in women of reproductive age and the majority of them do not warrant any treatment at all. They develop as part of the menstrual cycle and fade in a month or two, sometimes without the woman realizing the presence of spots.

Unfortunately, not all cysts are the same. Tiny, fluid-filled follicular cysts, which will resolve by the following period, are a completely different clinical scenario from an endometrioma that will continue to slowly deplete ovarian reserve, or a dermoid that is potentially dangerous to rupture. The most helpful thing a gynecologist in Jaipur can do is to help you determine what sort of ovarian cyst you have, what its symptoms actually indicate, and whether or not the ovarian cyst treatment is really needed, or watchful waiting is the proper, evidence-based approach.

What is An Ovarian Cyst?

An ovarian cyst is a balloon-like sac filled with liquid or solid material that forms in or on one of the two ovaries. The two almond-shaped ovaries manufacture eggs and oestrogen and progesterone hormones. Cysts may develop on either ovary, are a few millimetres to several centimetres in size and contain clear fluid, blood, fatty tissue or a mixture of all three.

The American College of Obstetricians and Gynecologists (ACOG) states that ovarian cysts are very common in women during their pre-menopausal years and are found on pelvic ultrasound during a large number of routine exams. The clinical difference is between functional cysts that occur as part of the normal cycle and are usually not there for long and pathological cysts that occur abnormally and which do not resolve.

Types of Ovarian Cysts: Functional vs Pathological

There are two types of ovarian cysts: functional and pathological.

The table below contains the primary types, their features and if they are likely to improve without treatment:

Type	Category	Description	Resolves Alone?
Follicular Cyst	Functional	A follicle does not break open and release an egg; becomes filled with fluid.	Yes, within 1-2 cycles
Corpus Luteum Cyst	Functional	Follicle seals to release egg and becomes filled with fluid.	Yes, within 1-3 months
Endometrioma(Chocolate Cyst)	Pathological	Ovary has endometrial tissue, which is dark fluid-filled and bleeds during menstruation.	No, requires treatment
Dermoid Cyst(Teratoma)	Pathological	Originating in tissues like hair, skin or fat, and forming from germ cells	To take away a tumor - No
Cystadenoma	Pathological	Grows from surface of ovary; may be large; serous or mucinous	No - monitoring and frequently surgery
PCOS-related Cysts	Functional / Hormonal	Polycystic ovary - multiple small follicles not actual cysts	Managed medically

The most significant difference in practice is the difference between the first two rows and all the rest. The functional cysts (follicular and corpus luteum) are not diseases. They are a natural result of ovulation and typically go away on their own in 6-12 weeks. It is correct to reassure and to perform an ultrasound follow-up. Pathological cysts (endometriomas, dermoids and cystadenomas) will not go away on their own and will need management decisions.

Causes of Ovarian Cyst Formation?

Once you know the causes of an ovarian cyst, you'll have an idea of why certain cysts are present and how they're treated unlike others.

Hormonal Fluctuation (Functional cysts): These are cysts that develop during hormonal changes in the body.

The ovary makes a fluid-filled sac called a follicle each month, which holds a growing egg cell. During the normal cycle, the follicle breaks open at ovulation, allowing the egg to be released. It can keep filling with fluid to form a follicular cyst if it does not burst open. Following ovulation, the emptied-up follicle (corpus luteum) may also become fluid-filled instead of dissolving. These are purely hormonal, and are the body's normal though not always reliable cycle physiology.

Endometriosis (Endometriomas)

In endometriosis, the tissue that normally lines the inside of the uterus forms on the outside. This tissue can spread onto the ovary and bleed during each period, a blood build up eventually forming a dark brown "chocolate" cyst. Chronic pelvic pain, painful periods, pain during sexual intercourse and decreased fertility are all highly correlated with endometriomas. They are not cured by themselves and if not treated properly, can slowly destroy healthy ovarian tissue.

Developmental Origin (Dermoid Cysts):

The origins of dermoid cysts are totipotent germ cells that are the cells capable of forming any kind of tissue. That's why they're so weird: They have hair, skin tissue and cartilage, teeth, and fat inside them. Grow slowly, benign, most often in younger women. There is no medical management and they must be surgically removed.

Surface Growth (Cystadenomas)

Cystadenomas arise from the epithelial (surface) cells of the ovary and get filled with either a watery fluid (serous cystadenoma) or with a thick mucous material (mucinous cystadenoma). They can get very large without any symptoms, especially mucinous cystadenomas. They are generally not serious but must be monitored carefully because they occur from the surface and are on the spectrum towards ovarian neoplasia.

Hormonal imbalance and PCOS.

Polycystic Ovary Syndrome (PCOS) is a common condition that can be mistaken for ovarian cysts. In PCOS, there are many small follicles in the ovary which have not fully developed to ovulate; these are not PCOS cysts but rather arrested follicles. It is not caused by a structural problem with the ovary, but by insulin resistance and androgen excess. So the treatment of PCOS is not the same as the treatment of any single ovarian cyst, as it requires hormonal and metabolic management more than surgery.

Ovarian Cyst Symptoms: An incidental discovery to an emergency.

Ovarian cyst symptoms are present on a spectrum. Some women do not have any symptoms and find out about a cyst when they get a routine scan. Others have a variety of symptoms, from discomfort to emergencies.

In roughly 90% of individuals, symptoms are mild and may involve a stomach ache or a headache, or even no symptoms at all.

Most ovarian cysts, especially functional cysts, don't cause any symptoms. They are discovered during an examination of the pelvis for a different purpose and do not lead to any pain, disorder of the period or any complaint. In these situations the clinical question is not "how do we treat this" but rather "is this a cyst that needs to be monitored?

Mild to Moderate symptoms

Fullness or heaviness of the pelvis:A feeling of fullness or heaviness in the lower abdomen, usually worsened by sitting or lying in specific positions

Irregular or heavy periods:Hormonal disruption associated with functioning or endometriotic cysts can result in irregular periods, heavy bleeding and pain during periods.

Bloating and swelling of the abdomen: Larger cysts push other organs of the abdomen out of place and lead to abdominal swelling.

Pain with sexual penetration (dyspareunia): This is more likely to be caused by endometriomas and larger cysts that are causing displacement.

Incomplete emptying of the bladder or urinary frequency:When a large cyst presses on the bladder, its capacity is diminished.

Lower back pain: Referred from a large cyst which compresses or displaces pelvic structures.

Symptoms that are urgent to evaluate:

If you develop any of these symptoms, get medical help right away:

Sudden, severe pain on one side of the pelvis after a rapid onset ovarian torsion (twisted cyst which compromises blood flow to the ovary) or cyst rupture are emergency states that must be treated quickly and effectively.

Fever and abdominal pain, it indicates the infection in the cyst or peritonitis after rupture.

Feeling faint, dizzy, lightheaded, and get abdominal pain could mean that there is haemorrhage in the cyst and bleeding inside.

Torsion is characterized by vomiting and intense abdominal pain, and must be treated with surgery within several hours to save the ovary.

Mayo Clinic's clinical overview of ovarian cysts indicates that abrupt, intense pelvic pain, fever and vomiting are medical emergencies. Next day will not be the day to make an appointment with a female gynaecologist in Jaipur or the emergency department.

Diagnosing ovarian cysts.Diagnosing the cysts.

Transvaginal ultrasound or abdominal pelvic ultrasound is the most common way the majority of ovarian cysts are diagnosed. The ultrasound may help determine the size, location and texture of the cyst (smooth or irregular), and if it contains any solid material or echoes that indicate the presence of blood or fatty tissue. These ultrasound characteristics can help differentiate functional vs pathological cysts and can be used to help determine the need for prompt follow-up.

Other tests a best gynecologist in Jaipur might conduct include:

Blood test – CA-125: A blood test that is raised in some ovarian cancers. Importantly, CA-125 is also raised in endometriosis, fibroids and infection and so is not diagnostic alone. Best used in women after menopause in which malignancy is a formal diagnosis to exclude in women with complex cysts.

MRI or CT scan: When ultrasound is not conclusive or if a cyst is of a character that needs to be better defined before making a surgical decision.

HCG (pregnancy test): R rules out ectopic pregnancy which can have the same symptoms as a ruptured ovarian cyst and is always necessary to be ruled out.

Hormonal panel (FSH, LH, AMH, testosterone): Relevant when a PCOS-pattern of multiple follicles is seen and clinical assessment is needed to distinguish PCOS from other hormonal causes.

Ovarian Cyst Treatment in Jaipur

There is a time when you don't need to treat the cyst, and that time is now for functional cysts.

In a clinical review published in 2018 in PMC, it is confirmed that in pre-menopausal women, cysts that are less than 5 cm in size have a high rate of spontaneous resolution and should not be surgically removed.

The usual method is a repeat ultrasound done at 6-12 weeks to make sure it resolves. Watchful waiting is dangerous when given wrong indications like endometriomas – it can cause loss of ovarian tissue over time and decrease ovarian reserve. It is a clinical decision, not the patient's choice, whether a cyst is functioning or pathological, and thus requires action versus watchful waiting.

Medical Management

Hormonal contraceptives can be used to suppress new cyst formation in women who have had recurrent functional cysts, by preventing ovulation. It is not a treatment for a pre-existing cyst – it does not break down an existing cyst – but it is an evidence-based approach to preventing a cyst recurring in selected patients. Hormonal treatment may help suppress endometriosis, but won't effectively cure endometriomas that have already formed.

Laparoscopic Cystectomy The Preferred Surgical Approach.

If surgery is the only option, laparoscopic cystectomy is the recommended procedure. The cyst is removed using 3-4 small incisions, less than 1 centimetre, and the healthy ovarian tissue is preserved. In this way, fertility-preserving surgery operates: The removal of the cyst wall without the destruction of the surrounding ovarian cortex or the follicular reserve.

Laparoscopic cystectomy vs open surgery

• Surgery: Laparoscopic (24 hours hospital stay) or open (3-5 days hospital stay)
• Return to normal activity:7-14 days versus 4-6 weeks
• Scarring: 3–4 small scars (which are less than 1 cm) vs single large scar in the abdomen.
• Fertility outcomes: Preservation of ovarian tissue is better with the use of the laparoscopic technique.
• Blood loss: Much less with laparoscopy, open surgery can be critical if patient has anaemia due to chronic bleeding

Open surgery (laparotomy) should be reserved for the presence of any suspicious features for malignancy, very large cysts that cannot be removed laparoscopically or when dense adhesions are formed from previous laparotomy, and laparoscopy would be unsafe. The surgeon will make these decisions based upon imaging and clinical history.

Torsion and Rupture requires emergency surgery.

When the cyst twists the ovary on its blood supply, it is a surgical emergency known as ovarian torsion. The longer the wait for surgery, the less likely it is that the ovary can be saved. Furthermore, if there is a large amount of haemorrhage, then emergency surgery is necessary. Both conditions are characterized by an abrupt onset of severe pain in one pelvis and should be regarded as emergencies and not as something for which treatment should be undertaken at home.

Ovarian Cysts and Fertility

Cysts that function do not affect fertility and clear up without disrupting ovulation. The primary type of cyst that causes decreased fertility is called endometrioma; as they grow, endometrioma is a progressive process that depletes the follicular reserve in the adjacent ovarian cortex tissue. Surgery to remove the condition restores fertility for many who have it, but there is also a loss of healthy tissue during the surgery and there is an element of timing and technique.

Dermoid cysts do not directly cause any problems with ovulation, however, if they rupture, it can lead to chemical peritonitis, which can cause damage to the fallopian tube and lead to adhesions occurring. Any female trying to conceive with an ovarian cyst needs to have an in-depth discussion with a best gynecology hospital in jaipur specialist, as the type of ovarian cyst will dictate the urgency and approach.

Ovarian Cyst Care at Jaipur Vatika Hospital

Dr. Rinku Barwar MBBS, DGO   FOGSI Manyata Certified, Obstetrics and Gynaecology department at Jaipur Vatika Hospital provides the treatment of all types of ovarian cysts in a hospital environment at Thikariya, Jaipur-Ajmer Expressway.

Same visit diagnostics: Pelvic Ultrasound referral and NABL accredited in-house blood tests such as CA-125 and hormone panel, all within the same day no external delay required.

Laparoscopic cystectomy: Surgical procedure to remove the bladder using a keyhole approach and performed in hospital under general anaesthetic and under full monitoring in ICUs

Emergency gynaecological service: 24 hours a day emergency service for ovarian torsion and ruptured cyst (surgical intervention is required on the same day)

Fertility-aware planning: All reproductive-age women surgical procedures performed with awareness of the implications of ovarian reserve and fertility before surgery.

Emergency: On the Ajmer Expressway, at Thikariya, the location is direct, no traffic in the city centre in case of emergency, and is just below 15 minutes from Bagru, as well as from Dudu.

Conclusion

Ovarian cysts, in the majority of cases, are not pathological, harmless, and will resolve on their own. The medical acumen is in determining which are the minority of cases that are pathological and should be actively treated, and in planning that treatment – including with the aim of either relieving symptoms or preserving fertility. If you have a diagnosis of ovarian cyst or if you have other symptoms that are not related to the menstrual cycle, it is recommended to consult a highly experienced specialist.

Thikariya on the Ajmer Expressway provides same-visit ultrasound coordination, in-house diagnostics, laparoscopic cystectomy and 24/7 emergency gynaecological services from the Obstetrics & Gynaecology department at Vatika Hospital in the city of Jaipur. Book via the JVH E-Consultation App or call +91-8209809753.