Ovarian Cysts and Masses can be a danger to a woman’s health and should never be ignored. An ovarian cyst is a fluid-filled sac that develops on the ovaries. Cysts are fairly common in menstruating women.
What are Ovarian Masses?
Ovarian masses are growths on or in the ovaries – the small reproductive organs located on each side of a woman’s uterus that store and release eggs and produces female hormones. At times it may be referred to as a pelvic mass. Pelvic mass is a general term for any growth or tumor on the ovary or in the pelvis. A pelvic mass can be cystic (cystadenoma), solid (fibroma), or both (dermoid). A pelvic mass can be benign or malignant.
What are the Ovaries?
The ovaries are an essential component of a woman’s reproductive system and an important part of a women’s health. They lie on each side of the uterus and produce estrogen and other hormones that are related to menstruation and pregnancy. In a monthly process called ovulation, follicles on the ovaries release a mature egg. This egg travels down the fallopian tube, where it may or may not be fertilized by a sperm.
There are many types of ovarian cysts and masses
Fortunately, most are benign, but some can become cancerous. Here are some of the more common types of issues:
This is the most common type of cyst. A functional cyst can form either when the follicle fails to release the egg or fails to dissolve after releasing the egg. Functional ovarian cysts are not the same as ovarian tumors, including ovarian cancer, or cysts due to hormone-related conditions such as polycystic ovary syndrome.
Cells on the outside surface of the ovary form cysts, typically filled with fluid.
Cysts that are composed of other types of tissue such as hair, skin, and teeth.
The endometrium, which normally lines the uterus, can grow abnormally on other organs and tissues, including the ovaries. This disease is called endometriosis.
According to the NIH, each month during a menstrual cycle, a follicle grows on the ovary. A follicle is where an egg is developing. Most months, an egg is released from this follicle. This is called ovulation. If the follicle fails to break open and release an egg, the fluid stays in the follicle and forms a cyst.
Corpus Luteum Cyst
This is another type of cyst occurs after an egg has been released from a follicle. Such cysts often contain a small amount of blood. The endometrium, which normally lines the uterus, can grow abnormally on other organs and tissues, including the ovaries. This disease is called endometriosis.
Ovarian cysts are more common from puberty to menopause. This period of time is known as the childbearing years. Ovarian cysts are less common after menopause. Some studies suggest ovarian malignancy (ovarian serous carcinomas) may originate in the fallopian tubes and then spread to the ovary. These tubal lesions have also been found to spread to the peritoneum, leading to an apparent peritoneal carcinoma. Germ cell and stromal tumors do arise from the ovary itself.
Ovarian cysts that are not part of a menstrual cycle are known as ovarian tumors. Some tumors can be cystic or filled with fluid, some can be solid, and some can have both cystic and solid components.
Symptoms of Ovarian Cysts and Masses
Many times, ovarian cysts and pelvic masses have no symptoms at all. You may not know you have a cyst or tumor until your next pelvic exam. If you are experiencing any symptoms, however, it’s very important to make an appointment with your OB-GYN to have an examination. In other cases, cysts may cause problems if they get larger, if they twist (ovarian torsion), or if they burst and cause internal bleeding. At that point, immediate attention and treatment are needed.
- Dull aching in the lower back or thighs
- Abdominal pain and bloating
- Difficult or frequent urination
- Pelvic pain shortly before or after the beginning of your menstrual cycle
- Pelvic pain with sexual intercourse (dyspareunia)
- Loss of appetite
- Nausea, vomiting or bloating
- Weight gain
- Menstrual irregularities or abnormal bleeding
- Fullness or heaviness in your abdomen
- Pressure on your bowel or pain during bowel movements
- Difficulty emptying your bladder completely
Diagnosing Ovarian Cysts and Masses
While cysts and masses are not uncommon, it’s important to have them examined by your OB-GYN. Most of the time, your OB-GYN will evaluate the mass during a pelvic exam, and then turn to more advanced technology for further examination.
Most believe that a Pap smear test can detect ovarian cancer. In fact, there is no reliable routine screening test for ovarian cancer, so women with a family history of the disease or other risk factors should talk to their doctor about genetic testing and other steps to monitor or help reduce their risk of ovarian cancer. Routine health care check-up along with cancer screening and annual pelvic examinations are recommended to follow up on symptoms of ovarian cancer.
In premenopausal women, adnexal masses include ovarian cysts, ectopic (tubal) pregnancies, benign or malignant ovarian tumors, endometriomas, polycystic ovaries, and tubo-ovarian abscess and risk of malignancy is low. In females of reproductive age, adnexal masses can be physiologic or complex. Common causes for adnexal masses in premenopausal women are follicular cysts and corpus luteum cysts. Abscesses can form as a complication of pelvic inflammatory disease.
This can help the doctor determine the size and find the precise location of the mass.
Magnetic Resonance Imaging (MRI)
This imaging test can provide a highly detailed image of your body to show the extent to which the tumor has spread. With the increased use of imaging and the recognition by health care doctors that ovarian cancers present with subtle symptoms, more ovarian masses are being detected in postmenopausal women using MRI.
During this procedure, a thin, flexible, lighted tube is inserted through an incision in your abdomen. It can give the surgeon a better look at the mass, and can also be used to take a biopsy or remove the mass altogether.
Your OB-GYN can test your blood for various hormones that indicate the presence of cancer. The blood can also be tested for a protein called CA-125, which is commonly elevated in women with ovarian cancer. A gynecologic oncologist may be consulted for findings worrisome for cancer such as thick septations, solid areas with the flow, ascites, evidence of metastasis.
The differential diagnosis for pain in women with ovarian cysts includes tubo-ovarian abscess, ruptured ectopic, ruptured hemorrhagic cyst, and ovarian torsion.
Common causes of ovarian cysts include:
- Hormones. Functional cysts may be caused by hormonal problems or drugs used to help you ovulate.
- Endometriosis. Endometriosis tissue can attach to the ovary and form a growth.
- Pregnancy. An ovarian cyst can develop early in pregnancy to help support the pregnancy until the placenta forms.
- Pelvic infections. Infection can spread to the fallopian tubes and ovaries and cause cysts to form.
Treatment for Ovarian Cysts and Pelvic Masses
Most ovarian cysts tend to resolve on their own and don’t cause any long-term harm. Many patients with simple cysts found through ultrasonographic examination do not require treatment. If your symptoms aren’t bothering you and if you are premenopausal woman, your OB-GYN may recommend a plan of “watchful waiting”. A follow-up exam may be recommended so that your doctor can check on the progress of the cyst or pelvic mass.
Other treatments for benign cysts include:
Birth control pills
Hormonal birth control pills prevent ovulation, which decreases the chances that new cysts will develop. Birth control pills have also been shown to relieve pain associated with cysts.
The vast majority of ovarian cysts and masses in premenopausal patients are benign, so a laparoscopy is a great option for many patients. This is a surgical procedure which uses a laparoscope to remove ovarian cysts through a small abdominal incision.
Laparotomy and debulking
This is a more invasive surgical procedure in which the surgeon makes a larger incision in the abdomen to remove larger cysts and tumors, and any other tissue onto which the masses have spread. The surgeon takes out as much of the tumor as possible, which may mean the removal of the ovaries, fallopian tubes, uterus, or other tissues.