Normal women have small white organs called
ovaries placed by the side of the womb. They are normally about half a lemon
in size and are responsible for the production
of hormones called oestrogen and progesterone in the
body. They extrude human eggs or ova every month by a process called
the follicles which harbour these ova get filled with a
watery fluid or even blood . This
gives rise to what are called ovarian cysts. They are basically membranous
sacs in the ovary filled with fluid.
More often than not, these ovarian
cysts are harmless and could be left alone.
But there are situations where surgical intervention
will be needed.
The various types of ovarian cysts generally found are described below:
Harmless functional cysts:
Due to the routine
use of ultrasonography for a myriad of conditions,
ovarian cysts are normally found in many womenThey could be harmless cysts which are called
‘’functional cysts”. They
normally appear and disappear by themselves.
By and large simple cysts that
are less than 5-6 cm in size do not need any intervention.
A repeat ultrasonography after
3 months may show disappearance of the
cyst. If the cyst persists, it is better to have the cyst removed
by a procedure called ovarian
If a woman has a simple cyst of 5-6cm size, should she take any precautions?
In women with 5-6cm cysts, it would be better to avoid sudden movements like dancing, jumping etc for a couple of months, as the cysts
may twist and cause pain. Once twisted, if it worsens, surgery may be required. After a couple of months, the cyst may disappear by
itself. If the cyst has twisted, there may be vomiting,with severe abdominal pain.
Twisted ovarian cysts:
Sometimes the cysts turn around or undergo a twist, so to say.
This is usually associated with intermittent abdominal pain,. The pain
is usually more in certain positions, like turning on to one side. Sometims
it may be accompanied by vomiting.
A twisted ovarian cyst, if left alone, will
have a jeopardised blood supply and this will lead to gangrene of the
ovary.In the picture, you can see a blackened ovary which has undergone gangrene twist for a long time.
So whenever there is acute pain in the abdomen and an ovarian
cyst is diagnosed, the woman is subjected to surgery, usually ovarian
cystectomy. It can be done laparoscopically in
places there are facilities to do the procedure or by open surgery.. If
surgery is delayed and the ovary has undergone gangrene, the ovary will
have to be sacrificed.
Can twisted ovaries untwist?
Sometimes an ovarian cyst may twist badly with the patient getting severe symptoms. When the symptoms are severe, the doctor may advice surgery. Meanwhile
with some sudden movement the cyst may untwist and the pain may go off. Thus a woman who was advised surgery is suddenly relieved of her symptoms without
needing surgery. this leads to doubts in the minds of the patients and her helpers that the doctor had ordered unnecessary surgery. However, as far as the doctor is concerned,
it is difficult to take the chance that the twist may go off. If the twist does not go off, the ovary will undergo gangrene and become useless. Therefore, the doctor would
rather be safe in the presence of severe symptoms.
If a schoolgoing or college going girl develops a twisted ovary, will surgery for the twist jeopardise her potential for fertility in future?
Generaly, ovarian cysts that twist are harmless functional ovarian cysts. Untwisting such cysts with ovarian cystectomy will not jeopardise her potential for fertility
in future. There is no need to be guilty of having a less perfect ovary just because one has undergone ovarian cystectomy in a twisted ovary.
Will the cysts recur?
Functional cysts may seldom recur, though it is very uncommon. Taking medications like oral contraceptive pills can prevent ovulation and thereby cyst formation for a while.
However, it is strogly recommended that young girls should not get their ovaries removed just because they are scared that there may be a recurrence of cyst in the ovary.
Ovaries are valuable organs and should not be destroyed by any means.
If a woman gets ovarian cyst after the age of 40 is it not better to remove the uterus also?
In this age group, special tests like ultrasonography and CA125 can determine if the cyst is cancerous or not. If there are no indications that the cyst is cancerous,
it is better to remove only the cyst. Hysterectomy, the surgery for removing the uterus is a more complicated surgery and should not be undertaken unless the uterus has
some problem in it requiring removal. In certain cases, the ovary may be removed on the whole.
What if a woman gets a cyst after menopause?
If the cysts are just 3-4 cm in size , simple, and there are no indication that the cyst is harmful, it is better to wait to see if the cyst will disappear.
Sometimes the ovarian cyst is filled with dark,
chocolate coloured fluid, which is old blood. This is caused in women
who suffer from a disease called endometriosis. In endometriosis, a
tissue called endometrium, which normally lines the uterus,is found in
places outside the uterus. The uterus, normally sheds this endometrium
outside at the time of menstruation. Instead, if the endometrium is
found in the abdomen , the woman is said to have endometriosis. A collection
of endometrium along with blood, in the ovary, which enlarges to form
a cyst, is called an Endometrioma or Chocolate cyst. If it occurs in
women who do not have children, it may cause infertility. The ideal
treatment for endometrioma is laparoscopic ovarian cystectomy,
Endometriomas, in spite of very good surgery
do tend to recur, as, the basic disease Endometriosis,with retrograde
menstuation, where the menstrual blood goes retrograde into the abdomen,
is not cured. Repeated ovarian cystectomies in such patients will lead
to loss of precious ova. Infertile patients with recurrence of endometrioma
should think in terms of undergoing procedures like Artificial Reproductive
Technonlogy instead of undergoing repeated surgeries.
Benign ovarian tumours: Sometimes ovarian cysts are
caused by noncancerous benign tumours like serous cystadenoma, mucinous
cystadenoma, etc. These cysts do not regress and need surgical removal.
The cyst can be removed by cystectomy through laparoscope or open surgery.
Once removed , there is not much chance of recurrence.
Dermoid cysts: Sometimes, the ovarian cyst is
filled with many tissues like hair, teeth, bone, fatty sebacious material,
etc. These are called Dermoid cysts. These are called germ-cell tumours.
Usually this occurs in the younger age group. Treatment is by cystectomy.
There is very little chance of recurrence. In one study,
after Dermoid resection, 3.4% patients were seen to have
a recurrence within the study period of 6 years. Dermoids
could also occur bilaterally and there is a small risk of
malignancy in untreated patients. It is possible to get
pregnant even after removal of Dermoids.
Malignant ovarian cysts: Malignant
ovarian cysts usually occur bilaterally, although it could
also occur unilateally. Ultrasonogram
in such patients show solid elements in the ovarian cysts,
besides the usual fluid that is seen in non-cancerous cysts.
Tumour markers like CA -125 are raised in such patients.
This could be detected by testing the blood. Special ultrasound
examination like colour Doppler ultrasonography can show
increased blood flow in the cyst.
cyst is malignant, in young patients, in some particular
cases, it may suffice to remove only the affected ovary.
In most cases, in the older age group the uterus along with
both the ovaries will have to be removed . Open surgery
is the preferred modallity of surgery in these patients.
for surgery in ovarian cysts:
1. The cyst persists after 3 months; Persistent ovarian cysts could
be caused by benign ovarian tumours and need removal.
2. The cyst is associated with pain or increase
in size: Pain could be due to a twist in the ovary, which
may lead to loss of blood supply to the ovary and subsequent
death of the ovary.
3. Endometrioma: A common cause for ovarian cysts
is an endometrioma. In this
condition, menstrual blood collects over the ovary, finally
ballooning it into a blood filled sac. This is
called an endometrioma and the blood inside the
sac is usually old blood.
4. Cancerous cysts:
Cancerous cysts usually have
solid components besides the usual liquid contents
of simple ovarian cysts. These
differences could be detected by ultrasonography.
A special type of ultrasonography
called colour doppler ultrasonography could detect the presence
of increased blood flow in the ovary suggestive of malignancy
in the ovarian cyst.
Some blood tests like CA125 levels could
also be useful in the detection of malignancy.
Ovarian cysts in pregnancy:
Ovarian cysts may occur during
pregnancy. If seen in the first 3 months it could be a
functional cyst and could be left alone. If severely
symptomatic, immediate surgery may be needed. Otherwise, doctors
wait till the 4th month to see if the cyst disappears. If it
persists, ovarian cystectomy may be done
Laparoscopic ovarian cystectomy
is possible in pregnancy and is safe in pregnancy in experienced
hands. We have done 4 cases of laparoscopic ovarian cystectomy
in pregnancy in our unit and all of them had good obstetric
Q:What are the types of surgeries
performed for ovarian cysts?
A: Ovarian cysts could be removed by peeling
them off the ovaries by a procedure called
cystectomy. Sometimes the ovary is removed along
with the cyst. Both these procedures could be
done either laparoscopically where there are
just 2 or 3 holes in the abdomen and the patient
requires very little convalescence, or by open
surgery, where the abdomen will have a long cut
in it and the patient may have to refrain from
lifting heavy weights for a few months.
Disappearance of cysts:
Clinical situation: A
14 year old school girl gets mild abdominal