From Myths to Evidence: A Clinical Review of Ovarian Cysts

Ovarian cysts are fluid-filled sacs on or around the ovaries. The female body has two ovaries responsible for the production of eggs and hormones for reproductive activity. Ovarian cysts are mostly linked to the reproductive cycle. However, they also affect post-menopausal women.

Causes of ovarian cysts may be functional or pathological.

Functional Cyst: These develop as a part of the normal process of fertilization. They are more common than pathological cysts and are often benign. These cysts usually resolve on their own within months.

  • Follicular Cyst: The ovaries contain many follicles, about 300,000, that house the eggs. During puberty, these follicles mature and release the eggs. Follicular cysts happen when these follicles do not release the egg but rather get swollen and filled with fluid.
  • Corpus Luteum Cyst: These happen when the progesterone-producing corpus luteum, after ovulation, does not dissolve but instead produces a cyst.

Pathological Cyst: These are caused by abnormal cell growth and can occur before or after menopause. They can be filled with fluid (cystic) or be solid-like. These do not usually resolve on their own and may require surgical removal. They include the cystadenomas, teratomas, endometriomas, and ovarian cancer cysts.

Symptoms and Complications of Ovarian Cysts

Cysts can be asymptomatic and unnoticed. In other cases, they might get twisted (ovarian torsion), rupture, or bleed. Most of the symptoms present as

  • Pelvic pain

  • Bowel movement discomfort

  • Inability to pass urine

  • Sudden weight gain, especially in the stomach

  • Unexplainable vaginal bleeding

A pelvic exam is done to detect any swelling or cysts in the body. If detected, the doctor may suggest ultrasound, hormonal, blood, and pregnancy tests.

Treatments

Observation: As most functional cysts are usually asymptomatic and go away without treatment, the health practitioner may recommend observation and checkups in weeks or months.

Medication: Medications are prescribed as a form of auxiliary treatment for the management of ovarian cysts. They manage the symptoms or the causative reason. Ibuprofen and/or paracetamol are given for pain management, contraceptives are given to maintain hormonal balance, doxycycline and/or ceftriaxone are used for inflamed cysts. Checkups are also recommended to monitor cyst growth.

Surgery: Usually associated with pathological cysts. Surgery is recommended based on the size, type, symptoms, and growth of the cyst. The two types of surgery for ovarian cysts are laparotomy and laparoscopy. Both are performed under general anesthesia.

Common Myths about Ovarian Cyst 

All ovarian cysts in reproductive-age women are benign and require no follow-up.
→ While many are benign, complex cysts, endometriomas, or persistent cysts can be early signs of malignancy or conditions like endometriosis and need follow-up imaging or referral.

Ultrasound findings of cysts don’t need documentation if asymptomatic.
→ Some physicians may underreport or ignore incidental cysts, especially if the patient isn’t presenting with pain, delaying care if the cyst becomes symptomatic.

Painful cysts should be immediately surgically removed.
→ A reflex to surgical intervention overlooks conservative management. Many cysts, even painful ones, can resolve with monitoring unless they rupture, twist, or show malignancy signs.

Ovarian cysts = PCOS
→ Some may conflate simple cysts with polycystic ovary syndrome (PCOS), failing to distinguish between transient functional cysts and the endocrine-metabolic disorder PCOS.

Once a woman has a cyst, she must avoid hormonal contraception.
→ A myth rooted in fear of exacerbation, but in reality, combined oral contraceptives can reduce the recurrence of functional cysts.

Ovarian cysts are not an emergency unless there's visible bleeding.
→ Doctors may underestimate the seriousness of ovarian torsion or ruptured hemorrhagic cysts, which require urgent care even in the absence of vaginal bleeding.

Teenagers cannot develop ovarian cysts.
→ Some clinicians overlook or misattribute pelvic pain in adolescents, assuming cysts are unlikely, though they are common even in post-menarche girls.

If CA-125 is normal, malignancy can be ruled out.
→ CA-125 is nonspecific and can be normal in early-stage ovarian cancer. Overreliance without proper risk stratification (like RMI or IOTA rules) is a clinical error.

Ovarian cysts are rarely seen in postmenopausal women.
→ They can occur, and any cyst in postmenopausal women warrants more scrutiny due to higher malignancy risk.

Fertility treatment should be postponed until cysts resolve, no matter the type.
→ Not all cysts interfere with assisted reproductive technologies. Blanket delays can be unnecessary and frustrating for patients.


Comments

Post a Comment

Popular posts from this blog

Ovarian Cysts: Clinical Presentation and Pharmacologic Management

Image
Ovarian cysts are a common gynaecological condition and may cause significant morbidity, including pain, infertility, or life-threatening complications such as rupture or torsion. Early recognition of symptoms and appropriate intervention are critical to preventing adverse outcomes. In many African healthcare settings, barriers such as limited access to specialized gynecological care, cultural stigma surrounding reproductive health, and low health literacy contribute to delayed diagnosis and treatment. Clinicians play a pivotal role in patient education, ensuring women understand the implications of ovarian cysts—including their potential impact on fertility and indications for surgical intervention. This article delineates the clinical manifestations of ovarian cysts, explores pharmacologic strategies for symptom control and cyst resolution, and outlines circumstances in which surgical management becomes warranted. 1: Clinical Manifestations of Ovarian Cysts Ovarian cysts may be incid...
Read more

Ovarian Cysts in Pregnancy

Ovarian cysts are diagnosed in approximately 1 in 1,000 pregnancies , with the majority discovered  during  first-trimester ultrasound examinations. While most are benign functional cysts that resolve spontaneously, approximately 2-5% will require intervention due to complications such as torsion, rupture, or malignant transformation. The physiologic changes of pregnancy—including increased vascularity, uterine enlargement, and ligamentous laxity—create unique diagnostic and therapeutic challenges. Classification and Clinical Significance Functional Cysts 1. Follicular Cysts Develop when a dominant follicle fails to ovulate or regress Typically 2-5 cm, unilocular, and anechoic on ultrasound Most resolve by 1 6 weeks gestation  as hCG levels decline 2. Corpus Luteum Cysts Present in 100% of early pregnancies (physiologic) Average size 3 cm (range 1-11 cm) Critical for progesterone production until 10-12 weeks May hemorrhage but rarely rupture (<1% of cases) Pathologi...
Read more